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Keeping Boundaries

Maintaining Safety and Integrity in the Psychotherapeutic Process

Richard S. Epstein, M.D.

  • ISBN 978-0-88048-660-6
  • Item #8660

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Keeping Boundaries is an across-the-board review of the subject of boundary maintenance in psychotherapy. Using a comprehensive approach, this book examines the problem of therapeutic boundaries and boundary violations from multiple viewpoints, including historical antecedents, sociological mechanisms, object relations theory, psychodynamic theory, practical technique, and the mental health and training of psychotherapists. It covers a variety of boundary issues, including dual relationships, informed consent, fees, gifts from patients, maintaining confidentiality, avoiding abuse of power, and helping therapists to protect themselves against exploitive patients.

Written in a clear and jargon-free style, this book provides the therapist with practical clinical advice supported by extensive references and clinical vingnettes.


  • General Aspects of Therapeutic Boundaries and Boundary Violations.

    The nature and function of therapeutic boundaries. Ego boundary development and its relationship to the therapeutic frame. Factors common to all boundary violations.

    Specific Boundary Issues.

    Introduction to section II. Stability: Creating an atmosphere of trust and reliability. Whom should a psychotherapist treat? Problems of patient selection when a dual relationship exists. Respecting the patient's autonomy: maintaining a position of neutrality. Balancing the therapist's financial needs against those of the patient: monetary compensation in psychotherapy. Confidentiality. Maintaining anonymity. Abstinence and the management of erotic feelings in psychotherapy. Treating the patient who tries to exploit the therapist.

    Issues Concerning the Mental Health and Training of Psychotherapists.

    Psychological characteristics of therapists who commit serious boundary violations. Education and self-assessment: how can therapists learn to improve their boundary skills? Appendix. References. Index.

About the Authors

Richard S. Epstein, M.D., is a psychiatrist in private practice in Bethesda, Maryland. He is President-Elect of the Washington Psychiatric Society, Clinical Professor in the Department of Psychiatry at Georgetown University School of Medicine, Washington, DC, and Clinical Associate Professor in the Department of Psychiatry at the Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland.

For mental health professionals in need of a comprehensive, accessible, erudite guidebook on boundary issues, this book is highly recommended. For professionals involved in teaching about boundary issues, it is an excellent source that covers the most salient and important points. Reading Keeping Boundaries will enhance clinical understanding and ethical behavior for mental health professionals in particular and professionals in general.—Psychiatric Services

This book should be read by all psychiatric trainees and clinicians. It is a comprehensive and practical integration of theory and practice.—Bulletin of the American Academy of Psychiatry and the Law

This book is outstanding and should be read by every psychiatrist and psychiatric resident. It is the first book I have seen that adequately addresses the problem of appropriate behavior on the part of the psychiatrist. Specific problems are explicit, well illustrated by clinical examples, supported by current literature, and preventive strategies are discussed. . . . Dr. Epstein has provided a treatise in this area that will be useful for years to come.—George Dawson, M.D., General Hospital Psychiatry

Keeping Boundaries: Maintaining Safety and Integrity in the Psychotherapeutic Process by Richard Epstein, MD, is a thoughtful, thorough, and clinically sophisticated contribution to a complex aspect of psychotherapy. It provides scholarly and practical advice in an area often filled with more heat than light. It is an excellent addition to both the new and the experienced clinician's library.—Robert J. Ursano, M.D., Professor and Chairman, Department of Psychiatry, Uniformed Services University of the Health Sciences

This book is the most thorough and complete treatment of the subject of therapeutic boundaries that I have read. [It] should be read by all psychiatrists, regardless of whether they actively practices psychotherapy or pharmacotherapy.—Jonas R. Rappeport, M.D., Chief Med Officer Emeritus, Circuit Court for Baltimore City, Assoc Clin Prof of Psychiatry, Univ of Maryland, School of Med, Assoc Prof, Johns Hopkins Univ, School of Med

In this marvelous book on boundary maintenance in psychotherapy, Dr. Richard Epstein covers it all. No longer does the therapist need to search through assorted works to find usually brief discussions about maintaining treatment boundaries. The psychotherapist who reads this book will be empowered to keep the sound treatment boundaries that are so essential to the good care of patients.—Robert I. Simon, M.D., Clinical Professor of Psychiatry, Director, Program in Psychiatry & Law, Georgetown University School of Medicine, Washington, DC

This worthy and interesting book deserves careful attention in its own right, aside from its place in the psychiatric enterprise. . . . Well placed case vignettes remind us of the temptations that beset psychotherapists, the traps that some fall into, and the exacting responsibilities of the profession.—The Journal of Nervous and Mental Disease

Keeping Boundaries provides a through overview of the function of boundaries in psychiatric treatment and the hazards, from potentiality to severe, of their transgression. Experienced therapists will find much of value in this book, and it should be among the basic readings for residents and beginning therapists.—American Journal of Psychiatry

Boundaries are an important topic for both the general and forensic psychiatrist. While Dr. Epstein's book is geared toward a study of sexual contact between doctor and patient, he covers all the other borders that the clinicians approach. This book should be read by all psychiatric trainees and clinicians. It is a comprehensive and practical integration of theory and practice.—Bulletin of the American Academy of Psychiatry and the Law

Keeping Boundaries provides valuable material not only for all mental health residents and other trainees, but also for every medical practitioner. Making a self-assessment by using the Exploitation Index every few years certainly will assist a physician to prevent boundary violations. An ounce of prevention is worth a pound of cure or a million-dollar lawsuit or charges from the Board of Physician Quality Assurance.—Straight Forward

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