Boundaries are needed in therapy, but we should also consider what we are walling out
Like all relationships, boundaries are necessary in therapy. When I consider navigating boundaries as a therapist, I often think of Robert Frost’s poem “Mending Wall,” best known for its line, “Good fences make good neighbors”:
“Before I built a wall I’d ask to know
What I was walling in or walling out
And to whom I was like to give offense…”
As Frost suggests (laments), it’s best we understand what we’re walling in or walling out.
Therapy generally invites all of the patient in. There are some required exceptions: Violence and certain kinds of extreme speech aren’t acceptable, clothes are to remain on, and many or most wishes and fantasies shouldn’t be expected to be met (though should be freely shared). On the therapist’s side, privacy and autonomy are important—not just as rights but as limits to facilitate what therapists call “the frame.” But just as in the case of Frost’s wall, therapists should strive to build a frame that can contain as much of the meaningful parts of patients as possible.
The challenge of boundaries became even more pronounced (and discussed) during the pandemic
The pretense of disinterested therapists, holding themselves back and only bringing their “work” self and “doctor” persona to the relationship, was always a fiction. During COVID, though, boundaries became even more complicated due to the new(ish) realities that the pandemic suddenly had sprung on therapists.
The challenge of boundaries was not new to 2020 but came to the forefront of discussions in therapy (and then worked its way further into common discourse as so often happens with language common in therapy). This happened for a few reasons: First, during the pandemic, therapists were subject to the same fears and adjustments as patients. Even while therapists held onto their mandate to prioritize the fears and vulnerabilities of their patients, there could be no pretense of hiding that we, therapists, were ourselves scared.
The second big adjustment was that patients and therapists were suddenly in one another’s homes, albeit remotely. Therapists and patients were both subject to the much talked about (and often humorous) intrusions of toddlers, pets, and spouses. There was an intimacy to this—one that invited in possibility but also felt to many therapists like an understandable encroachment.
Therapists cannot avoid both being and feeling exposed in the process of therapy
As COVID has become less of a concern, many therapists have still remained fully remote. This is due to many reasons. One that is for the most part unspoken is the reality that new therapists emerge into the field unprepared for just how intimate the work is and how much of themselves they need to bring. In order for therapists to receive the whole selves of their patients, therapists themselves must both be and feel exposed. This is terribly hard for a therapist even in the context of incredible training and supervision.
Therapy, even when organized around a proper frame, invites all kinds of feelings (often called transference) from patients. In good therapy, patients get angry at their therapist, idealize their therapist, are overcome with curiosity about their therapist, and develop strong sexual feelings. The therapist experiences these things toward their patient too. Of course, in many cases, the “rules” about which of these feelings are discussed in therapy aren’t aligned. Most things are on the table for patients to share with the therapist; many are not in the other direction. Either way, these experiences are highly exposing for both the patient and the therapist.
Rigid boundaries too often keep out that which is vital to making meaning in therapy
To be clear, this is not a diatribe against all boundaries. Therapists should hold parts of themselves back (both for the sake of their privacy and for the sake of the therapy). Yet, the boundary too often keeps out that which is not only part of the therapy but essential to therapy. The most challenging of these for patients and therapists alike are love and hate, conflict, sexual feelings, attraction, bodies, tension, and bad feelings. These are hard to be with, hard to see in others, and hard to have others see in us. In most professional engagements, the rules that govern proper discourse seek to render out most of these experiences. You don’t tell your dermatologist that you’re attracted to her or share with your accountant that you find his voice shrill. And that seems for the best.
Therapy, though, should invite in the whole person. Therapy trades on the idea that the therapy relationship itself is part of the therapy—that we find in others and therefore, in our therapist the hopes, dreams, likes, dislikes, frustrations, and fantasies that we’ve found in other relationships, that exist within ourselves. The danger, as with a fence, is that we keep out some of the very parts of our neighbors (our patients) and ourselves that are vital to making meaning in the therapy relationship.