Let's look at your lifestyle. You develop your own style, your own tempo and rhythm, your own way of thinking, feeling, and behaving, your own sense of personal identity, your own way of life. Ask yourself, do your clients see you as a college educated, fast moving, go-getter who values cleanliness; or as an average intelligence, slow moving person with a free flowing lifestyle?...or somewhere in the middle of these two extremes?
♦ 2 Areas of Incompatibility
Obviously, you react to your client's lifestyle and they react to yours. Incompatibility can result on two levels:
-- 1. The first level of incompatibility is the difficulty you have in understanding and accepting people who are different from you.
-- 2. The second area of incompatibility is the transference of attitudes and feelings from your previous experiences with persons who have displayed similar personality patterns to that of your clients.
Think of a client that has a lifestyle totally different from your work ethic, cleanliness, pace of life, and so on. Next think about the impact of your lifestyle on that client, and how it may affect the goals the client wishes to achieve in his or her session.
2 Levels of Tempo
The first level of incompatibility, that of tempo, is reflected in your lifestyle which can affect the boundary you set regarding timing in your therapy sessions. Timing can be set by your personal tempo by which you live and operate and the effect that it has on your capacity to relate to the client who has a different tempo.
♦ 1. How Rapidly You Speak
Do you feel you move too rapidly or too slowly for a particular client? How often do you have a complete or partial breakdown in the client's inability to keep pace with you? If you work with groups, you can observe this tempo both with individuals and with the group. Thus the first level of tempo is how rapidly you speak.
♦ 2. Setting Boundaries Regarding Unfolding Information
A second level of tempo is setting a boundary regarding the unfolding of information. How quickly do you present certain information or perspectives to your client? Let's look at this boundary as it relates to an out-of-control client in a crisis situation. Even the most out-of-control affect cannot last forever; in fact, it usually cannot even sustain itself for a whole session. Consequently, depending on the amount of time left in a session, the first approach to apparent loss of emotional control is the boundary of tempo and to let the emotion play out, as long as it is not destructive to the client. Obviously your boundary-of-tempo changes if the client threatens you physically or starts to destroy property.
3 Steps to Setting Boundaries with Out-of-Control Clients
In the situation of out-of-control clients in a crisis situation, my internal feelings tell me when to start setting a boundary. How I set this boundary is by asking the client to focus on me. I state:
-- 1. "I need you to look at me," or "to look up," etc.
-- 2. Next, I talk about any behavior connected to the affect. I say, "I want you to stop pacing now; Please sit back down." In setting this boundary I lower my voice significantly and speak much more slowly than usual, but with emphasis. Thus, I use tempo to set a boundary.
-- 3. Once the client has stopped the behavior, I sometimes focus on their breathing. If it is appropriate, I say, "Let's get your breathing back to normal. Follow my lead." This joint rhythm of breathing is maintained until the client becomes calmer.
All along I try to remain as aware as possible of my own body language, which I find is most effective in reinforcing this boundary if it expresses calmness.
For my client who loses control on a regular basis, I find setting this boundary with a structured and predictable sequence of interventions and statements is helpful.
Peer-Reviewed Journal Article References:
Drum, K. B., & Littleton, H. L. (2014). Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations. Professional Psychology: Research and Practice, 45(5), 309–315.
Kir-Stimon, W. (1977). "Tempo-statis" as a factor in psychotherapy: Individual tempo and life rhythm, temporal territoriality, time planes and communication. Psychotherapy: Theory, Research & Practice, 14(3), 245–248.
Pinner, D. H., & Kivlighan, D. M. III. (2018). The ethical implications and utility of routine outcome monitoring in determining boundaries of competence in practice. Professional Psychology: Research and Practice, 49(4), 247–254.
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