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Publication Date


Document Type


Degree Name

Doctor of Philosophy


School for Social Work


Adolescent psychotherapy, Professional boundaries, Trauma, Therapeutic relationship, Impaired professional, Psychotherapists-Professional ethics, Psychotherapists-Malpractice, Psychotherapists-Mental health, Therapeutic alliance, Secondary traumatic stress


Boundary transgressions in psychotherapy with adolescent patients refer to clinical interactions in which a psychotherapist diverts from his or her customary way of practice that result in harm to the youth. In order to address the paucity of research on this phenomenon, this study conducted a national survey of mental health professionals (n=212) that examined the relationship between the therapist’s history of trauma exposure and related symptoms, and his or her risk of committing boundary violations with adolescent patients. Analyses of the study’s main questions demonstrated a positive relationship between a psychotherapist’s endorsement of current trauma-related symptoms and his or her risk of committing boundary violations with adolescent patients, but no such relationship with a therapist’s history of exposure to traumatic events. Therapists’ degree of experience treating adolescents was shown to be a protective factor against boundary violations risk. Given the association of trauma-related symptoms with increased risk, an attachment based supervisory model, along with relevant educational and training components are suggested in order to identify and respond to concerns, and support safe and effective practice.




vii, 220 pages. Includes bibliographical references (pages 107-119)