In addition, boundary issues are more prevalent in relationships with patients with certain per- Suzette Du Rand friend or acquaintance even though this kind of therapeutic relationship is usually superficial and will end soon (Baca, ). Define “boundary crossings” and “multiple role ethical violations” and . The therapeutic alliance evaporated, and the client successfully sued the therapy ( Bogrand, ; Clarkson, ; Ryder & Hepworth, ). important to address the issues of social role and professional boundaries .. Just as multiple relationships confuse therapeutic relationships, they can also that Mr. Rand's policy allows up to 20 sessions of psychotherapy, the case.
Energy Blocks and Disease When the emerging Self becomes injured and defenses are established, the flow of Self-energy becomes blocked-disconnected from bodily, emotional, and cognitive awareness.
This breakdown in the integrative processes of body and mind translates into specific patterns of disease that might be experienced physically, mentally, or emotionally.
In IBP, these patterns are brought directly into the here and now of the therapy session. The therapeutic relationship creates a potentially powerful context in which the energy that radiates from the Core Self can be influenced. The task is one of realigning and reintegrating the intellectual and emotional energy with the natural flow of energy as it is released and contained within the body.
In this way the sense of Self-expansion occurs in a complete and integrated manner — a renewed relationship with Self. The Healing Relationship Within the framework of IBP, all injuries to the Self occur within relationships and can be healed only within a relational context. Energetically speaking, the therapeutic context might be seen as a meeting of two energy fields that define the Self-boundaries of the therapist and the client.
Any withdrawal, uncertainty, or discomfort communicated to the client in this process could easily repeat the conditions of the original injury and recreate the defensive reaction. The Issue of Sexuality Since IBP therapists work directly with the aliveness of the body, the experience and expression of sexuality is an essential part of the therapeutic process.
Repressed sexual energy; along with all of its emotional, intellectual. In working with bodily awareness, therefore, the pelvic area becomes a critical point of focus, even if the client chooses not to work on the more cognitive or verbal aspects of sexual experience. Therapists who are not at ease with their own sexual energy can easily transmit their discomfort around this issue.
The reemerging Self of the client could then be tragically reinjured without any gesture being apparent or any word being uttered. The therapeutic task is for the client to open the flow of his or her sexual energy and integrate its fullness into an expanding sense of Self.
This means that the therapist must be fully energetically present within his or her own boundary; allowing and supporting the process. From this perspective, enlightenment is a neurophysiological event-energetic, immediate, and directly accessible through the senses. The key to learning and healing is to let the event occur while containing and Integrating the experience. Energetic discharge or emotional catharsis alone is not helpful or curative. Since little of the experience is actually retained, any developmental effect cannot be sustained or integrated.
Release with containment, on the other hand, allows the body to retain this energy in the system, to expand, to make choices. IBP therapy contracts and expands the Self by establishing and working with its energetic parameters or boundaries. When the Self energy flows freely, and with awareness, these parameters are sensitive and flexible, constantly shifting in response to the needs of the authentic Self and the changing conditions of the external world.
In this sense, boundaries are both intrapsychic and interpersonal, making it possible to have autonomy as well as relatedness, and, above all, choice.
Grounded in both body and consciousness, boundaries allow the Self to become fully present and available to engage with others and the world in a sensitive and responsible manner. By freely expanding and contracting their own energy field, people with effective boundaries can remain present, yet determine the degree to which the Self will actually participate in any current situation.
Around such people, it is possible for others to sense this state of presence and containment within the energy field, though it is most clearly seen in the eyes. When the eyes are open and clear, energy exchange can occur with the environment and with others. But it is also apparent through behavior.
People who fail to develop effective boundaries cannot live in their bodies in the here-and-now. Without boundaries, there is no sense of Self.
And, if there is no Self, there can be no relationship. This is paradoxical and can be confusing, since it is often believed that a close or intimate relationship is a merger involving the loss of one Self to the other. In reality, it is only by having boundaries that one can establish a relationship with another, a relationship in which both people can be uniquely themselves and be intimately related to each other without loss of Self.
Oneness, merger, and symbiosis do not constitute a relationship that involves two people. Unboundaried associations often are considered to be close or intimate unions when, in fact, there is only one Self present, the other having given itself up through fear of abandonment. This pattern of merging, as a reaction to abandonment anxiety, usually begins in early life when the availability of the parent-figure is a matter of survival for the infant.
Later, in the adult, it manifests in clinging behaviors and a constant need to be close to significant others. Since such people continue to experience feelings of abandonment, however, the injuries continue to occur and the need for Self-protection continues to increase. On the other side of the coin, some infants experience a profound sense of invasion as they attempt to meet their early bonding needs and this anxiety can be carried into adult life. When defenses are substituted for boundaries because of invasion anxiety, a person deals with issues of closeness and intimacy by creating a wall of distance and by cutting off feelings of longing for closeness.
