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Boundaries in therapy

AliceinWonderland

AliceinWonderland

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https://www.psychologytoday.com/articles/199905/drawing-boundaries

I think this is such a balanced, wise and well-considered article, I thought I'd share. I think it really gets across the subtlety of how things that are commonplace in other settings can have more meaning/be more problematic in the therapeutic setting. And also how the guiding principle should always be that things are done/not done based on whether they ultimately benefit the client. I think the writer gets across how this is not always straightforward to determine, and how it's not always possible to have hard and fast rules.

For therapists--and clients--who are struggling with boundaries, the paramount question must be: Does this serve the patient's therapeutic interests? If an act or an encounter threatens that goal, it is suspect, even if its exploitative potential is not obvious.
 
pepecat

pepecat

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That's a really interesting article, and I agree with pretty much everything.

Boundaries are important - and it's important that both sides know what the boundaries are. I think sometimes the therapist knows what the boundaries are, because they set them themselves, but they may not always make them clear to the client and things get a bit confused.
 
AliceinWonderland

AliceinWonderland

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That's a really interesting article, and I agree with pretty much everything.
Yes, I do too.

The first time I had therapy, which is over twenty years ago now, my therapist was very clear on boundaries and the reasons for them, but I was pushing for 'more' than the therapeutic relationship could or should give, and I sometimes pushed against them. I fantasised about her being my friend, and wished she could be my friend. I felt she understood me better than anyone else in the world, and I suppose she did. She said to me once, quite matter-of-factedly (which was the right way to say it), that if we'd met in other circumstances it's possible we'd have got on and been friends, and she may have been right, but the important thing was that she was making clear that because we'd met as client and therapist it wouldn't ever be possible for that to happen.

One small boundary issue concerned getting a drink of water. This was before the days when it became normal to carry a bottle of water everywhere with you, so what I used to often do was go and help myself to a cup of water from a small kitchen that was along the corridor from my therapist's office. I didn't really think about it, but I suppose it was a staff kitchen. There wasn't usually anyone in there. But after a while she told me I wasn't allowed to, that clients weren't allowed to do that. It felt a great injustice. To make the point of how unjust I felt this was, and how uncared for I felt that I wasn't even allowed to get a drink of water, I began bringing a drink of water with me, in a plastic cup, which I carried with me for the ten minute walk from where I worked (the therapy took place in my lunchbreak at that time). It was a sort of protest. At the time I couldn't see that there were boundary issues to this, I just felt it was one of the basic things you should do for someone, provide them with a drink of water if they were thirsty (this comes from the religious background I'd had, I think Jesus says something about always giving someone a drink of water if they ask). But as we talked about it, and she tried to explain to me that there was more to it than the simple drink of water, that there were issues of crossing the boundary from spaces where client's were allowed to be, into an area which is just for staff, (as well as issues of what I was needing and wanting from her, and issues of power and control maybe) I began to see her point. I was still resistant to accepting it though. And it still felt like evidence of a cold, harsh, uncaring world where I was being denied a simple thing that wouldn't cost much to give. But I think in delving into these sort of boundary issues a lot is discovered about what my needs/wishes/fantasies are, and about the ways in which these weren't met in childhood, and how the losses and hurts from that affect me now. I suppose it provided a context to explore my feeling of impotence and hurt at not getting something I wanted/needed, in relation to someone I saw as a mother-figure with whom I was exploring what mother-figure's are supposed to do, and what happens when they don't do those things.

Over the course of that therapy I learnt from her what the boundaries are in the sort of therapy she practiced, and I guess they were probably on the stricter side than in other styles of therapy. But I think that did benefit me in the long run, even though it felt unfair, and painful sometimes at the time. And as a consequence I learnt about the way I push boundaries in real life, and how it comes across to people when I want things from them that aren't appropriate for me to expect, and how that's been down to having unmet needs as I was growing up, and therefore is understandable even if it's not going to go down well.

