Boundaries in the Therapeutic Relationship
By Marjorie L. Rand, Ph.D
Boundaries define personal space, in psychotherapy and in life. This space is called the intersubjective field. It is in the intersubjective field where most spoken and non-spoken boundary negotiations take place. Boundaries can be characterized according to general categories: boundaries of propriety and space, behavioral, verbal, and energetic. Within these categories there are various types of boundary styles, such as strong, healthy boundaries; rigid, inflexible or distant boundaries; and boundaries which are lacking in definition or are fused. Spatial, behavioral, and verbal boundaries are the most commonly considered characteristics of boundaries.
Energetic boundaries are more somatically based and less commonly described. Attending to and using the body in psychotherapy makes boundaries clear, allowing both therapist and client to participate in the relationship more comfortably and can help to prevent vicarious traumatization in the therapist.
Navigating the levels of connection and distance is done through the practice of boundary formation, which is how physically close or distant the therapist and client must be to be comfortable with each other. Spatial boundaries refer to the concept of having someone inside one's space or too far away to make a connection. For instance, where the therapist and client sit in relationship to each other is an aspect of this. Often, both think they should sit closer than they actually feel comfortable doing. A therapist who is aware of her own body can sense her level of comfort or discomfort, and adjust herself accordingly. She can then encourage the client to do the same. One way optimal distance can be felt is through breathing room. A sign of discomfort may be a tension in the body or an awareness of holding the breath, which indicate that the therapist and client may have been sitting either too close or too far. Once optimal distance has been reached, it is not unusual for both therapist and [CLIENT?] to indicate this by taking a breath. 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. 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 (2002) reminds us that therapeutic boundaries often remain implicit because the therapist and client are, in essence, "tied to their chairs." Remembering that people and chairs can physically move may free both client and therapist of this limitation.
Behavioral boundaries include knowing when to stay and when to leave, or taking an action in one's own behalf. The therapist who ignores his own needs in the service of the client, runs a great risk of becoming vicariously traumatized. A common example occurs when a practitioner needs to cancel or re-schedule an appointment, but decides it is more important for the client to see him/her. 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 (1994) 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 same is true of the therapist/client relationship, and is accomplished by attending to body sensations. 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. Reactions of both therapist and client can be made explicit by verbal descriptions, increasing good communication within the therapeutic relationship, explicitly the ability to take care of oneself.
Verbal boundaries address the concept of social space; for example, the secrets one keeps, or how intimate a detail one might reveal to an acquaintance or even in a marital relationship, refers to the honest ability to say yes or no, or to express an opinion. How does the therapist know what she feels to answer the client's questions honestly, as opposed to giving answers which will satisfy the client's needs? Often the response to the question might be known by an awareness of the presence or absence of discomfort in the body, such as tension, a headache, or a stomachache. This depends on the practitioner's ability to feel in her body what is comfortable, and what is not, called somatic markers (Damasio, 1994).
It is the professional's job to know, by the signals in her own body, what is right for her at what time. If she says yes, and is unaware of the no in her body, she may be in contradiction to her true feelings and may be at risk for compassion fatigue (Figley, 1995). Verbalizing preferences (what I like or don't like), values (what is okay or not okay) are examples of setting verbal boundaries. Failure to do so in the therapeutic relationship can make the therapist vulnerable to vicarious traumatization.
Boundaries define the space around our bodies. This space has an intangible, but physically palpable, energetic quality. Physical boundaries may extend beyond the body, varying in size or radius, sometimes larger or smaller.
Think of a time when you have felt uncomfortable when a person was standing too close to you. In that instance, you were aware of your personal space and the other person encroaching on it. It may have been a particular person at a particular time who made you uncomfortable, but the same person might not have at another time. Unlike defenses, which are rigid, boundaries are flexible and can change, depending on the person or situation.
Visit Dr. Marjorie L. Rand's website at www.drrandbodymindtherapy.com.