Very often both can exist at the same time. This creates a classic double bind. In their place, infants construct defenses, designed to distance them from external threats and from the pain of their own feelings. As the defensive layers rigidify through repetitions of the initial injury, they become chronic, structural, and fixed in nature. Cut off from the authentic experience of his or her own body and from the responses of the external world, the child begins to identify with these defenses as the Self.
Sensitivity, responsivity, and adaptability are replaced by a set of fixed repetitive attitudes and behaviors. Where boundaries are always flexible and centered in present experience, these defensive patterns are rigid and rooted in the past.
Self, Body and Boundaries
Cur off from authentic feelings and resistant to external feedback, the defensive or false Self is often presented as the very opposite: This is who I am, what I think, and what I do, and nothing you say or do is ever going to change that. Within this relationship, the Self is seen as an experience that is more or less fragmented split off and unbounded or cohesive contained at any given moment. Each person is more or less connected to this energetic experience, depending upon the situation, particular defensive style past history of relationshipsdegree of presence, groundedness in the body, and, first and foremost, body awareness.
Awareness, in and of itself, is curative, and provides choices. In IBP therapy, continued attention to ever-changing boundary issues in both the therapist and the client during the therapeutic process promotes both awareness and choice.
On the other hand, the practitioner must be sufficiently aware of his or her own needs to allow this, without becoming entrenched in the fantasy. Its energetic core, or essence, resides in the body and can be experienced directly only through body awareness. In its fullest form, this Self is more than physical, more than emotional, and more than cognitive. It is the sum total of all our aspects, and more.
It exists at the core of our experience. When we are conceived, the energy of the Self becomes embodied and, even before we are born, traumas and injuries to the development of Self can occur. Evidence of this is increasingly well-documented through research in the field of pre- and perinatal psychology. Studies demonstrating the ability of newborns to recognize messages received in utero have become commonplace.
The evidence now suggests that the unborn child is in a state of constant communication, receiving messages from many different sources at many different levels. The manner in which this information is processed and stored has led researchers to conclude that an organized sense of Self actually begins its development in utero. Physical health problems such as poor nutrition, drugs, or illnesses present obvious dangers. By the same token, however, abortion attempts, ambivalence about the pregnancy, death or divorce in the family, or difficulties in the parental relationship also could be injurious.
Developmentally speaking, these injuries or traumas to the emerging sense of Self can occur as early as conception through the first three years of life. In response to such assaults, a layer of defense is built over the injury and, over time, these defenses are transformed into styles of relating designed to protect the developing Self from further injury.
In the helpless stages of intrauterine development and infancy, defensive reactions are truly survival-oriented. The police came to your client's home this morning to arrest her year-old son for assault. She is extremely distraught. And what if your next client is in the waiting room now?
Marjorie L. Rand, Ph.D
Should you ask if she would mind dropping you off on the way home? A new client has rheumatoid arthritis and struggles to unbutton her heavy coat. Do you rush over to help her? The small town in which you practice has suffered an economic decline. A client asks if he can pay you for psychotherapy services by doing your yard work, as he does landscaping on the side. Your yard requires extensive maintenance, so should you accept? Your client starts bringing fancy coffee and croissants to every session.
Is this an innocent pleasure? Case adapted from Pope and Keith-Spiegel, You realize that you have disclosed a great deal about your personal life over several sessions. Should you pull back? You want to sell your car, and have a sign on it out in the parking lot and another on your bulletin board in your therapy office waiting area.
Your client decides to purchase it from you. You assure the client that it is in excellent condition and a good buy. Should you go through with a deal? The client you have treated for depression over the last six months tells you that she plans to visit her sibling who lives across the country in a few weeks.
With the exception of boundary violations that clearly violate any standard of care, ethics codes cannot possibly give specific guidance when it comes to mandating appropriate ways to socially interact with counseling and psychotherapy clients across all possible situations. Many boundary crossings can involve no ethical transgressions and even prove beneficial to the client.
However, as we will illustrate, remaining vigilant regarding our own needs and vulnerabilities as well as those of our clients is fundamental to ethical practice. As for our examples, not everything turned out well in the actual cases upon which they are based. The distraught mother scenario illustrates a double boundary crossing. To offer the client extra time seems a kind gesture but runs counter to the therapeutic agreement. In the future, this actual client felt entitled to extra time and resented not getting it.Good boundaries free you - Sarri Gilman - TEDxSnoIsleLibraries
In the meantime, clients-in-waiting have an agreed upon appointment obligation altered. One can feel sympathy for the distraught mother, but the matter does not qualify as an emergency. In fact, the mother might more appropriately focus on other actions e. Yet at other times, offering extra time would be prudent, such as in a true emergency situation.
The client who was asked for a favor turned into a bit of a fiasco. The client asked if they could stop on the way home and have dinner together.
The therapist refused politely, noting he had to get home to his family. But now the client, who later became a stalker, knew where he lived. This was a fairly new client with some issues that should have signaled caution on the part of the therapist. His myopic focus on his own convenience ended up costing him dearly.
Regarding the client struggling with her winter coat, what seems like an obvious helpful gesture requires brief reflection. This seemingly helpful act involves physical contact, and not all clients will feel comfortable with that. Some may even feel it as intrusiveness.
