Why Do We Need Boundaries in Psychotherapy? [2] (With a Focus on Helping Survivors of Childhood Sexual Abuse.)

“The very best thing we can do for others isn’t soaking up their pain, it is actually holding space for them. Holding space for a person means giving them the room to grieve or vent while still maintaining our own boundaries.”
Mateo So

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    Image: Marco 40134 Flickr.com

Boundaries in psychotherapy need to be broached in initial discussions; these boundaries need also to be elastic and permeable.

Sometimes boundary crossing might be in the interest of the client. Inevitably there are grey areas; supervision may be important here, as we have seen in the Casement example. 

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An illustration of breaking boundaries in psychotherapy that was helpful to the client is found in Dr Robert Hobson’s description of his sessions with ‘Sam,’ a 14 year old boy who presented as angry and resentful.

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This sullenness remained, until one day, things changed. His therapist had just heard a cricket match on the radio and began to ‘pour out’ his thoughts about cricket to Sam.

The therapist describes this in the book (above) as ‘an irresponsible piece of behaviour.’ However, Sam enthusiastically joined in the discussion, smiling and exchanging views.

After that, he began engaging in a meaningful and productive psychotherapy experience.

Dr Hobson’s ‘boundary breaking’ was the catalyst for this:

In a moving cricket conversation, our immediate experience was shared and shaped in verbal and non-verbal symbols of a language which emerged between us. It was not merely a matter of talking about events. It was a dialogue, a meeting, a talking-with in mutual trust-a personal conversation. A simultaneous giving and receiving. A finding and being found.”

Forms of Feeling. Robert Hobson.

Dr Hobson devised The Conversation Model of psychotherapy; this concentrates on the client/therapist relationship, leading to inter-personal learning. It is a model of therapy I was influenced by as a psychotherapist, with its important focus on mutuality.

Survivors of Childhood Sexual Abuse: Therapeutic Boundaries.

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People who have been abused in childhood and whose boundaries have been violated often find it difficult to establish boundaries.

They might also have necessarily erected rigid boundaries, to keep danger away. They may be silent, closed off behind an invisible protective shield.

Sometimes people enter therapy uncertain about managing boundaries, feeling used or mistreated. The therapist who demonstrates clear, yet negotiable boundaries, can set a helpful example.

The survivor might test the therapist’s boundaries, never having learnt what is appropriate.

This could be a cry for help, trying to find someone who will show and perhaps explain, healthy boundary-keeping.

“To my abusers, the act of setting appropriate boundaries was viewed as hostile aggression. They believed that I was denying them something that belonged to them if I resisted. I was a resource to be exploited for their personal use. I was property who didn’t have any rights over my time, my energy, my body, or my possessions. I viewed myself that way too. I believed that they were justified in being angry with me for saying no but I wasn’t justified in being angry with them for abusing me.”
Christina Enevoldsen

Whilst the abuse occurred, especially if it was by a family member, there was inevitably terrible confusion over roles and boundaries.

The victim’s boundaries are violated physically, emotionally and psychologically and the thinking processes of the abused child become disorientated.

Frequently, the blame is directed by them at the self, as abused children are often told it was their fault.

There is often denial by the abuser, family or friends, that abuse has occurred, making the child feel alone, a liar, or crazy for having a different reality, which is not affirmed by others.

The boundary between fantasy and reality is confused; sometimes the abused person cuts off from reality during the abuse as a coping mechanism.

The child’s sense of agency, rights and personal power are often destroyed or damaged; this is a desperately invasive, core injury.

If the adult then enters psychotherapy, either individually, or in a survivor group, issues of boundaries are often paramount.

There is frequently acting out within and outside the therapy. This is a kind of memory and is a way of communicating indirectly to the therapist how things have felt in the past, when there was no secure base.

For example, lateness for therapy sessions, or missing sessions, may occur. The meaning of this, if repeated, if possible needs to be caringly and mutually understood by both therapist and client as the therapy progresses.

Psychotherapy with survivors, depending on their emotional state, may be painful and lengthy.

Trust issues may be understandably difficult, as is relating the abuse story, which may feel re-traumatising. It needs to be heard by the therapist with empathy, valuing, patience and care.

Any pushing through boundaries, or emotional ‘walls’ that may have been erected to protect the child self, is only repeating the abuse.

Clients need to proceed at their own pace; that is a way of setting their boundaries in terms of allowing others into their private world of painful memories:

“Boundaries are not just the therapist’s rules; clients get to set boundaries in the therapeutic relationship too.”

(Erin Stevens [@clientfirst] on Twitter)

For survivors, learning that they have the right to say no, becoming more assertive, and standing up for oneself, may be a struggle.

Being clear about one’s beliefs, needs and views also might be hard, given the boundary confusion that inevitably characterised the survivor’s childhood.

“Daring to set boundaries is about having the courage to love ourselves, even when we risk disappointing others.”
Brené Brown

Helping abused people decide on their own boundaries leads to increased assertiveness, combatting old feelings of powerlessness.

Achieving clarity in stating what you do and do not need, or want, from the therapy, is crucial. Clients are in control of whatever and how much they wish to share.

In time, with a sensitive, respectful and supportive therapist, survivors can find they experience more self-esteem and value, greater self-knowledge and an increasingly clearer sense of self.

The survivor needs to feel equal with the therapist, but with different roles. The abusive ‘one-up, one-down’ experiences of the past may thus be challenged, as the survivors learn that they have rights to be heard and respected.

Within a safe, containing and gently boundaried therapy environment, traumatised people can be given a new- and healing- experience.

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