ABSTRACT
The use of in vivo treatment procedures requires special planning and meticulous attention to issues regarding professional boundaries and ethical decision making. In the course of conducting in vivo treatment, the behavior therapist is faced with a multitude of questions and considerations involving boundary crossings and therapist self-disclosure. The seasoned therapist negotiates this complex therapeutic process by first possessing a thorough understanding of the clinical research literature, developing an effective therapeutic alliance with the patient, utilizing peer consultation and supervision when necessary, and relying on an individualized case formulation. The case formulation, which helps to determine the focus and pace of treatment, also provides guidelines with respect to managing the therapeutic relationship and timing the introduction of various therapeutic techniques, including in vivo procedures. Finally, the case formulation offers the therapist direction regarding when and how best to utilize self-disclosure and to effectively manage therapeutic boundary crossings.
