I believe very strongly that clear and consistent boundaries are one of the most fundamental elements of the therapeutic relationship. They contain the relationship, frame it and promote trust. Boundaries don’t just come from the therapist; they are agreed upon within the relationship and the client’s boundaries need to be heard and valued.
When clients don’t know where the therapist stands on particular boundary issues, not only can this be very anxiety-provoking, but tripping over the therapist’s unspoken boundaries can be tremendously painful too. I once saw this described on an internet forum as akin to stepping on an invisible electric fence, and this elegant metaphor provides the title for my blog post.
Aside from the obvious ethical violations, there are few clear-cut answers about how we manage boundaries in our practice. There seems to be a lot of differing opinions, and I feel that our ethics, learning and experience provide a frame for making our own best judgements (alongside the honest and open use of supervision) about working in the interests of our clients.
I will say a little bit about some of the most commonly discussed boundaries in the therapeutic relationship:
Time boundaries: I still struggle to understand it when clients report regular therapist lateness; to me this is a straightforward issue of fulfilling the contract. If I have agreed to meet a client at a specific time and place it is my duty to fulfill that. Habitual lateness by the therapist can be very problematic for a client; I have spoken with clients who report high levels of anxiety due to a therapist’s unpredictability. I would argue that this type of inconsistency could trigger feelings relating to childhood trauma or abandonment. It can and should be avoided. Running over time in sessions also may have its pitfalls. A distressed client may appreciate some flexibility about extending the length of a session, and I think it’s important that there is an open discussion about the purpose of that, and when and if the client might expect something similar to be offered in the future. It is also important to pay attention to how the client feels about the extra time. It’s easy to assume that the client is happy to have a longer session, however they could be holding some anxiety about the inconsistency or may feel indebted to the therapist and more reluctant to bring up any problems that arise in the relationship. It is so important to check in with the client about any changes to the session frame.
Self-disclosure: We self-disclose just by being. Our gender, age, race, clothing, body type, accent are all apparent before the relationship has even begun, and it’s really important to be mindful of how we are being received by our clients. I am also aware that my presence on social media is a form of self-disclosure and I pay careful attention to what I post and how I approach my online relationships. my personal social media accounts are also restricted. I feel this is helpful both to myself – I am in pursuit of a healthy work/life balance – and also to my clients – I feel it is important to be mindful of how it might feel for some clients to see me in non-therapeutic roles and relationships. So what about self-disclosure in the therapy room? Congruence, or genuineness is, I believe, fundamental to the efficacy of the therapeutic encounter. If I am not me, then the relationship cannot be real, and as a humanistic therapist, I believe that the relationship is of paramount importance. So how much of myself, and what of myself do I share? These are difficult decisions which take place in-the-moment. There are relationship-specific contexts and multiple therapeutic factors to take into account. As I write this part of the post, I find myself thinking that self-disclosure really deserves its own post. There is so much to consider. Will the disclosure enhance the relationship? Is it the best way to illustrate a point? Are there any risks associated with it? What is the therapeutic purpose? Could it be received as minimising or dismissing the client’s experience? And not to mention: Is the therapist comfortable with revealing this part of themselves? As I so often say, it is essential to ask the question “Who does this serve?”. If the answer is not “the client” then I would suggest that it is not appropriate to disclose. I would also urge caution when faced with an uncomfortable personal question. It seems important that the therapist gives themselves time to reflect on their feelings about the question and the potential impact of giving an answer, rather than feeling pressured into a response.
Out of session contact – It seems to me that the therapist’s out of session contact policy is something that should be decided upon and communicated to the client at the start of the relationship. I don’t think there is any one right way to approach such a policy but I do think it is crucial that whatever the therapist offers, they can deliver on it. As we all know, we need to make time for self-care in order to avoid burnout and I think we have to be really honest about what we are willing to offer, and what we can offer. I think it’s important to avoid a situation where the client uses the out of session contact as it was offered, only for the therapist to feel overwhelmed and suddenly change the boundary. This can be experienced as shaming, rejecting and can be incredibly painful. It goes back to the analogy of the invisible electric fence – the client does not know where the fence is, but it doesn’t half hurt when they tread on it. If the therapist does need to adjust what they are offering a client, I think this has to be handled very sensitively to avoid inadvertent hurt.
Touch – There are many schools of thought on touch, and I think it is pretty much universally agreed that touch should never be forced upon a client, nor does any sexual touching ever have a place in the therapy room. Personally, I believe that any touch should be client-led and client-initiated, and I also feel that the use of touch in the therapy room should happen alongside discussion about therapeutic purpose and the client’s response. It seems to me that like any aspect of the relationship, an ongoing dialogue is really important to the work.
So these are a few of the potential electric fences as I see them. There are plenty of other boundary issues I have not been able to cover in this post – gifts and dual relationships both spring to mind, and it is probably not the last time I will look at boundaries in this blog.
As I began by saying, the boundaries of the relationship are essential, they are what makes it safe. They are what makes it therapy. We can’t (and shouldn’t) take away the safety of the boundaries, but what we can do is make those boundaries as visible and clear as possible, so nobody has to trip over an electric fence.