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Ethical Boundary Considerations and Repressed Memories of Sexual Abuse
Boundaries are essential for healthy relationships. For therapists, boundaries aren’t just vital for their relationships with family, friends and colleagues; they’re also critical for their relationships with clients.
Therapists must set boundaries both outside the office and inside their sessions. Doing so helps clients "have the most meaningful and healthy therapy experience," said clinical psychologist Deborah Serani, PsyD.
Boundaries keep the session focused on the client and their needs, she said.
For instance, Serani rarely discloses personal information in session – unless it’s helpful for the treatment. "…I might help a client feel less alone by sharing ‘I know what it’s like to go through chemotherapy with a loved one.’ Or ‘I had the same situation happen with that store in town. It’s not just you they were being rude to.’"
Serani also sets physical boundaries. She arranges chairs so there’s plenty of personal space for both her and her client. She keeps the space clutter-free. And she doesn’t hug clients.
"[I]f someone feels the need to hug me hello or goodbye or needs to shake my hand every session, I generally ask what these physical exchanges mean for them. In therapy, expressing words is always better than acting out actions."
Serani only returns emergency phone calls, and doesn’t respond to "messages about incidental things or questions in between sessions." The intent is to empower clients to problem solve on their own, she said.
When psychologist John Duffy, Ph.D, started his practice, he was overly available to his clients. He initially believed that this was the only way to truly help. But it just backfired.
"Because of my disregard for my own boundaries, clients called frequently. I found myself resentful, until a client pointed out that not only had I not set up appropriate boundaries, I had disregarded boundaries all together. This setup was unhealthy, for both me and my clients," said Duffy, also author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens.
Today, he creates clear boundaries and sticks to them. He discusses these boundaries with clients. "I find this to be a gift not only to myself, but to my clients as well."
Below, Serani, Duffy and other clinicians spill additional details on how they set boundaries with everyone in their lives.
They know themselves.
Serani, also author of two books on depression, knows that she’s a sensitive person who has to work at not feeling what she sees. So she sets a firm boundary about how much information she takes in. She limits her time online, avoids news shows and tries not to get sucked into gossip-fueled chitchat.
She’s also "fiercely private," setting a boundary not to reveal too much about herself in conversations.
Joyce Marter, LCPC, a therapist who owns the counseling practice Urban Balance, has always known that spending time with her kids before and after school was a major priority. That’s why she structured her business a certain way: "My business hours are school hours. I have employees using my office during the evenings and weekends so that I can’t compromise those boundaries."
They realize that saying no is really an opportunity.
"I used to say ‘yes’ to everything, because I didn’t want to disappoint people in my life, or I wanted people to like me. Then, I would complain about it," said Christina G. Hibbert, PsyD, author of the forthcoming memoir This Is How We Grow and an expert in women’s mental health, postpartum issues and parenting. Today, she regularly reflects on her needs and priorities.
"I have learned that saying ‘no’ to someone else is really saying ‘yes’ to something that’s more important to me. It’s easier to do this when I’m clear on what really matters to me. And, I am clearer on what matters most to me when I honestly check in with how I feel."
They prioritize their needs.
As a wife and mom of six, Hibbert knows very well that if she doesn’t respond to her own needs, they won’t get met. She typically says: "This is what I need right now. I’m sorry I can’t agree to what you need," or "Yes, I know this is what you wish would happen. I love you. And, no."
For Marter, a big obstacle in setting boundaries is being spread too thin. So she delegates as much as possible. "At both work and home, I delegate the tasks I am not good at, don’t enjoy or don’t feel are worth my time."
She’s found that it’s usually a win-win for everyone. Delegating provides work and learning opportunities for her employees, interns, vendors and even her kids. "It promotes their development and lightens my load."
They remind themselves of the importance of boundaries.
Saying no to someone can trigger twinges of guilt. And therapists also struggle with feelings of guilt. "I have found it hard to prioritize some friendships over others but I have learned that time is precious and best spent with those who fill my ‘cup,’ rather than empty it. I sometimes struggle with guilt around this, but remind myself of the saying, "if you spend your life pleasing others, you spend your life," Marter said.
Hibbert has realized that it’s easier to communicate her needs and set boundaries than deal with "the aftermath of not listening to my heart. My heart never leads me astray."
Psychologist Ryan Howes, Ph.D, has a similar perspective. He said:
It might feel good to avoid the conflict now, but in a little while, when I’m doing something I don’t have the resources for or interest in, I’m going to be miserable, angry at myself, and possibly resentful toward my well-meaning friend.
Better to suffer through a pinch of disappointment now instead of a relationship-threatening gash of resentment later.
They may offer an alternative.
When sticking to his boundaries, Howes is honest and polite, and usually offers an alternative. For instance, if his friend wants to go to dinner, but Howes would rather relax at home, he might say: "Thanks, but I’m bushed and really need some couch potato time tonight. How about lunch on Friday?"
They don’t confuse being needed with being loved.
Some people take on the role of martyr because it helps them feel important and needed, said Howes, also author of the blog "In Therapy." Yet doing so only leaves individuals exhausted, stressed out and depleted. It also breeds codependency.
"If you try meeting your own needs first, including the need for rest and recreation, and then give from your excess time and energy, you’ll find you give better quality with a better attitude."
If you have a hard time setting boundaries, several therapists suggested the Christian book Boundaries: When to Say Yes, How to Say No to Take Control of Your Life by Henry Cloud and John Townsend. It is "an excellent resource for the boundary-challenged, and has helped many people regardless of their religious affiliation," Howes said.
Again, boundaries are necessary for building healthy relationships. They give both people the opportunity to honor themselves and attend to their needs. For therapy clients boundaries help them focus on their own concerns and grow.
Boundaries also are individual, which means that it’s important to know your values and priorities. Then these values and priorities can guide your actions.
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