Clarifying Boundary Issues to Strengthen Therapy

Why the Therapy Process Needs to be Free of Boundary Issues to be Successful

Mary Jo Barrett

We all know that the collaboration between therapist and client is the keystone of therapy. What many therapists may not realize is how much clarifying boundary issues means in establishing and strengthening that collaboration.

Boundaries are what make us all feel safe and grounded in a variety of situations; around a relationship in therapy, they create a secure perimeter, which makes possible the level of emotional freedom and authenticity that’s critical to successful treatment.

As I’ve come to appreciate the importance of boundary issues and safety to my clients, I’ve woven a clarification of those issues into the fabric of treatment from the very beginning of each case. I explore their opinion about what style of therapist they like and their overall expectations. I explain that I’ve learned that clients appreciate a collaborative, predictable structure, and discuss how we can work together to make their therapy experience as transparent as possible.

I often say, “This is a unique relationship. Although we may become best friends of sorts, I’ll never hang out with you, and when things are going at their best, we’ll probably begin to end the relationship.”

I’ll take time to define with clients what makes them feel safe and what types of relationships they feel safe in. Then we’ll explore how we can bring those ingredients into our work together.

Because of my focus on safety and collaboration early on, I talk directly about issues that might not occur to other therapists. For example, potential overlaps between my clients and me in our personal lives. I bring up the potential for confusing encounters early on, and discuss with clients how we might deal with possible meetings outside of therapy.

These conversations create an accepted etiquette that clarifies and smoothes over otherwise awkward situations. Unexpected encounters can sometimes loom large in the minds of clients, causing days of rumination and requiring an hour of processing during the next session.

We spend a good deal of time talking about what might be called internal boundary issues of therapy: What clients can expect to happen in therapy and what I can do to make them feel secure during the process.

If they’ve been in therapy before, I ask them what was helpful and what wasn’t. If something in particular wasn’t helpful, we’ll devise ways to avoid the same situation. These may not seem like boundary issues as they’re traditionally defined, but they make the client feel safe and contained like good professional boundaries are intended to do.

Clear structures and predictability are necessary to the healthy boundaries of the therapy process. Unfortunately, without meaning to, therapists may replicate the abusive relationships in the client’s past. That’s why it’s necessary to make our intentions to keep therapy as safe and transparent as possible.

Tags: ethical issues | boundary issues | Ethical violation | ethics in therapy | healthy boundaries | professional boundaries | therapist | therapists

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Wednesday, April 9, 2014 1:47:14 PM | posted by mary jos
Hi Simon. I appreciate your feedback and love the way that you honor and empower the client by posing the question in a neutral way. Although the distinction may seem insignificant to some, I believe that it sets the tone for a respectful, productive relationship between the client and therapist.

Monday, April 7, 2014 10:03:02 PM | posted by Simon Mundy
Hi Mary. I live in a relatively small community with a variety of orientations to therapy. While seeing therapy as not stigmatising is an ideal we may hold to, for many people it is still the reality that, at least at the start, seeking therapy is felt, whether consciously or not, as not being entirely acceptable. I try to just ask the question in as neutral a way as possible "How would you like me to react if we meet in public?" This seems to me to honour their right and their ability to decide on and express a preference in our relationship.

Monday, April 7, 2014 9:58:31 PM | posted by Simon Mundy
Hi Don. I agree with you where the client's cognitive strengths are mostly in control of subconscious attachment affect. The problem for me is that neither client nor therapist is ever entirely clear that a particular issue won't get past that cognitive control. I prefer to talk in terms of therapy being time limited and to focus, barring severely disrupted personal development, on what the client wants from therapy. This implies the successful end of therapy without asking the client to face the loss of the relationship almost before ir's begun.

Monday, April 7, 2014 7:06:56 PM | posted by mary jos
Good article, but I question the need to develop an etiquette for dealing with possible meetings outside of therapy. Perhaps some clients can keep the unique nature of the therapeutic relationship in perspective, but others may perceive participation in therapy as stigmatizing if it is deemed necessary for the client and therapist to pretend that they've never met to avoid an awkward situation. I would have preferred to see less of what therapy is NOT, i.e., "we'll never hang out together" in the article and more of what therapy IS, a unique relationship between two individuals that benefits both.

Monday, April 7, 2014 6:38:24 PM | posted by Don Goin
Interesting point, but I see it a bit differently. If a client has abandonment issues, they will become evident early in therapy and may well be a major focus of the therapy; i.e., the working through of the transference. In the client with abandonment issues, termination may be drawn out and likely accented with anger, denial and acting out. But if the therapist has laid the proper foundation and established solid boundaries, the client, in working through the termination, will realize that this is, indeed, a different relationship, one that will endure and one in which saying “goodbye” does not equal abandonment.

Monday, April 7, 2014 4:14:27 PM | posted by Chris Hancock
Good stuff. Therapy is, of course, all about the connection and talking about the boundaries is so essential. I like a lot of the ways the author puts things. I am surprised to hear she tells her clients "when things are going at their best, we’ll probably begin to end the relationship." Such a statement reinforces abandonment fears and learned helplessness trends in many people. In giving the message that getting better = end of relationship, you communicate that to stay connected to you the client must remain troubled. And so unconsciously they will, in order to avoid abandonment. Then you've really handicapped them. It's one thing to encourage and support getting better. It's a another to link it to the loss of therapist. I personally feel that when and why to end is most cases the client's decision to come to.