How Close Is Too Close For Therapists And Clients?

[BoN-bOn]

Omg! If you’re a nurse I think (personally) that’s completely different! My God, who doe...

Thank you @UnicornSightings! Also remember that those with histories of trauma, when their stress cup is full (like when they are hospitalized), often feel the pain of everything all at once...many times it is the emotional pain that is the hardest for them. Something I know I’m all too familiar with. I’ve heard a lot of stories of heartbreaking trauma when patients just need to talk & get things out. & sometimes it is the most difficult patients who reveal the most painful stories. There are a lot of traumatized & hurting people in the world. I think a lot more than we realize sometimes. Sometimes I wish I had a magic wand to take away all of the pain, but until I find that wand, I will care & do my best to let them know they matter & are important to the world. & give them their pain meds on time. :)

 

[Suzetig]

Professional boundaries are professional boundaries there is no negotiating around them,

In therapy, I disagree. My T is very professional, experienced and has very clear boundaries. There have been occasions where she has crossed traditionally held boundaries - there's been clear thinking behind it and each time it's helped our relationship. I'm not being groomed nor am I dependant on her.

The other thing to bear in mind is that different modalities of therapy have very different approaches to boundaries. In classic psychodynamic therapy boundaries are very tight to promote transference, in client centred therapy boundaries tend to be more personally negotiated in the relationship and in CBT things tend to be more manualised depending on formulation. So when you refer to professional boundaries and ethics, what are you referring to because different theoretical approaches think differently and even registering bodies can't agree on commonly accepted clear boundaries other that not having sex with the client, which is always a no.

 

[Friday]

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

Professionals boundaries in psychotherapy = (mostly) Protection of the client
Professional boundaries in medicine = (mostly) Protection of the doctor/nurse

When a doctor or a nurse is crossing boundaries it’s nearly always good for the patient & bad for the MD / RN. It’s causes burnout, compassion fatigue, mental breakdowns, and a whole host of personal problems due to insane stress & coping mechanisms that increasingly fail to do the job.

Which is a large part of why the two paradigms don’t compare very well.

 

[Butterflies2023]

No. I cracked a joke that we should text in session because it's easier. She said we aren't supposed...

I just saw this thread. How is the relationship today?

 

[Stephernovas]

No. In a helping profession, you need clear boundaries. There are many risks, including favouritism. If you do something for one client, it’s hypocritical and unprofessional to not treat the other the same. As well, considering the clients state, blurring/crossing boundaries can cause more harm than good. Regardless of what helping profession (nurse, doctor, therapist), you need boundaries. What would happen if you stayed 20 min extra to talk to one patient per shift. Well, another patient sees that and wants the same extra care - outcome = bad review, distrust, as well, the helping professional is now overworking them self.

These are just small snippets of examples of why it’s not a good idea to mix this kind of work with friendship/pleasure. If you two are dying to be friends, then get a new therapist. I know from experience (not with a therapist), that although you may believe you can maintain boundaries, the other person may drop the ball and trip you up..HARD.

 

[Emotional girl]

I do think that boundaries is one of difficult things in therapy.You have two people who are working really close together and I think that some kind of feelings are bound to come to the surface whether they be negative or positive and it is down to the therapist to keep the boundaries in place.
I would say that I am really quite close to my psychologist and we probably could be friends outside our sessions but for me it is really important to have the boundaries in place as it means that I can trust him and I feel safe with him as I know he will not hurt me .
I suppose different things work for different people but I think boundaries are there for a important reason.

 

[Deleted member 12723]

I benefit and love the fact that there are very clear and firm boundaries with my therapist and I find it makes it so much safer for me. I could not do what you do texting her in a friendship capacity outside of her office. If that was offered to me I would then feel very uncomfortable and perhaps begin thinking about getting another therapist that did not blur the boundary lines. I am not saying that what you are doing is wrong or bad you are the best judge of what works best for you. Good luck

 

[scout86]

. If you do something for one client, it’s hypocritical and unprofessional to not treat the other the same.

I think that depends on what you're talking about. Since all clients aren't the same, and don't have the same issues, sometimes it doesn't make sense to treat them the same. For example, you may have one client who's self reliant to the point that they find it impossible to trust anyone else to help them. Ever. And you may have another who has learned that they are helpless to solve their own problems and they must always rely someone else. Probably, neither of those view points are totally accurate and neither of them are in the long term best interest of the clients. I think you'd have to deal with those people differently. One possible difference might be where boundaries are on contact between sessions.

 

[Stephernovas]

Now you’re just getting technical

 

[scout86]

How do you mean that?

 

[Stephernovas]

You are referring to therapy needs vs. boundaries now. Boundaries are the same with all clients. Yes, some clients will need to touch base with the therapist more often than another, or what have you, but at the end of the day the professionalism is still there. The client who needs to touch base more often isn't going to be allowed to go shopping with the therapist simply because she is currently isn't able to manage.

Given the contract/agreement you and your therapist signed when you began receiving services, as well as their regulations, they have you in a vulnerable position which they need to be careful with and respect. Everything they do must have a therapeutic rationale. Reputable therapists usually are registered. This means there is a code of conduct for ALL therapists. There are specific timelines as to when (with consent of the client), a therapist can cease being said person's therapist, and solely be their friend. I'm not saying being friends with them can't be a thing, but having dual relationships is pretty risky (again, unless appropriately employed. Then it can increase clinical effectiveness and therapeutic outcome).

 

[whiteraven]

Regardless of what helping profession (nurse, doctor, therapist), you need boundaries. What would happen if you stayed 20 min extra to talk to one patient per shift.

While I agree that all professionals (and not just healthcare professionals) should have boundaries, I disagree that they should all be the same with each patient/client all of the time. I've been a charge nurse on a psychiatric unit. That unit was divided into "secure" - for the patients who needed to be more closely watched - and "open." It was common to spend 30 or more min with a patient on the secure unit and a little less with one on the open unit. The former required more individual time and attention, whereas the latter often engaged in more group activities.

I think @Suzetig's comments are relative here, as well.

The other thing to bear in mind is that different modalities of therapy have very different approaches to boundaries. In classic psychodynamic therapy boundaries are very tight to promote transference, in client centred therapy boundaries tend to be more personally negotiated in the relationship and in CBT things tend to be more manualised depending on formulation.

Several years ago I saw a psychoanalyst who never spoke in therapy, to whom I never emailed or texted (although to be truthful, it was before all that was popular, but he would not do it now), and who I knew nothing about personally, except what kind of car he drove. Now I see a therapist who is also a Buddhist priest, about whom I know quite a lot, with whom I email every week (because it enhances my progress in therapy), who invites me to take part in his classes, and who I feel pretty close to.

There are boundaries in the latter relationship, but it is more laid back and open. Without the opportunity to have that kind of a relationship with a therapist, I would never be able to develop trust and I likely would be dead by this point.