Okamoto, A. K. (2003). The function of professional boundaries in the therapeutic relationship between male practioners and female youth clients. Child and Adolescent Social Work Journal, 20, 303-313.

An Abstract of "The Function of Porfessional Boundaries in the Therapeutic Relationship between Male Practioners and Female Yoth Clients"

Dr. Scott Okamoto presents the results of a study of 16 practicing male social workers who had young female clients located in a residential setting. The study sought to examine professional boundaries of the role of male youth social worker that protect both the social workers and the clients from involvement in any improper relationships (p. 303). It focused on 16 male practioners use of role boundaries to prevent such ethical violations. The study highlights the fact that the male clinician/female client relationship has traditionally been “one of the more challenging” (p. 304).

Okamotto defines boundaries as “limits or edges that define individuals as separate from others.” In the professional practitioner/client relationship, “boundaries are limits” that allow both parties to establish and maintain “a safe connection based upon the clients’ needs” (p. 303).

In the brief literature review section (pp. 304-305), he makes two distinctions in practioners and clients: (1) those with “thick boundaries” and (2) those with “thin” boundaries (p. 304). On the one hand, those with “thick” boundaries have “an autonomous sense of self and definite sense of personal space.” On the other hand, those with “thin” boundaries have less of a sense of the two characteristics mentioned above. The latter group of individuals has a tendency to merge with other persons in relationships and to lose a sense of self (p. 304). The study concludes that this latter group is more likely to violate professional boundaries and perhaps get into ethical difficulties. The difficulty is due to one of the following two factors: (1) the clinician’s personality, which may tend toward having “thin” boundaries; or (2) to a situational factor that “thins” the otherwise “thick” boundaries, e.g. a divorce or separation that leaves the clinician vulnerable at the time (p. 304).
The 16 participants in the study were given nine questions in an interview setting. The tape-recorded results were analyzed using a “qualitative research computer program” (p. 305-306). Eleven out of the 16 clearly indentified the need for professional role boundaries when a male is working with “high-risk female youth clients” (p. 307).
The study lists several reasons for definite role boundaries on the part of male clinicians working with high-risk female clients:
  • Past abuse issues with female clients dictate the need for clear role boundaries. Many clients were abused by males in the past, and subsequently they expected abuse by males to continue. Some “used sex as a survival technique” because of their past experiences. Clear role boundaries not only protected the clinician from an improper relationship, but it also “made the client feel safer” (p. 307).
  • Clinicians often feel a strong sexual attraction to their youthful clients. Here again, the past abuse predisposes some clients “to use sex” in their relationships with males. Clear role boundaries prevented clinicians from acting on their sexual feelings for their clients. Vulnerability for the clinician often came from some problem in the clinician’s personal life, and not one in the client’s life. The study made it clear that the responsibility for preventing any improper relationship rests totally on the clinician and not on the youthful female client (p. 308).
  • Female youth clients who have been abused in the past by males need a positive model of a relationship with a male. Setting appropriate role boundaries for male clinician/youthful female client relationships helps the client establish healthy relationships with males in the future (p. 309). For instance, how can an abused client recover and have healthy relationships with males in the future without a positive experience with a male clinician in their present setting? (p. 311)

Several participants in the study described how they set professional role boundaries that would avoid improper involvement with their clients (pp. 310-311).

  • Clinicians took special care about the language they used with youthful clients.
  • They exercised special care about the proximity to which they sat when they worked with their clients.
  • This often involved correct “body language” when dealing with clients. Distance from the client helped to establish the role of clinician.
  • Many used a redirecting technique whenever the client steered the conversation toward a sexual matter.
  • Most cited the fact that they made sure that they were never alone with their clients, especially in the client’s room. If circumstances dictated that the clinician had to go into a female’s room, clinicians stated they always had a female co-worker with them.
  • If a role boundary seemed in danger of being crossed, clinicians said they reminded the client that for what they were there. They always emphasized what interaction between the clinician and client is supposed to be—for the benefit of the client in her recovery.

Some further implications for clinical practice of social workers emerged from the study, as well. For instance, male clinicians need to be urged to work in teams when working with females in a residential setting. Colleagues can often see potential boundary violations before the individual can (p. 312). Also, role play and case studies need to be utilized in training clinicians for this type of work (p. 312).

There were several limitations of the study that ought to be kept in mind (p. 312).

  • There was no input on this subject from the female clients’ perspective.
  • There was no account taken of people’s sexual orientation. The study assumed that both clinician and client were heterosexual. One gay clinician said he had had not problems with his role. This ought to be explored in the future.
  • There was also no indication of mediating factors—(1) years of experience in the work, or (2) the age of the clinician.

This study dealt with social workers in particular, but it has implications for teachers who need professional boundaries for work with both sexes. Teachers are certainly expected to do “social work” in some cases of extreme student need. This article provides some effective strategies for establishing clear role boundaries for the safety of clinician and client.