Boundary issues in Therapy

Boundary issues in Therapy

Defining boundaries is to contract for safety and agreed ground rules in therapeutic work.

The behavioral therapist must ensure not taking advantage, especially sexual relationship with the client. On touching, even if innocuously benign, one way to determine this is to check if the touch (placing an arm over the client) or intervention is for the sake of client (client needs it), or for the sake of the therapist, that is gratification for himself: gratification of one’s own ego. The use of touch is with fair risk (even if it has only positive meanings for the therapist), and must be with the highest sensitivity, lest it be confused with sexual connotations. If a request is made to act in a particular way which is violating boundary, it would be useful to ‘talk through it’ and how ‘you feel about it’ rather than acting on the request. More so, a therapist needs a senior colleague, as a supervisor to discuss his work with from time to time, as also to be aware of ‘red flags’, an unusual behavior that patterns itself outside the norm.

Is the discussion an exploration of the goal: which is the primacy of the task. Even more, one needs to discern if the emotion is legitimate: a ‘need’ or a ‘demand’. In therapy, issues of transference, and counter transference keeps coming up in the process, and this needs to be understood.  A warm, empathetic understanding is enough. And mutual needs and respect needs to be protected, both for the therapist and the client.

Apart from space boundary, and confidentiality and trust, time boundary is also critical to negotiate: an important to clarify that this a professional relationship and that use of time is important, as time is finite.

Choosing the physical setting is also important to confirming the professional relationship. Having a designated office, rather than a lounge or eating house. Yes, the therapist does provide a service for a fee, but it is only with the adherence to these boundaries that the work can be done. While I notice a lot of pro bono work being done, I would recommend that in all cases a small minimal amount be charged to ensure value is perceived.

The relationship should always be singular: the relationship that arises from therapy. Other relationship like friendship, employer, etc intertwined must be avoided.

Also, introducing jargon, or expletives, or personal sharing of one’s own problems/ issues must be avoided. Power struggle needs to be avoided, as this would be manipulative.

Building contract and rapport is critical. ICF has clear guidelines defined on ethical behavior in the realm of Coaching. Mostly, common sense applies.