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<p>Therapeutic boundaries are essential to safe and effective psychotherapy, yet their negotiation remains complex and the relational processes through which therapists actively establish, maintain, and adapt boundaries are less well understood. This systematic review addresses the question: How do therapists negotiate boundaries within psychotherapy?&#xa0;A systematic literature review was conducted using PsycINFO, Scopus, and MEDLINE databases. Data were extracted from findings sections and synthesised using meta-ethnography. Quality appraisal was conducted to assess methodological rigour and relevance.&#xa0;A total of 25 qualitative studies met inclusion criteria. Seven themes were identified: contracting versus intuiting boundaries; boundary rigidity versus flexibility; emotive, reflective or procedural self-disclosure; therapist unease; self-restraint; caretaking versus bearing witness, and; analysing the boundary dilemma collaboratively, exploratorily or non-reactively. Quality appraisal revealed variability in methodological rigour.&#xa0;Boundary negotiation in psychotherapy is a dynamic, relational process shaped in sessions by therapist style, ethical deliberation, therapist anxiety and client distress. This review highlights the clinical utility of therapist restraint, capacity to self-regulate when faced with ethical dilemmas, and active, in-the-moment reflection for navigating boundary dilemmas.</p>

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How Do Therapists Negotiate Boundaries: A Systematic Literature Review and Meta-synthesis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月28日

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  • Josh Lawson,
  • Thomas Schröder,
  • Katie Russell

摘要

Therapeutic boundaries are essential to safe and effective psychotherapy, yet their negotiation remains complex and the relational processes through which therapists actively establish, maintain, and adapt boundaries are less well understood. This systematic review addresses the question: How do therapists negotiate boundaries within psychotherapy? A systematic literature review was conducted using PsycINFO, Scopus, and MEDLINE databases. Data were extracted from findings sections and synthesised using meta-ethnography. Quality appraisal was conducted to assess methodological rigour and relevance. A total of 25 qualitative studies met inclusion criteria. Seven themes were identified: contracting versus intuiting boundaries; boundary rigidity versus flexibility; emotive, reflective or procedural self-disclosure; therapist unease; self-restraint; caretaking versus bearing witness, and; analysing the boundary dilemma collaboratively, exploratorily or non-reactively. Quality appraisal revealed variability in methodological rigour. Boundary negotiation in psychotherapy is a dynamic, relational process shaped in sessions by therapist style, ethical deliberation, therapist anxiety and client distress. This review highlights the clinical utility of therapist restraint, capacity to self-regulate when faced with ethical dilemmas, and active, in-the-moment reflection for navigating boundary dilemmas.