Seminal ethics studies in psychology have evidenced significant variance among practitioners in their ethical attitudes toward and engagement in various nonsexual boundary crossings; they have also identified therapist and client factors that account for some of that variance (Borys & Pope, 1989; Pope, Tabachnick, & Keith-Spiegel, 1987). Boundary crossings, as defined by Gutheil and Gabbard (1993), are deviations from common clinical practices that are not necessarily unethical. Examples of traditional crossings include nonsexual touch and nonsexual multiple relationships. This study was designed to update the literature regarding nonsexual boundary crossings in light of contemporary study designs and demographic categories, significant American Psychological Association (APA) demographic shifts, revisions of the APA Ethical Principles and Code of Conduct (APA, 2017), and the advent of the Internet. Approximately 250 U.S.-practicing doctoral-level clinical psychologists were surveyed for their demographic characteristics and either ethicality ratings and practice frequencies for seven boundary crossings, including both traditional and Internet-based boundary crossings. Ordinal and binary logistic regressions were performed to test hypotheses regarding factors accounting for variance in these ethicality ratings and practice frequencies. Exploratory analyses were conducted to examine differences in data between traditional and digital crossings, and between the findings of this study and previous studies regarding ethicality ratings and practice frequencies. Therapist gender, theoretical orientation, clinical experience, and client gender were found to predict significant variance in ratings and frequencies for specific crossings. There was no significant interaction between therapist and client gender in predicting either ratings or frequencies. Therapists found two digital crossings (advertising online and providing psychoeducation online via social media) generally ethical, but found two other digital crossings (searching for client information online and accepting a social media request from a client) generally unethical. Therapists also appeared to more often express uncertainty regarding the ethicality of digital crossings than with regard to traditional crossings; and, they provided practice frequencies for some digital crossings that were inconsistent with corresponding ethicality ratings. These findings may reflect several decades of ethics training regarding traditional crossings, inconsistent ethical training regarding digital crossings, and the continuing need to emphasize self-awareness in formal ethics training.

LLU Discipline

Clinical Psychology


Clinical Psychology


School of Behavioral Health

First Advisor

Janet L. Sonne

Second Advisor

Stephanie Goldsmith

Third Advisor

David Vermeersch

Fourth Advisor

Jennifer Weniger

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Psychotherapy ethics; Logistic Models



Page Count

xii, 172 p.

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives