Cross-Cultural Perceptions of Boundaries: Brazil and United States

Michael Lamport Commons, Patrice Marie Miller and Thomas Gordon Gutheil
Harvard Medical School

This paper compared boundary perceptions by mental health professionals in Brazil and the United States. There were 60 participants: 28 Brazilians (20 females, 7 males and 1 not reporting) attendees a presentation on boundary issues from the Institute of Psychiatry, Federal University of Rio de Janeiro; and 33 Americans (18 females and 15 males) attendees from the Program in Psychiatry the Law, Department of Psychiatry, Harvard University, Massachusetts Mental Health Center, Boston. Participants responded to a survey on boundary issues, rating each issue to its degree of 1) harm, and 2) professional unacceptability.

A principal components factor analysis reduced the 87 pairs of responses to three clear factors. Factor 1 (Core Boundary Violations) contained 85 items constituting the most serious boundary violations. The "top ten" questions included some sexual violations, such as having sex with or necking with the patient, as well as some nonsexual violations, such as calling the patient to speak about matters besides therapy or hitting the patient.

Factor 2 (Separation of Therapist and Client Lives) contained 34 items that asked about situations in which the client and the therapist might encounter each other outside of the therapist's office. Factor 3 (Disclosure and Greeting) contained a preponderance of unacceptability items (65%). It had more to do with culturally-based professional acceptability of behavior rather than conceptions of harm.

The two cultures were found to be surprisingly similar, with only mild cultural differences. The authors attempt to interpret this and discuss the issue of cultural variation in boundary theory.