The personal and intimate nature of the relationship between professional carer and patient and the poignancy of the potentially terminal outcome of the illness challenges the way therapists manage boundaries. Reciprocity of feeling and strong links can develop, especially in terminal stages, and self-disclosure can convey our sharing something of humanity. It is argued that the final decision for therapeutic action rests with the patient and not the professional, however senior. The patient’s dependence often smothers that right. There is responsibility towards the patient and not for him. The role of the professional is to share in the relevant problem, not necessarily to resolve it. Clarity about expectations and boundaries is more than agreeing on practical issues; it is about sharing the power in the relationship. For professionals working in an organisation, the employing institution will make its own demands about their use of time and resources. Dual responsibility to the patient and the institution can lead to ethical dilemmas.
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