Why do boundaries matter in therapy?

Recently, on holiday, a friend confided in me that he was so relieved to see me; he declared himself to be totally “boundaried out”, that he was “awash with boundaries”. His partner is a psychotherapist, and so many of her approaches to people seemed to be influenced by what he thought was a ridiculous over-concern with boundaries. He had forgotten that I worked in the same world.

He was not complaining too seriously but did raise the question as to why therapists are so concerned about boundaries. The non-therapist is often amused, if not bemused, by the concern expressed by some therapists. Most people wonder what all the fuss is about and claim to regulate their relationships and so their boundaries with a minimum of fuss on the basis of common sense, or so they claim.

When a friend or acquaintance steps over the acceptable line of familiarity, unease enters the relationship. We may say, “That is a bit close to the mark”, or “That is none of your business”, or whatever one’s particular style happens to be. The right distance is re-established, and so it is dealt with.

If only!

Why do boundaries matter?

So are boundaries a matter of common sense? Are therapists who drive their friends mad by agonising over getting them right just a bit odd? Perhaps!

We can begin to think about this question by posing a couple of other questions: What function do they perform in human relationships? Are they about control of the relationship? Are they necessary, or are they just in the way of people really getting together in a truly intimate and humane way?

Boundaries and borders

Boundaries have a similar meaning to borders. Borders seem to have been around since humans began to live a settled life. Borders demarcate where one sovereign state begins and ends. The people of a particular area/region/country believe they have rights of ownership and the freedom to control all aspects of life that affect them. They believe they have the right to determine who can live within their borders, the right to impose their own laws, the right to control their economy. The right to determine how their citizens should live with each other and with ‘strangers’. History describes the ‘heroes’ who gave their lives to defend the ‘inalienable rights’ of a people to determine their borders from the intrusion of ‘foreigners’.

The word private is heavily inscribed on some doors and gates, telling us to keep away unless invited. “Out of Bounds” is probably a familiar phrase that springs to school-day memories for most of us. There were clearly demarcated areas where one was not allowed, under pain of punishment, to go.

The rationale for these boundaries was largely about control, sometimes about safety, at other times about repression. At best, these rules about where we could and could not go reminded us that we were not free to exercise unconstrained self-indulgence, roam where our will took us. We learned that our fellow travellers had the right to their space and that we had to respect this right.

It would seem that most people display ‘keep out signs' that warn the uninvited to keep their physical and psychological distance. We only allow those that we can trust to get close to us. These tend to include some family members and some friends. In some sense we have come to believe, either consciously or unconsciously, that these friends and family are necessary for our psychological survival and happiness. They are not just fun to be with.

Perhaps it is important to keep in mind that the word boundary may have different meanings between and within different cultures. Ideas about openness, personal space, physical contact and familiarity can vary considerably between individuals, families and cultures.

As in all relationships, boundaries have an important function. Back to the question: what role do they play in our relationships? Their main role is to help us regulate our relationships. They do this in several ways; they protect the balance between autonomy and attachment, between dependence and independence, between intimacy and distance.

They help us to allow those to whom we relate to be. We want to engage with the lives of our friends and family in a healthy, supportive way without threat of unwanted familiarity. This, at times, is difficult.

Boundaries in the therapeutic relationship

So what has all this got to do with how we therapists relate to our clients? What is so special about this particular relationship and why are therapists so concerned to get it right?

The relationship between therapist and client is particularly close and intimate; at its centre is the trust and vulnerability of the client. For some clients, their relationship with their therapist may feel more intimate than many other relationships.

The client takes a huge risk in disclosing their fears, their deepest secrets, their most private feelings. The client may allow their mind to focus on experiences, present and past, that they have previously blocked or found difficult to explore. These are likely to be disturbing, if not frightening.

In any relationship where there is deep trust and disclosure of confidences, a special intimate relationship can develop. When this happens, the therapy may be given energy and focus. This can be positive and contribute to therapeutic change, but the closeness of the relationship also makes clear professional boundaries essential.

