NOTE: THIS ARTICLE WAS ORIGINALLY PUBLISHED IN BINAH MAGAZINE'S COLUMN A SNEAK PEEK INSIDE AS A RESPONSE TO AN OUTPOURING OF LETTERS GENERATED BY THE PREVIOUS ARTICLE BOUND TO HAVE BOUNDARIES (ALSO ON MY BLOG) 

If I would have known what an outpouring of mail and phone calls my article Bound to Have Boundaries would generate, I would have hired a secretary!

Instead, I read through all the mail on my own, took careful notes, and now write this follow up in response to all my eloquent writers whose letters raised so many questions focusing on nuanced issues of boundaries between client and therapist. Even though I feel I had addressed all of them in my original column article, perhaps the conciseness of the column (in which I am allotted only a certain amount of words) prevented full clarity. So here goes.

I love the way one writer wrote, “I believe that boundaries, as with all other concepts, must be set with good sense and compassion.” And I am so glad that we share that sentiment.

It is possible that some readers thought that boundaries means to strictly adhere to contact only within sessions. Not at all. As a therapist, my clients have my email address, my cell phone number. They can call, email, or text. But there are no violation of boundaries when they do so because these in-between-session contacts are already embedded in the therapeutic structure. I will clearly delineate these boundaries by saying something like, “If you need to, call and leave a message. I will call you back when I have free time, although it may not be for a few hours.” I may say, “If you text me, I can answer quicker, but I do not do text conversations other than to set up or change appointments.” I will encourage journaling throughout the week and say, “Email the stuff so I can read/print it out before you come.”

Sometimes, when I know a person needs more frequent contact than I have time to give, I will say, “Call and leave a message. I won't answer it but you will know that I have heard you.” Often that knowledge is enough.

And I would follow up that statement with, “And if really need to reach out, tell me that specifically in your message so I can call you back.” And usually that knowledge of my availability is also often enough to hold a client in-between sessions. Because if leaving a message or email is not enough, a client can help me know what she needs and we can build a new structure, that will have its own set of boundaries.

So it's not that therapy must be rigid; not at all. Each therapeutic experience and relationship is unique. The needs of each client is unique. We create a new therapy for each client. What remains the same is the need to build in boundaries within the individual structures.

If a client is struggling with maintaining boundaries (she needs to call endlessly, texts endlessly, checks out where the therapist lives), then it just becomes another piece of therapy; grist for the mill, as Dr. Irwin Yalom calls it. Nothing more or less. But if a therapist cannot maintain the boundaries, then the structure and safety for the client has been compromised.

Therapist self disclosure seems to have generated much controversy.

There a few types of self disclosure. Disclosure about therapist's training and background relevant to practice, disclosure about therapist's life outside of the therapy room, and disclosure in the here-and-now of the therapeutic session.

Rule of thumb is that a client has every right to request information about the therapist's training, theoretical orientation and method of doing therapy and expect a clear answer about anything related to those. I personally feel that a client could ask a therapist who her supervisor is, with which rav is she sho'el eitzah, and the contact information of the licensing board to which she is answerable to in case of questionable practice. Every licensed therapist is under the jurisdiction of a licensing board to which clients can formally lodge complaints should a therapist act unethically.

A client should be able to ask how a therapist practices and continue to demand answers throughout therapy. The therapist should absolutely be able to answer a client's questions intelligently. Not just say, “The more you talk, the better you will feel.” She should be able to clearly explain her theoretical orientation, modalities and interventions she uses, and explain the rational behind her methods. Although therapy may look like a just talk kind of thing, there are many ways to practice therapy responsibly that are evidence-based techniques and theories.

A client can ask a therapist any question she so pleases about the therapist's private life. Because the therapy room is a place for the client to say whatever she wants. Nothing is forbidden.

It is the therapist's prerogative to either answer or to decline answering. My personal preference about answering client's questions is to usually answer if I don't mind doing so, and then follow up either then, or file it away for a different time to explore the client's motivation and need to ask. If I don't want to answer a question, either because I feel it is not appropriate to reveal, or it would not be helpful to the client, I will be honest with my reasons for withholding.

When I will self-disclose without the client's request to do so, I will do it usually for the one simple reason. To break the client's isolation. I, too, I share with some of my teen clients, had been lousy at math in high school, even almost failing geometry in tenth grade.

I too, I may tell adult clients, struggled with toilet training my child.

I will usually choose self-disclosure that is not a present issue for me as I do not want to burden my clients with my troubles. That would not be fair to them as it would a terrible breach of boundaries.

Sometimes, my self disclosure is simply to reveal myself as human. And within that humanness to form a connection to a person who badly needs to feel the caring of another human beside him who is not so different in many ways. So yes, I may say that I love writing or vanilla ice cream with colorful sprinkles, same as they do. Or explain that I must reschedule an appointment not because their lives and problems are inconsequential or inconvenient to me, but because I must attend my child's PTA conference that evening.

I use my judgment when I feel it would be beneficial to give my client a reason for my rescheduling and when it is simply okay to just say, “I need to reschedule. When would be another good time for you?”

But simply to engage in small talk about myself? No. Absolutely not.

Everything in the therapy hour must be purposeful. So if a client may need small talk to create an opening to talk about the big stuff, the small talk must be purposeful and is laden with meaning as well. Self-disclosure as a means of small talk is unacceptable, in my opinion.

The last type of self-disclosure is one I use when I work in the here-and-now of the therapy session. It's letting the client know what is happening in the therapy room with me as I feel it and see it. What I am thinking or feeling in response to what is happening between us. It's something like, “I feel that you are disappointed in me somehow. Maybe it's because you feel I am not doing a good enough job in helping your anxiety go away.”

Such self-disclosure usually allows the client to relax that his thoughts are not forbidden, and it's okay to criticize me, to let me know what is not working for him, and what he needs from me to get better.

Sometimes I will say, “It feels to me that it's hard for you to like me so much. And instead, you get angry in this room. Like you did right now, when you turned your face away from me as you spoke.”

Some clients may think that if a therapist stays overtime in session, is available at all times, lets the client call indiscriminately, and engages in conversation about her family, her troubles, or her interests, it is a sign of her caring.

I would say unequivocally these boundary violations that are not within context of anything I have written in this article are more a sign of the therapist's own issues, incompetence, and failure to care.

When a therapist cares about her client, the client knows. And if the client does not know, then chances are that part of the client's reasons for coming into therapy is the difficulties she or he is experiencing in interpersonal relationships and other boundary violations in his life outside of the therapy walls.

When boundaries are violated, a client usually can feel something is wrong. But the love-like relationship is so strong, it's hard to break out of that cycle.

The greatest caring a therapist can demonstrate is how to protect one's boundaries so that true interpersonal relationships can exist and flourish. Including the therapeutic one.

My book, Therapy, Shmerapy, can be found in bookstores or online