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Transcultural Psychiatry
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Cross-cultural Boundary Dilemmas: A Graded-risk Assessment Approach

Daniel Savin

Richard Martinez

University of Colorado Health Sciences Center

Behavioral health professionals are constantly faced with the dilemma of how to define boundaries in their relationships with clients. When working with groups from diverse cultures, defining boundaries becomes even more complex. This article urges a flexible approach, using the graded-risk model (Martinez, 2000) and a list of cultural factors for clinicians to consider. Possible benefits of reaching out to clients in concrete ways, as well as risks, are emphasized. Clients’ notions of appropriate boundaries must be considered in the decision-making process. Case examples from a refugee mental health clinic are used to elucidate a flexible approach to boundary decisions.

Key Words: boundaries • culture • doctor–patient relationship • professional ethics • professional misconduct • psychotherapy

Transcultural Psychiatry, Vol. 43, No. 2, 243-258 (2006)
DOI: 10.1177/1363461506064853
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