Boundary violations in forensic inpatient facilities : survey tool development and survey results

Abstract

The primary objective of this study was to determine the incidence rate of boundary violations (BV) in forensic inpatient treatment settings, the extent and the nature of the violations, and the characteristics of individuals at risk to commit them. The Client-Staff Interactions (C-SI) survey was developed and used for these purposes. The survey was administered to 154 staff members in three inpatient settings. The tool demonstrated good internal consistency. Preliminary principal components analysis of the 10 summed section scores suggested three orthogonal higher-order components (Boundary Violations, Interfering Factors, and Supportive Factors). The results confirmed that while BV were occurring within the treatment settings, nonsexual violations were reported more frequently than sexual BV, and staff reported significantly less BV for themselves compared to their peers. The data supported the hypothesis and the proposed model, The Continuum of Boundary Domains (Daniels & Wong, 2007) that BV could be located on a continuum with underinvolvement at one end of the continuum and overinvolvement at the other end. It appears that some staff interpreted boundary crossings (BC) as BV rather than an acceptable therapeutic approach. Reports of negative emotions were positively correlated with reports of BV, such that staff members who experienced higher levels of negative emotions also reported more BV. Supportive factors, such as seeking supervision and being engaged in activities that support the team, were correlated only with BC; however, engaging in these supportive activities did not decrease staff members’ negative emotional experiences. Staff under the age of 40 reported more disinterest (DIS) than staff who were over the age of 50, and degree-level prepared staff reported more DIS than diploma-level prepared staff. Some post-hoc explanations were offered for these observations. It is recommended that continuing in-service education and discussions about appropriate boundaries are necessary to increase staff members’ knowledge regarding various types of BV, in particular disinterest (DIS) as a form of BV. The Continuum of Boundary Domains model can be used to conceptualize the various forms of BV.