A thematic analysis of therapeutic boundary violations
Research type
Research Study
Full title
A thematic analysis of therapeutic boundary violations in high secure hospitals
IRAS ID
312199
Contact name
Phil Willmot
Contact email
Sponsor organisation
Nottinghamshire Healthcare NHS Foundation Trust
Duration of Study in the UK
0 years, 11 months, 31 days
Research summary
Therapeutic boundaries are defined as the edge of appropriate behaviour at a given moment in the relationship between patient and therapist, as governed by the therapeutic context and contract, a definition which emphasises their complex and dynamic nature. Some boundaries are enshrined in law or professional standards, for example the prohibition on sexual relationships between professionals and service users. Others are more informal, vary between professions and settings, and are often not explicitly recorded, for example how much personal information professionals should disclose about themselves, or the limits of “appropriate” humour. Boundaries exist to protect service users and staff from harm.
Professional boundaries are particularly complex and important in long-term psychiatric hospitals, where staff and patients may be working together for several years, where nursing staff in particular may spend many hours each day with a particular patient, and where strong attachments can form between service users and staff. In such settings, the consequences of boundary crossing can be extremely serious, resulting in physical, sexual or emotional abuse or neglect, leading to deteriorating mental health, disrupted therapy and even suicidal behaviour for the service user, and in dismissal or prosecution for the staff member.
Unfortunately, serious boundary violations do occur from time to time, and when they happen they are thoroughly investigated. Unfortunately, the sensitive nature of these investigations and the need to protect vulnerable service users limits the extent to which the findings from these reports can be disseminated and lessons learned to prevent further boundary violations.
The proposed study involves a thematic analysis of reports into boundary violations and near misses at the three high secure hospitals in England (Ashworth, Broadmoor and Rampton). As well as providing a larger sample, the use of data from multiple sites should help to enhance the anonymity of people mentioned in the reports. The data for this study consist of existing investigation reports into boundary violations in those hospitals that have been made available to members of the High Secure Hospitals Boundaries Working Group (HSHBWG). The HSHBWG consists of senior clinicians from each hospital who are involved in the management and oversight of therapeutic boundaries. No new data would be collected during this study.
REC name
Wales REC 4
REC reference
23/WA/0314
Date of REC Opinion
8 Nov 2023
REC opinion
Favourable Opinion