Factors relating to boundaries and self-disclosure within mental health contexts

Section A: Presents a systematic literature review synthesising and critiquing the evidence-base surrounding the use, and impact of therapist self-disclosure in cross-cultural therapy contexts with clients from ethnic minority groups. The review found that as well as mirroring the use and impact of therapist self-disclosure in more generalised therapy contexts, therapist self-disclosure was used to invite conversations about therapists’ and clients’ cultural or ethnic differences and identities. This included therapists using self-disclosure to validate clients’ experiences of racism or oppression and assert their commitment to an anti-racist stance. Risks to therapist self-disclosure within cross-cultural contexts are discussed, and findings and clinical implications are considered in the context of developing therapist cultural competency. The review found that studies had some methodological limitations (such as relying predominantly on self-report methods), and future research should further explore self-disclosure as the mechanism of change, and other possible therapist and client intersecting, or mediating factors.

Section B: Presents a grounded theory study exploring how case-managers in Early Intervention in Psychosis Services (EIPS) develop their understanding and practice around navigating boundaries. EIPS are a unique service model, in which an assertive outreach approach is adopted. Case-managers employ flexible boundaries to meet clients in the community and support them towards recovery and holistic goals. Current boundary theory is therefore not easily applied to this clinical context. Participants were 13 EIPS case-managers. Semi-structured interviews with participants were analysed using grounded theory. A concentric model emerged, defining different layers of influence impacting case-managers navigation of boundaries. The model also depicted how case-managers navigated boundaries with clients over time. This model adds to current boundary theory outside of therapy contexts, and can be used as a tool in clinical practice to guide clinicians’ thinking and reflection around boundaries within EIPS. Other relevant clinical and research implications are discussed.