Asking before acting is essential. The client who brought coffee and sweets to the 10 a. She began to focus less on her own issues and more on that therapist as someone with whom she could have a relationship with outside of the office. The therapist finally picked up on what was going on and attempted, unsuccessfully, to pull the relationship back to the business of therapy. The client experienced the request to cease bringing coffee and sweets as both an insult and a rejection.
She never returned to therapy. Although this case did not result in an ethics complaint, the therapist felt guilty over failing to better perceive how meeting his own needs for what seemed like an innocent pleasure caused pain for a client he liked.
The economically strapped landscaper provides a more complicated case, and we will have more to say about bartering later. However, in such cases, taking someone up on what seems like a good match can turn into an ordeal.
The Therapeutic Relationship in Counselling and Psychotherapy
Ultimately, the client successfully sued the therapist for exploitation. Unfortunately, the therapist became defensive and told the client that the client must have caused the damage. The therapeutic alliance evaporated, and the client successfully sued the therapist in small claims court.
Finally, certifying the need for an emotional support animal, as opposed to a trained service animal e. Crossing them has many potential effects. The work of mental health professionals is conducive to permeable role boundaries because so much of it occurs in the context of establishing emotionally meaningful relationships, very often regarding intimate matters that the client has not spoken of to anyone else.
Yet, mental health professionals continue to hold differing perceptions of role mingling. These perceptions range from conscious efforts to sustain objectivity by actively avoiding any interaction or discourse outside of therapeutic issues to loose policies whereby the distinction between therapist and best buddy almost evaporates. However, even those who would stretch roles into other domains would condemn conspicuous exploitation of clients.
Some mental health professionals decry the concept of professional boundaries, asserting that they promote psychotherapy as a mechanical technique rather than relating to clients as unique human beings. Instead, acting as a fully human therapist provides the most constructive way to enhance personal connectedness and honesty in therapeutic relationships Hedges, and may actually improve professional judgment Tomm, Those critical of setting firm professional boundaries further assert that role overlaps become inevitable and that attempting to control them by invoking authority e.
The answer, they say, involves educating both clients and therapists about unavoidable breaks and disruptions in boundaries and to ensure that therapists understand that exploitation is always unethical, regardless of boundary issues. As the scenarios at the onset of this course reveal, however, exploitation is not the only harmful result of boundary crossings. We believe that the therapist retains ultimate responsibility for keeping the process focused.
We see no reason why maintaining professional boundaries needs to diminish a therapist's warmth, empathy, and compassion. The correct task is to match therapy style and technique to a given client's needs Bennett et al. Furthermore, we believe that lax professional boundaries can act as a precursor to exploitation, confusion, and loss of professional objectivity.
Conflicts, which are more likely to arise when boundaries blur, compromise the disinterest as opposed to lack of interest prerequisite for sound professional judgment. As Borys contended, clear and consistent boundaries provide a structured arena, and this may constitute a curative factor in itself. In short, the therapy relationship should remain a safe sanctuary Barnett, that allows clients to focus on themselves and their needs while receiving clear, clean feedback and guidance.
Frank discussions about boundaries with clients during the initial informed consent phase is also recommended.
Cultural traditions, geography e. The ethics code of the American Psychological Association APA, offers a clear definition of multiple role relationships. Multiple role relationships occur when a therapist already has a professional role with a person and: The therapist must be able to discern whose needs are actually being met. Maybe it is the therapist's need for more closeness or distance. The distance at which each is comfortable may reflect the levels of abandonment or control each has experienced in the relationship with early primary caregivers.
Many therapists believe that to be compassionate, they should sit close to their client. While this may be true some of the time, often there is a need for more distance, because of a history of boundary violations, daily stress, or personal preferences regardless of history.
Self, Body and Boundaries
When a therapist has a strong preference for one or the other, it is important for therapist and client to discuss their boundary preferences, as most of the time issues of closeness or distance in the intersubjective field are implicit.
Making these boundaries explicit and concrete can be a critical aspect of developing and maintaining the therapeutic relationship and can help to prevent retraumatization of the client and vicarious traumatization of the therapist. Daniel Stern reminds us that therapeutic boundaries often remain implicit because the therapist and client are, in essence, "tied to their chairs.
The therapist who ignores his own needs in the service of the client, runs a great risk of becoming vicariously traumatized. This can lead to resentment, and even unconsciously blaming of the client, which is not good for the therapist, the client, or the therapy. Having clear boundaries for appointment scheduling models for the client the importance of self-care.
The ability to identify behavioral boundaries begins in childhood in a securely attached relationship, where cycles of arousal and relaxation lead to appropriate emotional self-regulation. Affect attunement is the ability to monitor the level of one's affects. Schore discusses the infant's attachment to the mother being based on the mother's healthy support of the baby's Autonomic Nervous System ANS cycles, and the mother's ability to self-regulate her own emotional states.
The therapist who can adequately identify her own levels of affect regulation and attune to those of the client, understands the meaning her own bodily reactions.