Shortly after moving into our house some time ago, we had some fence troubles. The tired wooden fence between our house and the neighbours’ showed distinct signs of sloping over to our end, at some points hanging dangerously low. Hence the joint neighbourly decision was made to have it fixed. Which in essence meant taking away the broken bit and getting a new fence installed. Whilst we were in this process, the subject of spending a bit more and putting in a small gate between the two backyards was raised by highly enthusiastic kids on either side of the fence. (In retrospect, maybe the tiredness of the old fence was partly due to the said youngsters’ climbing over it to visit their little mates on the other end!) Our adult arms were effectively twisted, and lo and behold – the new fence, and even more so the new gate, were soon bringing much joy to all involved.
Why did this plan work so well? The answer is clear: it created connection, without getting rid of boundaries.
The process of psychotherapy works well (mostly!) because of this exact same principle. We establish connection, rapport, a sense of being on the same page, working together towards a shared goal, yet without fusing our identities or feeling a sense of confusion or trickiness around the relationship. “Boundaries” is a topic which gets quite a bit of airtime in psychologists’ training and supervision. Partly because it is truly essential to the therapeutic relationship, and partly because it is so tricky and thorny to get “just right”.
In psychotherapy there are a few boundaries that shape the nature of the relationship. Amongst others: time, place, payment, how the therapist positions him/-herself in terms of self-disclosure, openness, physical touch and general way of relating to the client. In terms of the first three, I believe there is a huge sense of containment and predictability in sticking to clean, clear fences around time, place and payment with every session. After all, that is what makes it quite different to see a psychologist versus having a nice chat to a pal. Psychotherapy is an appointment with a start and end time, in a fairly neutral space, and requires from the client a certain level of planning, commitment and discipline to be there on time, leave on time, and pay for the session. Moreover, the content of the conversation is focused on important emotional issues. After all, you wouldn’t want to spend money to chat about the weather for 50 minutes! These implicit “fences” all help the therapy process progress clearly.
In some instances, it is very clear where a very solid fence should run. From an ethical perspective, for example, there is no room for gates when it comes to potential exploitation of the client. Therefore, all “dual relationships”, especially where power differentials could be at play, are to be avoided. The most obvious one that jumps to mind is romantic or sexual involvement, which is a big no-no, and could not possibly have any therapeutic outcome for the client. Other examples of dual relationships could be when psychologists are doing therapy with a friend, a neighbour, a family member, or their child’s teacher. This could be very tricky when the client would not feel free to open up and share as much as he/she could have done if the therapist were someone completely separate from his/her daily life.
Of course keeping this boundary clear and unambiguous is fairly easy in a city, but in a small rural town, some flexibility is often required! When I first started out in private practice in 2004 I was in a tiny town at the back of beyond in the South African Kalahari desert. I had the choice of either totally isolating myself from other residents in order to be the utterly objective single-role-only therapist, or be part of the community and find flexible ways of dealing with potential boundary crossings. I chose the latter, and still often chuckle to myself when I remember singing in a choir with a client, standing in the check-out queue for groceries behind a client and even planting trees in a client’s garden with a greening initiative I was part of! Was this a huge problem? No, it was not. The reason that it was manageable, is that we are dealing with a boundary crossing, and not a boundary violation. In other words, a gate in the fence versus knocking the fence down.
This is an important distinction to make: boundary violations are always bad news, and are always counter-therapeutic. This would include improper physical contact, planning friendly meetings outside of the therapy hour, accepting expensive gifts, and bartering (e.g. asking a carpenter client to fix your broken wardrobe as payment for therapy sessions). Boundary crossings on the other hand are sometimes unavoidable, as in the small town scenario I have mentioned. Other boundary crossings may include the therapist allowing a session to run over the hour, or to do a home visit to a terminally ill client, or make a phone call to a distressed client in crisis in between therapy sessions, or accept small gifts such as flowers or home-baked cookies. These are usually highly therapeutic gestures which the client will treasure and refer to in many years to come.
Additionally, therapists may choose where on the scale of “how high is my personal fence” they place themselves. Some would choose to reveal very little of themselves, hardly ever sharing personal information or stories, and most certainly not having family photos in the room. In an era long gone many psycho-analysts would even sit out of view of the client (who would be lying on the couch – literally!) in order to be as unobtrusive as possible. Recently, especially in therapy modalities such as existential psychotherapy or narrative therapy, the emphasis is no longer on the therapist having no personal identity, but rather on active engagement and appropriate sharing. This means sometimes putting a “gate in the fence”, and crossing over the boundary in a way that is therapeutic and focused on the client’s growth. This means that I won’t tell a personal story just for the sake of telling it. The motivation between sharing something personal will always be that I believe that it can help the client. Either by illustrating some principle, or by showing them that the obstacle they are struggling with is something that many others – including me – also grapple with.
Similarly, therapists have to position themselves in terms of how they feel about non-sexual physical touch (such as a hand on a shoulder, a hug or a handshake): this can indeed be a slippery slope which has to be navigated with caution. Having said that, touch is not necessarily a boundary violation, and can often be highly therapeutic when done within a proper, safe framework. Again, this has to be talked about openly in the therapy hour, without the psychologist making assumptions about how the client will interpret the hand on the shoulder or the handshake.
The most important motivation for appropriate self-disclosure, touch and other “gates in the fence”, in my mind, is that client and therapist are fellow humans and fellow travelers in this life. Especially in longer-term therapy it is always the relationship that heals. For a relationship to be deep and meaningful we certainly need a sense of knowing each other – and that will necessarily mean that the therapist will be engaged rather than aloof, and open to be known rather than aiming to be an objective blank slate. There is a caveat though: self-disclosure and other boundary crossings, have to take place within the parameters of the safe space which is therapy, and should never be an attempt to knock down the very fences that make therapy therapeutic.
Felix & Sage Psychology