How Close Is Too Close For Therapists And Clients?

[UnicornSightings]

I had TONS of transference going on with my last t (and my current one) and would’ve LOVED it if she would’ve gone the extra mile for me. Omg. That would’ve been everything. I just wanted her to adopt me. Be proud of me. Be her favorite client. I wanted her to reply to my emails with really long responses. I wanted a lot from her. And freaken bless her, she knew what she was doing and had utterly fantastic boundaries. I always felt safe and knew exactly what to expect. She once modified her email policy when I was twisting her words and being more hurt and didn’t waver when I asked her to change it back. In spite of all the lines that we both knew were in place, I felt supported and important and seen. With that I’m able to know what works for me and set my own boundaries. They are so very important, ESPECIALLY when you’ve had a traumatic upbringing with absolutely no boundaries.

 

[BoN-bOn]

Can you see though that the smile on the patients face meets a need you have? I'm not saying it's a wro...

Yes I guess you’re right about the smile. It does make me feel good to give others some happiness & it has always been appreciated. I do always want everyone to know that their life matters to me & that I don’t do my job just to receive a paycheck, I’m there because I want to help any way that I can. I’m not a therapist, but on the medical side of things. & I do understand your points completely about the therapist/client relationship. It’s a very fine line & one that could be easily crossed into dangerous territory. I agree it can be very therapeutic (with the checks & balances), as it has been with me.

 

[joeylittle]

@BoN-bOn - I take it you are an MD?

I don't think there's a lot of useful comparison that can be drawn between the boundaries in a therapist-client relationship, and the boundaries for an MD-patient.

 

[BoN-bOn]

No I’m a nurse @joeylittle , l guess I was trying to make the point that there are boundaries in every profession & there has to be some judgement on the part of the professional as to when those boundaries should or shouldn’t be crossed. Sometimes it’s helpful, sometimes it might not be, but it is the responsibility of the professional to decide. l deal with a lot of very sick, & emotionally broken people & spend a lot of time with them. More than an MD would. When you’re a nurse, sometimes you’re expected to fill a lot of different roles & a middle of the night ear to listen is on the list of those roles a lot of times. Compassion is one of my greatest strengths & I care about the well-being of each & every one of the patients I take care of & would never do anything outside of the scope of my practice or put someone at risk of harm. Sometimes a little extra compassion & care goes a long way. I see new grads come out & they are so rigid & afraid of doing something wrong they lose their compassion. I think it’s an important trait for anyone in the caring/healing business. Hospitalized patients are scared & vulnerable & I know that feeling all too well.

 

[UnicornSightings]

No I’m a nurse @joeylittle , l guess I was trying to make the point that there are...

Omg! If you’re a nurse I think (personally) that’s completely different! My God, who doesn’t want extra caring when we’re in such a scary place. I get the similarities for sure but let’s go ahead and assume the people you treat aren’t loaded with emotional trauma. Sure, what they are currently going through is traumatic but I don’t think it’s the same as like a therapist crossing boundaries long term. You are there for their physical healing and I assume it’s mostly very short term. That’s awesome you care so much! And hell, yeah maybe when they smile you get something out of it but of course you would! You’re human! It’s ok to feel good doing good for others. And I’m sure it motivates you to keep going. I think it’s often VERY different when you go to someone and trust them with what’s going on in your brain and heart though, you know? That’s a very different experience. Both vulnerable absolutely but different.

 

[EveHarrington]

And that is unfair.

I don't think it should be that way and it is in life, it should be on a case...

Ok. Stomp your feet and scream.

Life isn’t fair.

Who is going to pay for all that monitoring for every therapist with each and every client?

I’ve read your posts. I really think you should stop paying for your friends and find them organically. Therapists aren’t friends.

 

[joeylittle]

When you’re a nurse, sometimes you’re expected to fill a lot of different roles & a middle of the night ear to listen is on the list of those roles a lot of times. Compassion is one of my greatest strengths & I care about the well-being of each & every one of the patients I take care of & would never do anything outside of the scope of my practice or put someone at risk of harm. Sometimes a little extra compassion & care goes a long way.

Ah - yes, nursing, that makes sense. And, I don't disagree at all with the role of compassion in nursing. Nurses are often the source of real human connection, in a hospital environment. As you said, there can be a profound sense of isolation and disempowerment when being hospitalized. Nurses also seem to always know a lot more about what's going on, as far as the patient's experience is concerned.

