Navigating boundaries in mental health settings. A multicultural perspective

Section A
Therapeutic boundaries are defined in the literature as the limits or rules that govern the therapeutic relationship. While mental health services strive to provide culturally sensitive practices, the diversity in how boundaries are understood and managed across different cultural contexts is often overlooked. This review aimed to explore the factors that are considered important regarding therapeutic boundaries when working with culturally diverse clients in mental health settings.

A systematic integrative review was conducted in April 2024 across five databases. A total of 663 articles were screened based on inclusion and exclusion criteria, resulting in the inclusion of fourteen papers in this review. The review comprised seven empirical articles, one theoretical paper, four practice-based papers, and two pieces of grey literature. The included articles were quality-appraised using relevant appraisal tools.

Data analysis and synthesis were performed using thematic analysis, revealing four main themes with seven subthemes. The main themes identified were Power Dynamics; Culture, which encompasses cultural differences and the influence of dominant cultures; Harm versus Benefits; and What Might Help when making a decision, including reflective practice, supervision, and adequate training.

Future research should focus on exploring both clinicians’ and clients’ perceptions of therapeutic boundaries within diverse populations.

Section B
Background: Understanding how culture shapes therapeutic boundaries is key to effective care, especially in settings like Early Intervention for Psychosis Services (EIPS), where mistrust and disengagement are common. In these settings, the care coordinator (CC) plays a vital role in building trust and fostering engagement. This study explored the experiences of EIPS clients in navigating therapeutic boundaries within their relationship with the CC, with a specific focus on the cultural aspects of these boundaries.

Methods: Ten EIPS clients were interviewed, and the data was transcribed and analysed using Interpretive Phenomenological Analysis (IPA).

Results: Three Group Experiential Themes (GETs) were developed each with subthemes: Role Complexity, Blurred Lines, and Self-Disclosure. Respect emerged as an overarching theme, with all participants identifying it as key to navigating boundaries with the CC. Several noted its importance within their cultural values. Clients also highlighted the lack of boundary discussions and the absence of space to decline certain support, which contributes to power imbalances.

Discussion: Findings suggest professionals should create more space for open discussions about boundaries, especially for clients from marginalised groups who may face greater 3challenges asserting them due to power imbalances. A deeper understanding of cultural differences around boundaries would also support more equitable care.