Is There a Slippery Slope? Considerations Regarding Multiple Relationships and Risk Management

There are much anecdotal data regarding how boundary violations occur. Specifically, an informal consensus seems to have developed that such improprieties occur because of a notion commonly referred to as the "slippery slope of psychotherapy" (Gutheil & Gabbard, 1993). This notion implies that once a mental health professional crosses a boundary, a domino effect occurs whereby s/he is led through a rapid and increasingly serious series of violations at an almost exponential rate. In this article, we question the potential danger of this notion and argue that while such situations do arise, they are uncommon. We bring together ethics and research scholarship from a variety of sources to offer a more complex understanding of how such cases may arise and make recommendations regarding what practitioners can do to reduce them further.