NOTE: THIS COLUMN WAS ORIGINALLY PUBLISHED IN BINAH'S THERAPY: A SNEAK PEEK INSIDE
Listen to me.
You may find yourself in this scenario.
For months you have been miserable. Maybe years. You have spoken to friends, confided in mentors, consulted with rabbis, and vented to sisters. And you just couldn't seem to feel better. So you let your husband, your friend, your rav, even your own dear self, convince yourself to try therapy. And you do. And, it must be a coincidence, but within a few weeks of beginning therapy, you are actually feeling better. Like I said, a coincidence. Probably nothing at all to do with therapy; but okay, you will continue with therapy because just in case it's therapy actually that's making you feel better.....
But not only is therapy starting to bug you, the therapist is beginning to bug you, too.
You feel stupid paying her just to talk to her. I mean, can't you just talk to your sister?
And you hate the way it's exactly fifty minutes a session and as soon as that stupid clock ticks and tocks onto the fiftieth minute of the hour, your therapist tells you that time is up. Like, why can't she just let it be an hour, or an hour and half?
And it annoys you that you can't just call your therapist any old time you want to. I mean, you could; but it feels weird because you usually pay her so you feel strange if you call. And anyway, what exactly are you calling about? It's not like you can schmooze with your therapist. She's not your friend or anything.
You are not even sure what she is. Okay, she's a therapist. But what does that mean? And what's with all these boundaries?
If you are in therapy, these questions sound familiar. And if you are not in therapy, then you may have been wondering about the same things. Or if someone you know or love is in therapy, you may not understand these boundaries, and would like to understand so you can be more supportive.
Therapy is very different than any other relationship, even other helping relationships, because of its set of boundaries. These boundaries are about paying the therapist for each session. It's about how long each session is, how to manage out-of session contact between therapist and client, and the consistency of appointments. Boundaries manage client's request for physical touching/hugging, monitor therapist's self-disclosure, and maintain confidentiality. There may be other boundaries, but these are the main ones I will explore in this column.
Therapy works to relieve a person's symptoms that bring him into therapy to begin with, in ways that talking to a friend, sibling, or rav fail to help. It's because of the boundaries of the therapy experience, so different than the boundaries in a friendship, within family, or as a constituent of a rav, that a person finally finds relief from the the burden of pain, anxiety, or depression they have carried for months, or sometimes years.
If a therapist would not charge money, would not abide by the constraints of the therapy hour, the need to identify boundaries of contact outside sessions, and to maintain confidentiality, then therapist would be the same as the other helpers that did not help.
The therapy hour is an experience whose effects spreads over the week. It is not isolated to the single fifty minutes in which the client and therapist meet. It creates a disequilibrium in the client so that positive change is forced to happen.
Everything that happens in the therapy room is significant.
And that is why the therapeutic boundaries are so crucial. They keep the client safe while therapy does its work.
A therapist that keeps a client overtime past the session, or cannot create/maintain appropriate boundaries of out-of-session contact may be sending messages like, “Your problems are so terrible, I must help you more,” or “Only I can help you, so I will give you more time,” or “Your problems are so huge, you can't possibly manage them by yourself, so I need to give you more time.”
Boundaries of space and time and payment and touch give a powerful and positive message: “You are capable of doing the work you need to do to feel better, and I am only a temporary facilitator.”
It would be inappropriate in most cases for a therapist to meet a client in any other venue except for the therapy room, except where therapy is otherwise established (i.e. if a client is anorexic, therapy may take place in restaurants or other such places). A therapist would not invite a client to her home, attend her simchos, or spend an inordinate amount of hours together, even if there is payment for those hours. Touching or hugging a client is generally not appropriate, nor is a therapist's self disclosure. When a therapist self-discloses, it must be very carefully assessed if the information being disclosed is therapeutically necessary, or sound. It can never be for the therapist's aggrandizement or personal needs.
When a client pays a therapist, it forces the two to acknowledge that even though the therapist has chosen to go into this field from a desire to help; it is still a job, and is the responsibility of the therapist to do her job. If the job is not being done satisfactorily, there must be constant assessment of why, and how the client's needs would be best met. There are treatment goals and objectives; this is not simply two friends, or a mentor and disciple meeting once a week to talk. Payment makes that very clear. Foregoing payment blurs this understanding of the roles of client and therapist.
As a therapist, I know that a client struggles with her feelings of weirdness that she must pay to talk to someone, when she can talk to her friends for free. So when a client shows discomfort, or resistance, or anger at the reality of this and other therapeutic boundaries, I find it important to acknowledge them, even if the client is unable to process the reasons why they exist.
Of course, therapists are human (surprise! Surprise!), and sometimes we make mistakes with boundaries. And sometimes in our humanness, we also sometimes break boundaries. And yes, we will go over the fifty minutes, and we will take a reduced rate, and we will accept a call in between sessions, and we will accidentally self-disclose.
And if you want to know the truth, here it is: Sometimes we are really enjoying your company and wish we can spend another hour with you, and sometimes we wish we can hug you, and sometimes we wish we can see you for free, and sometimes we wish we can self-disclose and let you know how we really understand your pain because we have been there, too.
But because we care, the greatest gift we can give you is to keep you safe within the therapeutic boundaries and experience so that in time, you will no longer need us.
My book, Therapy, Shmerapy, can be found in bookstores or online