The Skin of Therapy: On Therapeutic Boundaries

The concept of therapy boundaries is both slippery and essential.

Posted May 30, 2019

The concept of ‘boundaries’ is essential to our ability to comprehend and commerce with ourselves, others, and the world at large. To distinguish things from one another is to use boundaries. For objects and systems to exist, boundaries must be drawn or identified. Cells have membranes; people have bodies; countries have borders.

Our basic psychology—the distinctions between inner and outer experience and between self and others—is enabled by and organized around boundaries: What’s mine and what’s yours; what’s permissible and what is not. Boundaries may be formal and clear—graduation, say, or the end of a presidential term—or informal and vague: I sense when you stand too close; when you tighten a screw, there’s a thin line between tight enough and too tight.

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Conceptually there exists an inherent tension around boundaries since a proper boundary defines both our connection with others and our separation from them. The border is what separates us, but it’s also the place where we make contact.

The notion of boundaries is foundational to the practice of psychotherapy. In this context, boundaries serve several important functions. For one, boundaries separate the therapeutic relations from other social rituals, connections, and engagements. In addition, boundaries help define the internal parameters of therapy itself, how the therapist and client interact within the session. In this context, therapeutic boundaries serve both a preventative function, to protect the client (and therapist) from harm, and a facilitative one—to help the therapy progress and succeed.

Healthy boundaries, therefore, must contain dual qualities. They must prevent harm and facilitate progress. Healthy boundaries, in other words, must be both firm and flexible, permeable enough to allow commerce with the environment, yet sturdy enough to maintain the system’s integrity and keep out noxious agents. Tall fences may make good neighbors, but thick barb-wired walls make a prison. You can’t go through life productively while clad in a medieval suit of armor. You also cannot move in the world usefully without a skin.

For example, predictability is an important feature of the therapeutic contract. The therapy session is clearly bounded. The client and therapist know when the session will begin and end. Yet flexibility and ‘give’ are essential here as well. A client in crisis may warrant a longer session. This tension has found embodiment in the very person of Freud himself, who advocated ‘hard’ boundaries in his writing, yet ‘soft’ (some say too much so) in his actual interactions with his patients.

How and which boundaries should operate within a session? The discussion tracks back to the dawn of talk therapy. Different schools of thought in psychology have approached this question differently. Psychoanalysts, on one hand, have traditionally upheld a position in favor of rigid, set boundaries. Newer approaches such as CBT, humanistic, or feminist therapy have sought to soften the old dictates, opting for a more flexible, egalitarian, and permeable notion of boundaries. 

Drawing on earlier work on the topic, the psychologist Ofer Zur has written much recently on the issue of boundaries, pointing out that the field's traditional approach to the issue has been largely fear-based, clouded further by increasingly menacing risk-management concerns. He has proposed a new, more positive approach based on pragmatism and trust. Zur and others have emphasized the difference between boundary crossings—unavoidable, acceptable, and oft-useful allowances in the commerce between people—and boundary violations, which are harmful and destructive.

Zur has argued that ‘slippery slope’ fears regarding boundary crossings are more often than not unfounded. A case in point is the issue of touch in therapy. Currently, the fear of sexualized touching (a boundary violation) compels many therapists (often at the advice of their risk-management consultants, trainers, or supervisors) to flat-out refrain from any touching under any circumstances. This is problematic for two main reasons. First, contrary to common slippery slope formulations of this issue, non-sexual touch is not an inherent or even common gateway to sexualized touch. Second, non-sexual touch is a powerful intervention, carrying potent healing properties for human beings. Like all other powerful interventions, it carries some risk. But the risk needs to be managed in ways other than banning the intervention altogether. Likewise, gifts, out of office encounters, and even dual relationships may under certain circumstances be helpful in facilitating therapy success.

For Zur, a fear-based approach to the issue of boundaries in psychotherapy is counterproductive. An enterprise rooted in hope cannot be led by fear. Likewise, trying to define the intricate work of therapy in rigid legal terms is ill-advised. Zur proposes cogently that “the appropriate meaning and applicability of boundaries can only be understood within the context in which therapy takes place. The context of therapy consists of client, setting, therapy and therapist factors.” The art of the work, in other words, is in adjusting the therapeutic frame to the contextual demands.

In sum, it appears that, with boundaries as with life itself, dynamic situations call for dynamic solutions. An honest, ongoing conversation is one such solution, and the right answer to almost every question remains: “it depends.”