Professional ethical frameworks are designed to protect clients, particularly where vulnerability and differences in power exist within the therapeutic relationship. Sexual or exploitative relationships between therapist and client represent serious breaches of professional boundaries and can cause significant harm. It is the therapist's responsibility to maintain appropriate professional boundaries and protect the integrity and safety of the therapeutic relationship.

I believe that the vast majority of counsellors would agree that their role is to promote the emotional health of their clients in a safe space. A safe space demands a clearly defined contract, mutually understood. This contract makes clear the rules of engagement – in short, the boundaries.

There can, however, be differences between therapeutic approaches in how some boundaries are understood and applied.

When approaches to boundaries differ

I use my own initial experience of analysis to point to one perception of the appropriate boundary. I began my own therapy with a psychoanalyst who encouraged me to lie on a couch; she remained relatively silent. It was as if she was ‘absent’.

She believed that her job was to offer herself as a blank screen onto which I could project the contents of my troubled soul. There were no greetings or farewells, sessions began and ended exactly on the minute. To me, there seemed to be a total absence of humanity.

My particular experience may be thought to have been rather extreme. I am, however, reminded of an account by a writer and analyst who refused to hold the hand of a very distressed patient who was asking for the reassuring relief of human contact.

He agonised over it but believed that physical reassurance might interfere with the therapeutic process as he understood it. This illustrates one particular theoretical approach to therapeutic boundaries rather than a rule that should necessarily apply across all forms of therapy.

This is very far from the experience of a good friend. My friend’s wife left their marriage after ten years, taking with her their two children. He became deeply distressed and gradually felt that life may not be worth living. He sought help from a pastor/counsellor.

My friend described how, on one occasion, he broke down in the counselling room, lay on the floor in the foetal position and bawled his head off. His counsellor responded with physical comfort. My friend experienced the warm tactile presence of another person as what he needed at that point in time. He believes this was the beginning of his recovery. He now manages his life very well.

Touch in therapy is a complex boundary issue. What may feel supportive to one client may feel uncomfortable, intrusive or harmful to another. Therapists need to consider consent, the client's needs and history, their therapeutic approach, professional ethics and the possible impact on the relationship before introducing physical contact.

A student on a diploma course that I tutored talked about her experience on a CBT course. Her supervisor had suggested that one way of helping a client who struggled in social situations could involve practising social interactions outside the traditional therapy room.

In the popular self-help book The Road Less Travelled, the author describes how he helped one of his patients to solve a problem with her car. Such examples illustrate how differently therapeutic boundaries have sometimes been understood across practitioners, approaches and periods of therapeutic practice.

Some therapists may view these approaches as inappropriate departures from established boundaries. Alternatively, there are those who believe in the importance of the presence of a warm, personal, caring and interested counsellor or therapist. These therapists may be uncomfortable with what they consider to be the cold, distant approach traditionally associated with some forms of psychoanalysis.

There has also been discussion within psychotherapy about the importance of genuine care and human connection within the therapeutic relationship. The challenge is not simply choosing between warmth and distance, but understanding how warmth can be offered without compromising the safety and professional nature of the relationship.

Finding the right therapeutic boundary

It is a little alarming that there seems to be such an array of understanding and practices of boundaries in human relationships in general and therapist/client relationships in particular.

The basic question for the therapist is: What works? What is therapeutic? How does one allow the client to find and manage their own inner strength without transgressing their private space?

How does one protect the client from the manipulations of one’s unconscious ego, the need of the therapist to be omnipotent, to ‘fix it’? How does one protect the client from the attractions of dependency and false promises?

How does one protect the relationship from sexual or other forms of exploitation? How does one avoid doing harm? How does one avoid doing anything that might impede the therapeutic process or get in the way of healing?

These are, of course, complex questions. At their core is the concept of boundaries. This is an issue that needs to be explored with the client and continually reflected upon by the therapist.

Ultimately, therapeutic boundaries are not simply rules designed to create distance. They help create the safety, clarity and trust within which therapeutic work can take place.