Time issues frequently emerge in discussions of boundaries. However, sometimes it is necessary to extend the time of an appointment on an emergency basis. This situation can be distinguished from becoming so engrossed with a patient or a patient's narrative that the therapist loses track of time and repeatedly runs over the designated appointment time. Trips outside the office are a common way station on the path to greater boundary problems. On the other hand, certain behavior-therapy approaches to variants of social phobia might well involve leaving the office to confront, say, the phobic situation as the last step in a desensitization program.
Hugs are another source of confusion among mental health care professionals.
Needless to say, it is different now. All hugs have become suspect because of their potential erotic content, an effect intensified among victims of trauma. I have suggested that clinicians who work with HIV-positive patients should contrive to touch such patients nonsexually at some point during each therapeutic encounter, e.g., by a handshake, pat on the shoulder or squeeze of the arm, specifically to counter the social ostracism such patients may feel. Finally, self-disclosure remains an area of controversy. A fundamental tension appears to exist between two notions.