How Close Is Too Close For Therapists And Clients?

[joeylittle]

I don't believe that these sessions of texting are out of line. It does not at all look like what you are describing. It's teaching and supportive and it helps me make progress in my life. So I'm ok with it.

I have a slightly different perspective on this - if it's useful, great - and if it's not, no worries.

When these conversations about contact outside session come up, DBT always comes to mind. In 'classic' (Linehan model) DBT therapy, the client is encouraged to contact their therapist for support as often as they need. There are a few things that are considered inappropriate; most contact is encouraged. And for the particular aim of that particular therapeutic modality, the contact is a good and necessary part of the big picture.

In other words, it's very possible to have forms of between-session contact that are well-defined and therapeutic.

Whenever you have questions about it, @Frenzy3674 - I'd strongly encourage you to bring it up. If you haven't talked with your therapist more about her "can blur the lines" comment, you should; if for no other reason than it will continue to help the both of you understand the nature of your between-session contact, and where the boundaries are.

I have a particular caution about texting, though. It may not be applicable in your situation, but it's something I think anyone who texts with their therapist should be aware of.

There is an immediacy to texting that can be very reassuring. The flip side of that, we all know, is waiting for a text...which can be agitating. You need to always be aware of your expectations in a texting relationship, and if it's your therapist - make sure that your expectations aren't going to inadvertently do damage to you or your end of the relationship. For example, if your therapist habitually texts you to check in a few days after a session...what will your response be when they don't? Will you be OK, or will you experience anxiety?

The upshot of that is - if you think you'll get anxious, it's important to tell the therapist that those follow-up texts are important to you; and, if for some reason they were to stop doing them without discussing it, you'd have a bad reaction. Saying this out loud helps clarify, for both you and the therapist, what your expectations are. Ultimately, there's going to be a time when those texts stop coming; that will be a conversation as well; something for you to navigate, with their guidance.

Semi-related: In the US, there are a few ethics guidelines for therapists as to how extra-therapy (dual-role) relationships with clients should be navigated, per the APA (American Psychological Association).

3.05 Multiple Relationships

...A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person..., or (3) promises to enter into another relationship in the future with the person...A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists. Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

Link Removed

I also find it interesting that there's a 2 year 'gap' required between ending therapy and beginning a sexual relationship with a former client...and that such a thing should only occur under extraordinary circumstances. I'm curious as to how they arrived at 2 years...?

Anyway - it's the responsibility of the therapist to know what they are/are not capable of, in terms of managing dual-role relationships with their client, and also for being always cognizant of the 'do no harm' mandate. If excess contact with a client outside therapy stands to ultimately do damage to the client, then it's their responsibility to put limits around it.

While the client does not technically bear any responsibility in this - I'm always an advocate for clients to talk about anything and everything that might be affecting the relationship in-session. Therapists are human, they aren't all perfect, and they do make mistakes. Your willingness as a client to speak up about your experience of the relationship, and your expectations, is part of how both of you can avoid making the kinds of mistakes that end up seriously undermining the real reason you are there: the therapy.

 

[Frenzy3674]

I have a slightly different perspective on this - if it's useful, great - and if it's not, no worrie...

We have actually discussed that two year rule. She said it's for the protection of the client but is uncertain as to how it was decided.

 

[Suzetig]

I think the 2 year thing is intended to demonstrate that a significant period of time has passed, so that any potential exploitation or dependency issues have been resolved rather than it having any clear clinical significance.

I agree with @joeylittle that in some cases some degree of between session contact can be helpful. For me, it needs to be initiated by the client, for a clear purpose and limited - rather than lengthy back and forth exchanges. The other way it can be helpful is when it's agreed in advance with clear understanding about replies. For example emailing thoughts to your T with an understanding that they will acknowledge your email and bring it for discussion.

I do worry when folk say their T is more like a friend, that their T initiates chatty, friendly contact or checks in with them daily because that feels less boundaries. Part of the work in therapy is learning to trust in a boundaried relationship, so friendly contact might help make it easier to open up - because it's just like talking to a friend - except your T has a professional role to fill. Professional boundaries may make it harder to open up but I tend to think those barriers are there for a reason and need to be worked with openly - it may take time to be open with T and it may be ok.

The danger with T appearing to offer friendship to get the client to open up is that it mirrors the dynamic in many abusive relationships where the client may have been groomed into thinking they were in a close loving relationship which actually was about exploiting or abusing them, often without them realising it until the relationship ended or went wrong. Hence the Ts responsibility to be clear about dual relationships and to be sure that any dual relationship isn't going to harm the client.

Clear communication about communication and it's meaning is important in therapy, it's part of the work and helps stop clients feeling taken advantage of.

 

[kilted]

There is a difference between types of therapy...... how the therapy is done.

Psychodynamic therapists tend toward zero/minimal self-disclosure and sometimes don't say much at all in the therapy session. I would suspect that the numbers of psychodynamic therapists who have friendships with their clients would be low as this type of therapy centres on the therapist remaining a blank canvas for the clients projections. Likewise Transactional Analysts using their contract based approach where everything is made as explicit as possible are less likely to get enmeshed.

Relational/Person Centred therapists on the other hand are probably far more likely to get entangled in friendships with clients as the relationship between client and therapist in the room is the meat of the therapy. The use of the therapists counter-transference, means the client may well experience an intensity of relationship, openness and sharing that has never happened before. Add to this relational therapy's encouragement to therapists to work on the edge of what is acceptable self-disclosure, and relational training establishment purist approach that places the relationship and the therapists ability to heal the client purely through the power of the therapists presence "in relationship" at the centre of the process and you have a powerful and potentially explosive process.

