Therapy is a fragile, paradoxical relationship always at risk of turning into something else--friendship, romance, the worship of devotee for guru. Boundaries can prevent this from happening. They remind client and counselor that by being therapy, there are things that their relationship can never be, but that what it is, can be relied upon.
A client is safer and maintains more power by staying inside the therapeutic frame rather than by attempting to alter it. Within its structure, a client can allow himself to be completely vulnerable. Good boundaries, however, are not equivalent to good therapy. Boundaries exist to protect the therapy; they are not the therapy itself. It is quite possible for a therapist to keep the boundary and lose the patient, by enforcing boundaries in a restrictive, legalistic, defensive manner.
One of the complaints I have heard most often from clients was just how bad, how invisible and impotent, their therapists' lack of emotional responsiveness could make them feel. And some therapists certainly use the boundaries to maintain this emotional distance.
But a bound relationship does not have to be an emotionally distant relationship. Therapists can be warm, responsive and authentic, and still maintain a protective frame around the alliance. Clients may have an easier time with boundaries if they can recognize that therapeutic boundaries, as artificial as they sometimes seem, ultimately serve their best interests.
SETTING LIMITS
YES
o Therapy takes place at regular times.
o Therapy takes place in therapist's office.
o If therapist's office is in home, it is clearly demarcated from living space.
o Therapist bills on regular basis.
o Client pays on regular basis.
o Therapist answers freely all questions about professional beliefs and practices.
o Therapist and client discuss client's progress and revisit goals on regular basis.
o Therapist proposes possibility of consultation with another therapist if therapy at impasse.
o Therapist keeps everything discussed in sessions strictly confidential.
o Focus of therapy is on client.
NO
o Client goes into business with therapist.
o Client performs some other service for therapist: baby-sitting, secretarial work, teaching assistance.
o Client invests in business endeavor associated with therapist.
o Client gives therapist keys to his Hawaiian condo for a weekend.
o Therapist sets client up on blind date.
o Therapist suggests that client see his spouse for other professional services.
o Client is a student in a class graded by the therapist.
o Therapist regularly takes phone calls during client's session.
o Therapist screams, yells, cries, blames patient, in an out-of-control fashion.
o Therapist eats lunch during client's session.
o Therapist discusses other clients' experiences during client's sessions.
o Client belongs to the same reading group as therapist.
MAYBE
o Client and therapist attend same large social event given by a third party.
o Therapist attends client's wedding or other major life event.
o Client attends a lecture given by therapist.
o Client sees same therapist for individual therapy as other family members or friends.
o Client and therapist have tea or coffee during sessions.
o Therapist offers client a hug at end of sessions.
o Therapist visits client in the hospital.
o Therapist extends session when client is especially distraught and no one else is waiting.
o Therapist conducts sessions over telephone when client is out of town.
o Therapist lends client a book to read.
TO DISCLOSE OR NOT TO DISCLOSE
How much therapists should reveal about their own lives is one of the most difficult boundary quandaries. Clients have a right to know everything that they'd ask of any health professional--where a therapist received her education, what kind of license she holds, her areas of expertise and how many years she's been practicing. But when questions cross over from professional qualifications to more personal matters, things can get tricky.
Should therapists divulge whether they are single, married for the fourth time or divorced? What about sexual orientation? Ethnic background or religious persuasion? Beliefs? Hobbies or interests? What about questions pertaining to the therapist's own mental health, and her experience as a therapy client? The extent to which a therapist discloses information depends greatly on her treatment philosophy, how she was trained and her own personality.
Whether it's in the client's interest to know anything about these more personal matters is also subject to debate. Knowing too much can actually inhibit the client's own truth-telling: "How can I talk about my sex life when she's so straight? .... A guy who spends his weekends going to poetry readings is not going to understand how I feel about sports," and so on.
Therapy may resemble an intimate relationship in some respects, but it's not a social bond. It can be most hazardous when a therapist starts to treat it as any other casual friendship.
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