For any book reviewer, it is important to specify any possible source of prejudice one way or the other concerning a particular book product. In the case of Boundaries in Psychotherapy, the present writer acknowledges that he has worked with its author in the past on several writing and professional projects related to the Ethical Principles of Psychologists and Code of Conduct

Boundaries in Psychotherapy is a book that I think many readers will find ahead of its time. As an overview, the text is 266 pages altogether, including a 12-page combined name and topical index, and some 18 pages of References that are a very helpful compilation of resources for clinicians. The book is divided into three broad parts, including 12 chapters that address many controversial issues in modern psychotherapy practice. These topics include self-disclosure; use of physical touch, exchanging gifts, time and money; home office arrangements, and telehealth. The text also includes a useful appendix devoted to examples of what the author calls boundary “violations,” as opposed to boundary “crossings.” The latter Zur says are intended to benefit patient care and can make the psychotherapy process more human and therefore more humane, without a connotation of exploitation or harm to the patient.

To this reader, the very best aspect of Dr. Zur’s work in Boundaries in Psychotherapy is the excellent research and professional base its author has produced. Its summaries of the literature are predicated both on prior empirical studies and on numerous published topical discussions among experts on ethics and psychotherapy. Dr. Zur especially excels in addressing among his topics some of the most important, and some of the most controversial, elements of applied psychotherapeutic practice. Obviously, his breadth and depth of clinical experience in a variety of professional settings is responsible for this commitment to excellence. His personal sensitivity makes Boundaries in Psychotherapy well worth reading, independent of one’s acceptance or not of the points of view Dr. Zur expresses.

In addition to these crucial points, this writer was deeply impressed with Dr. Zur’s detailed discussion of both the practical and the applied in psychotherapy practice. One example is Dr. Zur’s very sensitive treatment of considerations necessitated by having a home office. He addresses, and cites substantial literature to support, the various challenges and decisions that the clinician with a home office is apt to face. Dr. Zur’s extensive consideration of these numerous factors brought to mind a former client of this writer, who grew up in a household with a prominent mental health professional, part of whose practice took place in their home when my patient was a child. This particular client recalled an atmosphere of fear and chaos, as patients – often inadvertently and unpredictably, but also understandably – wandered to the “wrong” entrance to the home, unintentionally entered private parts of the home, and in other ways disrupted the child’s sense of proportion and quiet as she went about her daily activities. At least for this client, this atmosphere created distrust toward her parents, who did not perceive her feelings of threat. These considerations are treated delicately in Dr. Zur’s text.

Another example is the treatment in Boundaries in Psychotherapy of therapeutic touch. This very controversial topic yields a frank discussion by Zur of various forms of touching that might legitimately take place in a treatment context. Zur provides an extensive topical list of what he terms “types of touch” that can take place in treatment -- ranging from ritualistic or socially accepted gestures, such as shaking hands, a consoling touch of the hand or shoulders, or what Zur calls “instructional” touch. The author adds considerable discussion of the context in which touch might take place in treatment, and he provides discussion of both the scientific and cultural aspects of touch that may apply to specific patients or to specific treatment settings.

As with many of the topics addressed in Boundaries in Psychotherapy, Zur notes that therapeutic orientation of the clinician and patient perception of that orientation, are vitally important. Especially prominent is the differentiation between traditional psychoanalytic views, as opposed to other traditions in psychotherapy, such as those advocated by humanists and existentialists.

Regrettably, what this writer found troublesome about Boundaries in Psychotherapy also makes its appearance rather quickly in this text. Beginning as early as page 5, Zur comments about “risk management,” and he goes on to invoke the concept of “standard of care” as being “one of the most important concepts in mental health” (p. 7).

What this writer finds objectionable in these constructs is not their substance, but their implication. Psychotherapists whose attention is diverted from client welfare to the perceptions of others about client welfare are about as close to reality as a prosecutor like Michael Nifong is to an accusation of rape. That is, what Zur has trouble appreciating is that “standard of care” is not a mental health concept at all. It is instead a legal concept, imported from civil litigation.

Zur’s notion of “boundary violations,” draw him ineluctably to what this writer regards as an improper view of law. In actuality, the law is a valueless method of arriving at a rational (that is to say, a rationalizable) result, when two sides conflict. Although this may be -- as many lawyers like to claim -- preferable to solving civil disputes by combat, it does not follow that there is an actual legal standard by which to judge the “correctness” of any given rationale. Nor does it follow that the outcome of legal contention will be beneficial to people who need psychotherapy.

Thus, Zur tends to trot out the usual suspects, as he discusses how therapists might fend off claims that their boundary “crossings” have or have not become “violations.” These suspects include written records of various kinds, documentation of actions taken and not taken, and the worst of all worlds in the legal framework, “informed consent” about various procedures.

If we critique this otherwise terrific text in this framework, one of its limitations turns out to be that there is a relatively strong emphasis upon limitations placed on therapists based upon how the process of psychotherapy is perceived, as opposed to what it is.

A second limitation of this text is obvious from its title. That is, there is a strong emphasis upon one form of helping people, namely provision of outpatient, mostly one-on-one, psychotherapy services, and very little about what psychologists do apart from an office-based model. Of course, Zur does talk extensively about therapists leaving the office, perhaps to conduct treatment sessions for driving-phobic patients for example, or intentionally conducting sessions for certain clients under certain conditions, away from the office setting. Although this very helpful emphasis on treatment flexibility is a welcome respite from the straightjacket of a conventional, largely psychoanalytically derived, model of psychotherapeutic practice, nevertheless, it appears that too often, Zur is tacitly captive to a prevailing stereotype.

The simple fact of the matter is that there is a substantial gap between the clinical practice of psychology as a helping profession, as opposed to the “boundaries” that are under consideration by Zur, which are frequently imposed by legal considerations. The Tarasoff decisions, for example, are examples of a wholly concocted, irrationally applied, “standard,” which violates the usual legal presumption that individual “A” cannot be held “responsible” for the behavior of individual “B,” except under the most extraordinary circumstances.

Next, I disagree with the proposition advanced by Zur (his page 14) that ethical codes -- not only of the American Psychological Association, but of other disciplines as well -- “define the parameters of psychotherapeutic boundaries.” The purpose of the APA Ethical Principles and Code of Conduct is not at all to define parameters. It is instead explicitly the purpose of the Ethical Principles to try to define a floor for ethical practice -- not only in psychotherapy, but in other professional activities of psychologists as well. In other words, the Code of Conduct is designed only to define a lower limit of what is required.

This of course can leave psychology as a professional practice vulnerable to concern with appearances, as opposed to substance. Popular prejudice, sometimes in the form of ill-conceived statutes, and sometimes simply carried forward in poorly reasoned judicial decisions by non-psychologists, are too often responsible for replacing common sense and professional judgment, in the practice of our profession. Lack of a concrete definition of harm is a major failing in this regard.

Despite these caveats, my conviction is that Boundaries in Psychotherapy is an essential book for practicing psychologists in 2007. We need the essentially humanitarian, tactically and technically diverse, focus of a Zur as an antidote to the rigid and punitive intellectual and theoretical straight jackets that too often substitute for thinking among psychologists who dwell on “boundaries.” Perhaps, unfortunately, a profession that has taken 20 years, and has still failed, to define what it means to “harm” a person in a professional relationship (as in a “harmful multiple relationship”) has thereby ceded its ability to self-define. If that is the case, I am confident that other disciplines, particularly law, will be glad to define us for themselves.