I wouldn't be surprised if the majority of the therapists mentioned in these threads about boundaries are Person Centred or Relational, I would also suspect that they were not in supervision or personal therapy.

Having experience Person Centred and Relational therapists I would avoid them for trauma work.

 

[Suzetig]

Actually I think you'll find here it's the opposite. As far as memory serves me, folk who have posted here with boundary issues have invariably been working with psychodynamic therapists, although you're right about the lack of appropriate supervision.

Person centred therapists don't tend to work with transference/countertransference as a rule - purists will work with whatever comes up as belonging to the therapeutic relationship. Healing in person centred therapy is achieved in a therapeutic relationship, yes, but it's the clients propensity to towards healing not the therapists presence that makes the therapy effective.

The difficulty with psychodynamic therapy is that it retains the therapist as the expert and maintains a power inequality that can be very challenging for client and therapist alike. What I've seen happen here and elsewhere is a therapist struggling to hold boundaries, thinking they can manage strong feelings, transferential or otherwise without support and supervision and then getting in over their head. Not always, and I know some great psychodynamic therapists but the power imbalance has the potential to cause difficulties.

I disagree about your view of person centred therapy being inappropriate in working with trauma, my therapy pist is person centred and has done brilliant work with me. There's a growing researched evidence base in relation to person centred therapy in relation to trauma. Being used to using yourself in the clients therapy gives a good grounding in managing complex boundaries which comes into its own in working with trauma.

I think all therapy modes have their place, and some will suit some people more than others. It's also fair to say there are good and bad in every profession and in every modality, but your assumptions about person centred therapy being less boundaried is erroneous.

 

[joeylittle]

Psychodynamic therapists tend toward zero/minimal self-disclosure and sometimes don't say much at all in the therapy session.

I think you mean to say psychoanalytic, as in traditional psychoanalysis. Psychodynamic is what developed from a need for a more practical, guided form of traditional analysis. The main difference is, in psychodynamic the relationship between the therapist and the client is specifically cultivated by the therapist in order to facilitate all sorts of things, including transference. In traditional psychoanalysis, the therapist is much more careful to only function as a record-keeper and observer, not as a participant in the client's process.

(that's all just basic-basic layman's terms).

 

[Parley]

I think therapist are trained in head games and I have no interest in playing. I pay a therapist to listen. I need a release so at this time~ anything beyond listening is too close for me. I believe firm boundaries are necessary in every relationship.

 

[Riot]

I want to preface this by saying that I'm not saying that anyone or any post is right or wrong here.

But, I find it peculiar that everyone's been targeting the fact that the OP's therapist brought up a blurring of the lines in the 'relationship' so to speak. It doesn't seem to occur to anyone here that this could be a form of working the transference and counter-transference going on. Transference and counter-transference are not black and white, just like nearly anything else. Sometimes they can even be good and beneficial to explore them in a real time context.

Context is really, really important here. It doesn't sound like the OP is going to be ending therapy any time soon. This doesn't seem like some end-game priming or grooming. It seems, to me, like a therapist admitting counter-transference, bringing that counter-transference to the table as it should be, and hasn't been fully explored yet.

What I'm trying to say is, there is simply no way of knowing what is going to happen yet. I'm not in any way trying to say that everything is peachy, or that the OP should go in without the knowledge provided by those concerned, but I do think that labeling what has been described (as seen in the urgent context as it has been in some of these posts) is jumping the shark quite a lot.

 

[ms spock]

A week ago I read one post where she and her therapist actually became friends and their husbands became friends too... the therapy had to discontinue of course... it sounds to me like you would want to tear that friendship apart - simply because of the way they met?

Do you actually mean to tell me that you think it is okay that a client goes to a therapist, and the therapist stops therapy, after a short time, so she can be friends with the client? You don't see that as a breach of professional practices? You don't see a power imbalance? You can't see the potential for abuse of power?

This was the thread that the husband is really concerned at how the friendship evolved and says to her that she is too vulnerable to the "prior" therapist? The husband is challenging her over the relationship and how it began?

 

[ms spock]

This thread is obviously triggering for you,

You are free to make that assumption, but it is your assumption.

If you post on the forum - people will respond. If you don't want responses that disagree with or contradict your opinions, or challenge your ideas, then perhaps private message with people who agree with your points of view.

 

[Riot]

You can't see the potential for abuse of power?

I can see the potential for abuse of power from my husband, my parents, my teachers, police officers, bartenders, homeless people... the list goes on. Yes, there are regulations, etc., but as history has shown us, that isn't always the cut and dry for every single person alive. I can't personally judge their friendship because I don't know the full story. Even if I took it for what it was exactly from the information provided through text, it leads to the same idea.

I hear ya lady, I just think it's not so black and white like you're projecting. I don't think R was trying to start anything with you, either. You've been doing fantastic with your self compassion and grounding, please don't get worked up. I am saying this as someone who is always delighted to see messages from you. :inlove:

(Also, information is power, and you've provided a great deal of great information!)

 

[Rumors]

You are free to make that assumption, but it is your assumption.

If you post on the...

I don't have an issue with difference of opinion, however you picked apart every post that you felt applied to your meaning and then told us how wrong we all were. I clearly stated that I understood the boundaries were professional yet you chose to apply your traumatic history to my situation hence the reason why I see it as triggering for you. Perhaps you need to examine that a little harder...