Why are Boundaries So Important in Psychotherapy? Part 1.

“No is a complete sentence.”

– Anne Lamont

 

 

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“Boundaries define us. They define what is me and what is not me. A boundary shows me where I end and someone else begins, leading me to a sense of ownership. Knowing what I am to own and take responsibility for gives me freedom. “

– Henry Cloud

What is Meant by ‘Boundaries’ in Psychotherapy?

Boundaries in psychotherapy delineate the ‘rules’ that therapists set and maintain to protect and care for themselves and, most importantly, for the client.

It is crucial for all therapists to have clear professional boundaries, in order to work ethically and responsibly.

Different schools of psychotherapy have different thoughts about boundaries. For example, most psychoanalytical therapists would consider that hugging a client is unprofessional, whereas some others might not.

Whatever the therapist’s rules, it must be remembered that all boundaries are there for the therapeutic benefit of the client and in the client’s best interests.

Boundaries in therapy include issues such as fees, setting, appointment times, therapeutic relationship and confidentiality.

In therapy, the setting of boundaries is commonly discussed over the initial sessions. 

The Setting

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Image: Elica Coaching and Counselling. Sander van der Wel. Flickr.

The therapy room needs to be comfortable, consistent, quiet, and safe from interruption or distraction. It should be fairly neutral in terms of decor and furniture and relatively free from the therapist’s personal mementos/photographs etc.

The setting must be a containing, holding, secure space in which the client will feel free enough to express emotions, thoughts and fantasies that may feel unsafe, risky, scary or crazy.

The Relationship

The relationship between client and therapist needs to be one where confidentiality is paramount (however there are limits within the law) and where ethical boundaries are maintained. These boundaries impart safety and structure to the therapy; they provide constancy and security for the client.

Therapist and client should not have any other relationship with each other outside the therapy room; this includes any professional, personal or sexual contact (either in or out of the therapy situation). Most therapists do not have contact with their clients in between the sessions.

Generally, the therapist does not self-disclose. This would most often not be for the benefit of the client. Psychoanalysis emphasises the need for the therapist to function as a ‘blank screen’ for the client, in order that the client can project onto that ‘screen’ fantasies, thoughts and feelings.

Therapist self-disclosure would totally interfere with the process of transference.

However, some therapists and therapy approaches do consider some self-disclosure, when they deem such boundary breaks will be therapeutic for the client.

Appointment times

These will be pre-arranged by mutual agreement and will be regularly and reliably maintained. This creates a sense of routine, regularity and certainty amidst all the feelings of uncertainty that the therapy process will inevitably trigger.

As far as possible, appointment times will not be altered without proper advance notice. In terms of client cancellation of sessions, different therapists will have different guidelines here. Some therapists charge for cancellation or non-attendance of sessions.

The Analytic Frameanalytic frame

In psychoanalytical psychotherapy, the symbolic, metaphorical structure that surrounds the therapy process is called the analytic frame. This has been defined and described by the artist and analyst, Marion Milner.

The analytic frame is also literal in terms of the boundaries of the room and other real safeguards of the therapy, such as confidentiality and timings.

The frame has a crucial therapeutic holding and containing function:

“The frame marks off the different kind of reality that is within it from that which is outside it; but a temporal spatial frame also marks off the special kind of reality of a psycho-analytic session. And in psycho-analysis it is the existence of this frame that makes possible the full development of that creative illusion that analysts call transference.”

Marion Milner.

Milner’s quotation is also mentioned in Casement’s excellent book, On Learning From the Patient, below.

 

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Casement explores the importance of the therapeutic frame; he also examines times when the boundary might- or might not- be stretched or shifted.

His case study in Chapter 7, entitled Analytic Holding Under Pressure, is one in which he presents a therapy experience with a woman who asked him to hold her hand whilst she relived a very traumatic childhood experience.

She had undergone surgery at an early age, during which her mother, who had been holding her hand, had fainted. Because of this faint, the mother had withdrawn her hand. Now she wanted Casement to replace her mother in the transference, which would involve a break in the boundaries and a fracture of the analytic frame.

He was very tempted to do so, but his conclusions led him to decide not to; the sensitivity with which he explains his dilemma in this regard is both moving and insight-giving.

The way in which Casement manages this request and its reflections in the woman’s psyche, are fascinating and important. This chapter is certainly worth reading.

Casement’s use of supervision and of the counter transference, are brilliant examples of how boundaries form a crucial part of the actual therapy experience for both client and therapist.

He refers to Winnicott in a telling quotation that really, in my opinion, sums up the principal aim of psychoanalytic psychotherapy:

“There is no end unless the bottom of the trough has been reached, unless the thing feared has been experienced.”

Winnicott.(1970)

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Next Tuesday’s post will continue the theme of Boundaries in Psychotherapy.

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