NCAD Spotlight: Navigating Conflicts Around Proper Clinical Boundaries

The emergence of the peer support workforce in addiction treatment has led to many discussions in organizations about maintaining proper boundaries with clients. Angela Thomas-Jones, MS, LCMHC, MLADC, a New Hampshire clinician and co-founder of the North Country Task Force on Improving Opioid Treatment Outcomes, will discuss historic and evolving ground rules for self-disclosure in clinical care during an Aug. 16 breakout session at the National Conference on Addiction Disorders (NCAD East) in Baltimore.

Addiction Professional spoke with Thomas-Jones on the factors affecting clinical decision-making around disclosure. Her comments were edited for space and style.

How do you see the conversation changing around the setting of boundaries between providers and patients?

There is a paradigm shift. A great example of this is with peer support groups. In New Hampshire, one of the fastest-growing groups is the peer, the coach. The traditional mode of treatment was self-help, which was completely peer-to-peer. But today, this raises conflict with the role of the supervisor, etc. This model clashes with the traditional social work model, and particularly with psychiatry, where there's a clear line that you don't fraternize, that you don't put yourself in the equation.

How should clinical professionals approach the issue of whether to disclose to a patient details of their own experiences?

I encourage them to ask themselves this question before they self-disclose: What purpose does this serve and will this help my client? If you can't identify how this will benefit the patient's treatment plan, don't do it, because then you're just tooting your own horn.

You talk about the differences between overt and covert forms of disclosure. Could you explain?

Pictures of your family in your office, or pictures of your vacation, are an obvious self-disclosure. A wedding band on your ring finger doesn't necessarily mean you're married, but in our society it's a subtle obvious signal. But how we respond to a client's story, with the non-verbal language, the “uh-huh,” the “tell me more,” may say a great deal. That may lead to, “The same thing happened to me.”

How should a clinician best address the issue of boundaries with a client?

In the informed consent, this is the best place to talk about it. In the first meeting, the clinician can say, “This is what you can expect from my services.” I live in a very rural region, where going to the grocery store often creates an opportunity to cross paths with a client. I will say to my clients, “If we run into each other on the outside, I will give you the opportunity to acknowledge me. If you do that first, I will follow the lead.”

How are issues around boundaries affecting the peer workforce?

I am a state-approved supervisor for the development of the peer workforce. There is a perception that the peer is an equal to the client, but peers also are finding that they have to be responsible to the licensing board. There is a responsibility for managing the scope of practice, and there is some pushback. There are colleagues of mine who think the emergence of the peer workforce will be the ruination of the field. I'm choosing to look at it as an opportunity. We need to make decisions about how to make this work, instead of resisting.

Join clinicians and executives at NCAD East, Aug. 15-18 in Baltimore, and work to improve and refine patient care as well as develop sustainable and successful treatment organizations. Visit https://east.theaddictionconference.com for more information.