Client-Therapist Boundaries

[Eve B]

Here's a useful link about clients setting boundaries for their therapists from Mary S:

http://everydayfeminism.com/2015/08/6-strategies-for-setting-boundaries-with-your-therapist/

Unfortunately, many clients new to therapy aren't going to feel that empowered until their head gets really screwed up by the therapist.

[Eve B]

Put up a 'No Trespassing' sign to a therapist, and yeah, they'll likely notice and target it because issues clients don't want to talk about tend to be issues they may still need to talk about.  However, it is the client's money...

[Mary S]

Here's what I said when I first posted the link on Psych News:

"I recently came across this article giving advice to clients on setting boundaries in therapy: http://everydayfeminism.com/2015/08/6-strategies-for-setting-boundaries-with-your-therapist/ On the one hand I'm glad to see this advice on the web, because it is sorely needed. On the other hand, this addresses a large part of what I went to therapy to learn to do in ordinary life -- but therapy never addressed developing these skills, and I needed them in therapy even more than in ordinary life. Also, when I did try to assert my boundaries in therapy, I was likely to get responses like, "Do you realize you are asking me to give up my control?" -- not exactly positive reinforcement! "

I think therapy could be (and maybe is already in some cases) helpful if the therapist is willing (and able) to listen to the client, see the client as an individual, and help with the things that the client is looking for help with. But there are too many in the profession who take the attitude that "therapy is what I say it is, and you shouldn't tell me how to do my job in any way, shape, or form." That attitude is likely to be more harmful than helpful. Therapists too often fail to see the client as an individual, but instead as raw material to stuff into the therapist's favorite theory, in other words, as an object to be acted on as the therapist chooses.

[Mary S]

RealityCheque said, "Some things are made much, much worse by talking about them, especially with a therapist. "

I agree -- I had a lot of getting worse by taking about things to a therapist. But I didn't engage in "digging up trauma" and never wanted to get close to the therapist. In fact, to me a frequent problem was that the therapist tried to get closer to me than I consented to, and that resulted in claustrophobic nightmares and "daymares" that I still have thirty years later.

I would have no objection to paying for the services of someone who actually helped me. But too often, it seemed that I was there to be used by the therapist, not to be helped in any way that I could see as helpful. It was analogous to paying someone so they could use me as a prostitute.

[Eve B]

Therapy is like a loaded gun.  The gun's (and therapy's) harm depends on the aim and the squeezing of the trigger.  How the talking and sharing of personal information is being handled and processed is what can make therapy helpful or harmful or even have no effect either way.  Some clients don't believe their friends or family will understand so they turn to the 'stranger' psych professional or an online forum like ours.  Sure, there are issues that can be made worse by the disclosure, but if you're holding it in and suffering by keeping it secret, then it probably needs to be released.  Talking it out is just one option, and it can be helpful with the right kind of support. Therapists are emotional voyeurs, and they're trained to find that pain and pick it apart.  Clients coming into therapy should be aware of these risks, and it's also supposed to be mentioned in the consent forms.

[Mary S]

RealityCheque said, "You seem to have an inordinately bad therapist."

I didn't have just one bad therapist. The first (not counting one that I didn't go back to after the first session, since she just seemed pretty blah) got off to a bad start when I asked her what therapy was and she said, "You're the star." I probably gulped (learning to cope better with personal attention was something I hoped for as an outcome of therapy), and she responded by, "You may not like it; you may not like the process." But I went back, with the attitude of "facing the music". I did decide to quit after the third session (there was so much she did that seemed poor quality), but made the mistake (not wanting to be "avoidant") of going back for a fourth session to tell her why I was quitting. She responded with, "You expect too much; that's Your Problem." I had a hard time coping with that, but tried a second therapist, albeit with a voice in my head telling me not to expect too much.

The second therapist was perhaps the worst of the lot. In the first session she made pronouncements such as "You gave up your power (in response to my saying that I was somewhat shy) and "You have a problem with intimacy" (in response to my saying that a coworker with whom I had difficulty coping said something that was inappropriately intimate for the workplace). I gritted my teeth and came back. In the second session, she said that a metaphor for what I needed was something like a mold that a brick was made in, that would leave a shape when it was removed. Now I see that as appalling, but at the time, I found it shocking, claustrophobic, and extreme. Things just never got better -- her manner was very intimate (which seemed unprofessional to me), but when I tried to ask for something more professional, she said "Therapy is an intimate relationship". I tried asking questions when what she was doing didn't make sense to me, but got responses like "Are you sure you're not second guessing me?" and "Do you realize you're asking me to give up my control?" and "Consider me to be something like a computer: what you say goes in, mixes around with my training and experience, and out comes a response." Once she said, "I get the feeling you think this should be an intellectual discussion," with an expression and tone of voice of disgust or contempt on the word "intellectual". That seemed really prejudiced to me. Once she said, "I can't help you if you take everything I say as criticism," which fed into my tendency to blame and shame myself. I became kind of a basket case, but when I tried to tell her about it, she responded, "My clients' pain is precious to me," which sounded pretty sick to me. Finally I decided it was better to be a "quitter" than to continue.

I tried a third therapist. She at first gave me hope that she would help me -- at least, help "recover" from my experience with the previous therapist. But as time went on, she did more and more things that didn't make sense, including saying "I have my reasons" when I tried asking questions to help me make sense of what she was doing. She also started teasing me at times that were especially inappropriate. Finally I decided to quit her.

Thereafter I tried therapy off and on, with the hope that it would help me cope better with the flashbacks, etc. of therapy. I got a little better at not going back when the therapist seemed really out of it. Some seemed kind and well-intended, but not very in touch with the real world in all its complexity. The last time I tried therapy was about ten years ago. It actually was a little helpful, especially the practice in "speaking my voice" with some degree of acceptance on his part. But eventually he got into a weird agenda of how I was harming myself by focusing so much on how I was different that him, and that I should focus more on the similarities I had with him (which weren't many, and pretty superficial at that). So I quit.

[Mary S]

Eve said,
"Clients coming into therapy should be aware of these risks, and it's also supposed to be mentioned in the consent forms. "

When I first tried therapy, there were no consent forms. My third therapist was the first to have one -- but it only covered fees, length of sessions, and perhaps cancellation policies. I never had a consent form that mentioned risks, although the last time I considered therapy (but decided against it) the therapist sent me a draft of a consent form mentioning risks.

I believe therapists have a professional obligation to try to mitigate risks ("First do no harm"), but my impression is that few of them do see that as part of their job.

[Eve B]

I admire your resilience, Mary!  I think all that bad therapy made you stronger and smarter!  

For therapists to do no harm, they need to be taught specifically what the harm can entail. Considering the individuality of clients though, harm can be anything, and many therapists can't or don't want to see it even when the client tells them.