Another counsellor I saw in more recent years, always provided a glass of water waiting at the start of each session. Which seemed perfectly reasonable and a nice thing to do. The therapist I see now, who does psychodynamic psychotherapy the same as the one I saw before, she doesn't provide water routinely, but has on occasion fetched me a glass if I've asked, but usually I try and remember to bring a bottle with me if I think I'm going to need it. But these small acts of caring, like fetching water, or turning the heating up if I'm cold, it's recognised that they have more meaning than the actual act itself, that they have a bearing on the question of me having needs and wants, and expectations about how or whether they will be met, and whether I am entitled to voice them. It's been a key part of therapy for me to address how I have always felt unentitled to have needs and have them met, how I grew up feeling I shouldn't want things, and was bad for having needs. So simple things like being thirsty or cold take on bigger meanings in how they're handled. We talk quite a lot about boundaries. Sometimes I want to change the time of my session (previously when I was seen in the NHS this wouldn't have ever been allowable or probably possible), and it has taken some time to get used to the idea that I can ask for this, and there can be some flexibility. It's a real deep issue of who has the power, who has the ultimate control in the process, and what my rights are, and whether I feel entitled to be heard, whether I'm allowed to ask for things (of course I understand that I am, but because of it being so deeply ingrained that I have no rights and I will not be heard it's hard to accept it), and what will happen when I do. Asking for anything always feels so risky, always feels like it will potentially lead to rejection, abandonment and even derision (not that this would happen in real life with my therapist, but these are the feelings that come up when I ask for things, when I make it known that I have needs or wants). Yeah, I suppose that's what it comes down to, having been ridiculed and held in contempt as a child for having needs that are normal and natural for a child to have, and which when they aren't met, lead to hurt (and anger and sadness) and a belief that you must be wrong and bad to have them.
 
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pepecat

pepecat

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That is a decent article, yes. I think the thing that's different about here (UK) though is that that article refers to 'paid for' therapy, which is often the case in the USA, whereas here we have a mixture of both. Through the NHS there isn't that 'business transaction' element you have with private therapy - there can be positive and negative about that though, of course.

What I liked about the article was that it recognised that while it's important to have boundaries, sometimes they can be bent or blurred if need be, depending on the therapist and the client, and (for me) that's the important bit. There are, of course, some boundaries that should never be broken, like don't enter into a relationship with your client, don't socialise with them, don't tell them loads of stuff about yourself..... all the 'biggies'.

But other ones as mentioned in the article - like going outside for a walk with an antsy teenager, or what not, I think those can be more flexible depending on the client, the therapist and the relationship more generally. My first therapist I saw for 10 sessions. We ended just as we always had, with a 'bye' and that was about it. The one I saw after her, I saw for two and a half years... we ended with a hug, and I'd made her something as a thank-you, which she knew I was doing and was ok with. That was entirely appropriate, given the nature of the relationship. I saw her again more recently for a bit on and off as a sort of 'top up', and again when we ended, we hugged, and again that was appropriate, I think. I first met her 5 years ago when she assessed me, and a relationship like that, over that length of time, is very different from 10 weeks with someone.

She also let me call her in between sessions, perhaps knowing that I needed to know that option was there, even if I didn't use it. I rang her twice, in all that time, and both times i was in danger of hurting myself. I didn't take the piss in that respect (ringing a lot) and I imagine for some of her other clients, that option wouldn't be there because they might abuse it. I guess it's important not to be too rigid about some boundaries, as it could be bad for the client, but then with others you have to be very firm as clients could take advantage.

I guess the issues (problems) arise when one party - client OR therapist - want more out of the relationship than is good for either, and when it becomes a problem for the client or therapist then its bad news. You can get clients who want to be friends with their therapists, but you can also get therapists who tell their clients way too much stuff and want to be more than therapists to them, and either way, it's not good.
 
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