I would still stand by my statement, though. A patient in a hospital is in a very different set of circumstances than a client in a therapists' office.

Simply the difference in the number of people on the care team - 1 therapist, v. I'd guess anywhere from 3 - 10 (or more) hospital staff - changes the dynamic profoundly. Therapists see clients generally in a one-on-one dynamic, and it's easy for that kind of intimacy to be put out of balance, if the client is already prone towards seeking that, or the therapist is in need of it. It's harder to set that out of whack with a rotating cast of care-givers - just by virtue of being exposed to more than one person helping with your recovery. So even having that experience that there's one nurse going the extra mile for you - that's one nurse among multiple care-givers. The dynamic is different.

I see new grads come out & they are so rigid & afraid of doing something wrong they lose their compassion.

That's a shame. One can only hope that they eventually settle into the job and find it again.

 

[Deleted member 42665]

Ok. Stomp your feet and scream.

Life isn’t fair.

Who is going to pay for all that monitoring...

You worry about you, I will worry about me, thank you. I was merely stating that rules should not be made simply because of SOME people..... hence my comparison to the dog breed thing.

I would not stop my feet and scream by the way, I'm not a child. Bit of a drastic reaction I'd say.

 

[Suzetig]

Who is going to pay for all that monitoring for every therapist with each and every client?

In the U.K. therapists are required to have monthly clinical supervision from the time they start training throughout the whole of their career, this supervision arrangements monitors what's going on with clients, helps the therapist to understand the impact their work is having on them and helps them take steps to deal with any issues. It's also expected that therapists access personal therapy as and when needed to deal with their own stuff. It's an accepted part of practice and therapists pay for it themselves.

I think it's unfair to criticise someone who wants "more" from their therapist, it's entirely natural that where a relationship is caring, compassionate, accepting that clients may wish it were something more or different than it is. Especially when dealing with relational trauma where the therapy relationship can be both healing and triggering at the same time. It's for the therapist to work with the clients hopes and expectations sensitively in the knowledge that, in time, the client wants will change. That's exactly why therapists need to be clear about the boundaries they hold and why, and when it's ok to have some wiggle room.

 

[BoN-bOn]

I agree @joeylittle , it is different & there is definitely a difference in the level of vulnerability & potential for abuse. I think that some therapists are sometimes the same way though, they are so afraid to show compassion sometimes for fear of being sued or crossing lines that they are afraid to care & that is understandable. I think caring & compassion can be extremely important in healing the mind and body when it is used therapeutically & not used to harm or exploit someone. I certainly have difficulty discerning the difference at times with people given my history of abuse & inability to see when things were not healthy until it was too late. It’s a fine line for therapists to tread between caring enough & not too much. Makes me thankful I’m not a therapist because I’m quite sure I would be on the “too caring” end of things. Lol!

 

[BoN-bOn]

& that’s exactly what happens @Suzetig if it is handled appropriately. My first therapist worked with me after I left a very abusive marriage. She was so kind & caring & sometimes she allowed boundaries to be crossed in order to reach me because I trusted no one. The transference became very strong but eventually, as we worked closely together & I really began to trust her those strong feelings of transference dissipated & it was a different level of trust & respect that I gained from her & my NEED for her lessened over time. It is probably one of the most healthy relationships I’ve ever had in my life. Very healing & l know that’s what is happening in my current relationship with my T as l explore my healing on an even deeper level. & the goal is to carry what you’ve learned from that healthy relationship into other areas of your life. That’s what I meant by saying not all boundary crossings are unhealthy. Sometimes they are therapeutic if handled appropriately & consistently. Consistence is key I think. & some therapists take it too far, then try to change things in the middle of the game...that is when it becomes damaging. Thank you. :)

 

[anonymous]

I guess that’s when it’s up to us or them to decide if more boundaries should be put into place

Professional boundaries are professional boundaries there is no negotiating around them, over them, through them, or making "special little arrangements".

Otherwise the alleged professsionals are just grooming clients to do things outside of what is appropriate professional boundaries as defined the professional ethics as created by a professional bodies.

The long and short of it, is if you can't work within the professional boundaries then you should not be working with traumatised and vulnerable populations as you are not skilled, trained, professional or appropriate, and you are muddying the waters on a forum where the vulnerable populations don't need semi trained borderline unprofessionals who are engaging in highly questionable practices.