Why psychotherapists must remain vigilant about boundaries
Despite training, supervision, and ethical guidelines, psychotherapists—like all human beings—remain vulnerable to lapses in judgment. At best, these take the form of clinical misattunements. At worst, they can result in serious boundary violations with lasting harm. Understanding the structural and psychological functions of boundaries is essential to safeguard both therapist and client.
Clients come to psychotherapy principally to work on their relationship with self and others. Usually these relationships are not working because of dysfunctional patterns that are learnt in childhood and repeated in adulthood.
These patterns invariably also show up in the relationship with the therapist, also called transference. The client transfers onto the therapist their past relationships and acts as if in the past with their family of origin. This manifests in a number of ways, and it is the job of the therapist to point this out and work with it – also called ‘working through’.
Awareness of how transference plays out both in therapy and in the client’s wider relationships is essential to stopping or reducing these unhelpful and dysfunctional patterns so that the client can live in the present and relate accordingly, instead of acting as if they were still back in the traumatic past.
Regardless of whether the therapeutic approach is relational, behavioural or analytic, understanding how transference shapes the therapeutic relationship is essential, and an ability to work with it is key in addressing the root causes of the client’s relational issues. Alongside transference, therapists must attend closely to their countertransference—the emotional and bodily responses elicited by the client. These responses can be fertile ground for insight or, if unexamined, a pathway to boundary violations.
Hence the importance of tight professional and ethical boundaries which can contain reenactments (repetitions) of the past in the present, and a framework which enables the client to work through painful losses, stuck belief systems, and destructive behavioural loops.
Failure to notice how the past manifests in the present can lead to all sorts of reenactments of the client’s past in the relationship with the therapist which can in turn lead to ethical breaches, poor therapy, and conduct which is unprofessional and harmful to the client. Here are some common examples:
How dual relationships undermine safety, blur roles, and risk psychological harm
Therapist enters into a personal or business relationship with their client. This is one of the most serious ethical breaches, the main source of complaints and the most harmful scenarios in a psychotherapy relationship. Clients are not supposed to gratify the therapist in any way, be it through a professional relationship other than the therapeutic one, or in a personal way through a romantic, sexual or friendship liaisons. Of course some situations are more harmful than others, but all entail a crossing of boundaries from which there is no return.
The moment these boundaries are crossed, the therapy has ceased to be helpful and has become harmful. Whether this takes place during the therapy or after it has ended has equal damaging consequences.
It is the job of the therapist to protect the work and treat the client as someone who is seeking the help and support of a professional who is safe, boundaries and professional. The therapist is in a position of power. Therefore these boundary breaches are an abuse of their power.
Therapeutic relationships should always remain as such and the boundary held during and after the work, to protect the good work done. Some clients will wish for the relationship to become more. The therapist in his or her role becomes over time many things for the client: authority figure, mentor, teacher, parent, malevolent or benevolent figure, etc. These have to be held as projections and not-real. This isn’t to say that the rapport and good working relationship is not real, but the therapist has to be comfortable with being projected onto and hold these projections and feelings, whether positive or negative, with neutrality and not act on them.
When the therapist succumbs to impulses to gratify themselves or the client by changing the relationship into something else, the therapist has left their professional role and thereby their usefulness to the client. Moreover, it takes away from the client their opportunity to work through patterns that cause suffering.
The Rule of Abstinence: resisting personal gratification in service of the client’s process
The rule of abstinence in psychoanalytic psychotherapy in simple terms entails not giving the client direct satisfaction, for instance by offering personal information or explanations that do not aid the therapy or furthers the client’s development. Psychotherapy is not about satisfying the curiosity of either client or therapist. Arguably, anything that goes against the rule of abstinence is not a useful intervention and therefore does not help the client. This is because direct satisfaction takes away from the client’s capacity to symbolise (Etchegoyen, 1999 p.12). Symbolic meaning is essential in any therapeutic work and what leads the client to a deeper understanding of their psyche and therefore of themselves. Developing the capacity to symbolise is essential in that it is what enables the client to observe, understand, think and reflect on their life situation, and ultimately what enables a person to change.
Therapists are human beings and therefore experience human responses to their clients all the time. Some of these feelings can lead them to feel compelled to explain themselves (different from accountability), answer personal questions, defend themselves or overshare. Unfortunately there are many cases where therapists have acted on strong feelings with disastrous consequences for the both the client and themselves.
Offering up information or answering certain direct questions without exploring the symbolic meaning behind the client’s curiosity, or the therapist’s motivation to share, bypasses an opportunity for both client and therapist to truly understand what is happening in the client’s inner-world. This isn’t to say that every question the client poses needs to be interpreted or analysed, but it is a skill to navigate through the different possibilities a client presents us with in every session.
Some of the questions we need to ask of our interventions are:
- Does it further the work?
- What is the therapeutic use to the client?
- Does it aid the client’s development?
- Is this for my benefit or for the benefit of the client?
As Etchegoyen states: “The aim of Psychotherapy is to cure, and any process of communication that does not have this purpose will never be Psychotherapy”.
Holding the frame in practice
Therapists must not only understand boundaries intellectually but embody them in their clinical stance. This means cultivating emotional neutrality, self-reflection, and supervision as ongoing supports in maintaining the therapeutic frame. Ultimately, boundaries are not barriers—they are the structure that makes healing possible.
Sam Jahara is a UKCP registered Psychotherapist, Supervisor and Executive Coach. She is also the co-founder of Brighton and Hove Psychotherapy. Sam works with individuals and couples from Hove and Lewes.
Further reading by Sam Jahara
The psychology of the cult leader
Leave a Reply