When Therapy Calls for a Boundary Crossing

A Story About When Professional Helping Meets Human Concern

Dea Silbertrust

I'd been in psychotherapy for more than three years when I was diagnosed with an acoustic neuroma: a benign tumor was growing slowly on my left acoustic nerve, the one that carries information from the ear to the brain. It was the size of a golf ball and took a seven-hour surgery to remove. My recovery was prolonged, requiring 10 days in the hospital and several months of rest at home.

I was 31 years old and living alone. A half-dozen friends gathered around to support and comfort me. My widowed father traveled back and forth from his California home 3,000 miles away. I felt close to my therapist, whom I saw in group and individual therapy. She'd supported me when my mother had died suddenly during our first year of work together.

"My mother died," I'd uttered simply when she picked up the phone on the evening I got the news. My voice seemed disembodied, but her calmness brought me back.

"Tell me what happened," she asked, as the sound of running water and clattering dishes faded into the background. It was the first time I'd called her at home. Our brief conversation reassured me that I wouldn't float away in a bubble of grief.

But my surgery seemed different, and I wondered what to expect from her. I was nearing the completion of my own doctorate and knew that taking a phone call from a grief-stricken client was an acceptable boundary crossing. But what should a therapist do when a patient was seriously ill and couldn't possibly make it in for sessions?

When I opened my eyes one of the times in the ICU four days later, I felt myself emerging from the drug-induced haze of the post-op period. I felt safe in the cocoon of the ICU, but soon my medical condition no longer warranted it.

The room I transferred to on a regular floor was adequate for my medical needs, but the move was psychologically devastating. It had been a mere 12 hours since I'd fully awakened and my emotions didn't have time to adjust to so many changes in a single day. I was so exhausted and strung out from the drugs that I couldn't find the words to communicate my distress. Surgery is an assault on much more than the site of an incision. My psyche was struggling to integrate so many overwhelming experiences. Despite the crushing fatigue, I managed to call my therapist.

Again, I can't recall her words. What I clung to was the soothing rhythm of her speech, reminding me that this horror would pass. I wasn't losing my mind. I'd get well. Her gentle cadences cooled my fevered mind and lulled me back to sleep.

A week later, I went home, with my father beside me. I was shocked anew by the depth of my fatigue; the inability of my brain to attend to something as mindless as a TV sitcom. It was impossible to imagine that I'd ever resume work on my dissertation. I couldn't even brush my teeth without resting for two hours afterward. How would I ever finish my dissertation? I didn't have the energy to get to my therapist's office, but I desperately needed to see her. So she agreed to come to me.

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I lived at the top of a four-story brownstone with no elevator. The door to my apartment was on the third floor and led to another flight of stairs that opened into the hallway outside my bedroom. As I lay exhausted in my bed, I heard my therapist's labored progress up those long stairs, punctuated by gasps for breath. Even through the haze of my own convalescence, I felt alarmed by her physical condition, something that had never been apparent when we walked the short distance from the waiting room to her office.

"Don't be concerned," she said after resting a few minutes to catch her breath. "It's the result of smoking for too many years." In the three years I'd been seeing her, I'd never had a hint that she was a smoker.

Our meeting definitely wasn't your typical therapy session. I lay virtually immobile in my queen-size bed. My left eye, which refused to close even when I slept, was covered by a clear, plastic patch. What was left of my hair was cut close to the scalp, courtesy of a home visit from my hair stylist, who insisted on "evening" me out. My two cats surrounded me and purred throughout the visit. I imagined the contrast my therapist must have seen between the alert, active young woman sitting on the pre-op hospital bed and the one now lying before her. But she managed to mask the shock I later learned she felt.

We chatted about cats. I learned that her precious Siamese had died the previous year. "I was inconsolable," she admitted. She petted Hadrian, my black cat, noting that black cats often have Siamese in them. "I hope this doesn't make me get another cat," she laughed. That's all I remember about the visit: her slow steps, her labored breathing, her affinity for cats.

A few weeks later, I was back in her office, then back at group, then back to work. Over time, I finished my dissertation, got married, and started my own practice. Years after we ended therapy, I ran into my therapist at a convention. As we talked, my mind drifted back to that unimaginable time of my surgery and the way she'd reached across the traditional boundaries of the therapeutic relationship and saved me.

My therapist's willingness to trade the comfort and security of her office for the ill-defined crossroads where the role of professional helper meets simple human concern would be considered a boundary crossing by some. Recognizing that the physical and psychic dislocations that followed my surgery had hit me at the most primal level, she went beyond the normal definition of a therapist's role to soothe my wordless panic and ground me in the warmth of a familiar connection. In doing so, she demonstrated the difference between a boundary crossing and a boundary violation, and, more important, what it means to offer a simple act of grace to another human being.

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Dea Silbertrust, PhD, JD, is a licensed psychologist and associate managing partner of Bala Psychological Resources. She graduated from the law-psychology programs of Drexel and Villanova universities, and works with adults, adolescents, and families on eating disorders, trauma, and women's issues.

This blog is excerpted from "Boundary Crossing" by Dea Silbertrust. The full version is available in the May/June 2007 issue, Say Ahhhh...: Collaborative Health Care Just May Change the Way You Practice Therapy.

Photo © iStock

Topic: Ethics

Tags: boundaries | boundary issues | chronic illness | code of ethics | ethical | ethical and legal issues | ethical boundaries | Ethics | ethics in therapy | Family Matters | healthy boundaries | professional boundaries | therapeutic ethics | therapist's office | therapy ethics

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5 Comments

Sunday, March 3, 2019 7:32:13 PM | posted by wendy dytman
I also chose to go to a clieint's home for therapy sessions for months after her back surgery - she was practically immobile, in a lot of pain and very depressed.....Having the weekly therapy continue thru her recuperation was normalizing for her and gave her husband a break ... I felt that breaking the "boundary " was a lessor evil than abandoning her when she really needed someone to empathize with and understand what she was going through,

Saturday, March 2, 2019 2:14:22 PM | posted by Raquel Fernandez
Being compassionate is part of what we do as therapists. In some cultures this would not be a boundary crossing at all, but just what one does for another human being

Thursday, February 28, 2019 12:46:44 PM | posted by Joseph Lanzone
Thank you so much for this message of compassion. With all honor to ethics, boundaries, theories, etc., being a "therapist" does not elevate us to canonization - MSW does not mean Master of Sacred Wisdom. Acts of kindness are often easier when they are random. When they are strategically enshrined in transference, they cause us to be challenged by our intentions, which is good and necessary. I always discuss these challenges in collegial supervision, then follow my intuition. We are not therapists purely for posturing our own professional illusions. We are therapists to rationally answer the call of another's suffering. Joseph Lanzone, LCSWR, CASAC

Saturday, January 14, 2017 5:12:57 PM | posted by Wendy Dytman MFT
I, too, chose to see a client who I had been seeing for over a year in her home after she had back surgery and couldn't drive (or really move much). Her pain and isolation sent her into a deep depression and it was easy for her to tell friends she wasn't up to them stopping by, but she never cancelled our weekly appointment. For months I was the one she could talk to about her fears about her healing, her pain, and dark mood. I would do this again in a minute.

Saturday, January 14, 2017 12:57:19 PM | posted by Dr. Emily Chernicoff
What a beautiful account, Dea, and an important piece for so many of us who often try so hard to find a balance between what is 'right' and what is 'ethical'. Clearly, it is not always an either-or choice, but rather an "and". So glad you're well and shared this most moving experience with us. Thank you, Emily