Boundary crossings and violations

Scenario 4 - Risk management 

Olivia, a registered practical nurse working in an outpatient mental health program, cares for Bill. Bill has a lot of trust issues, feelings of rejection, and is very emotionally needy. Olivia often allows sessions outside office hours, and they often run late. Olivia drives Bill home in bad weather. One day, Bill asks Olivia to go to a show with him, but Olivia says no, saying this would cross a line. Bill gets upset and accuses her of ‘running hot and cold’.

Questions for discussion

  1. What might Olivia have done that contributed to this misunderstanding?
  2. Was it only a misunderstanding or did Olivia cross or violate a boundary? If so, which? Why?
  3. How might you reduce the risk of boundary violations if you were in this situation?
  4. If you were a colleague of Olivia’s how would you advise her if she came to you seeking advice?
  5. Were Bill’s upset feelings entirely related to his issues and emotional neediness?
  6. What would you do in this situation to re-establish the boundary? 

Key concepts this scenario illustrates:

  • Transference
  • Risk management 

While Olivia may have thought she was showing Bill kindness by offering to drive him home in bad weather, boundaries were crossed. When this was combined with appointments after hours and sessions that run over the allotted time, the patient perceived Olivia’s actions as a personal interest. These actions cross a professional relationship boundary.

In her response to Bill’s invitation to see a show, Olivia was able to appropriately maintain or re-establish a professional boundary. To ensure there are no future misinterpretations it would be smart for Olivia to work within established office hours and make every effort to keep appointments on time. Some flexibility is expected, but frequently doing this in her practice requires her to continually re-establish boundaries with her patients.




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Page last reviewed April 30, 2020