Boundaries in therapy

We may think of them as perimeters, marked by physical walls, hedges or fences, but what do they mean when referred to in the context of psychotherapy and counselling? 

What are boundaries?

At the initial conversation between counsellor and client, there will be an agreement as to how they will work together. This means:

• The number of sessions (if that is necessary within, perhaps an agency setting, where there is often a limited offer of around six sessions).
• How the sessions will be delivered (face-to-face or remotely, such as video link or telephone).
• The location (if face-to-face).
• The frequency of the sessions, such as once a week.
• There will also need to be an agreement about the cost of the sessions, and the frequency and method of payment of any fees which are due. 

These are the perimeters which provide a basic framework to the therapeutic relationship and are set by the therapist. 

Slightly closer in, perhaps, is the boundary which is the collaboration between therapist and client, and which is to do with how the sessions will remain confidential, and when that confidentiality might need to be broken. Also, on how there will need to be expectations of behaviour, such as whether or not the client fails to show up for a session, or if the therapist fails to show up and what the consequences might be of either of those eventualities.

It will need to be accepted that both client and therapist give a reasonable amount of notice of a change in arrangements. The therapist will often explain to the client that a session might be brought to an end if there is judged to be a risk of physical harm to the therapist or the client and that, if the client attends under the influence of drugs (other than prescribed medication) or alcohol, the session will have to be postponed until the client is in a position where they can fully engage.

Importantly, as well, is the need for the client to respect the availability and working hours of the therapist. The client will be asked to agree to these safeguarding terms, but the choice will remain the client's if they choose not to continue with the sessions.

These boundaries aim to provide a safe environment for the working alliance between client and therapist. A trusting, open and honest therapeutic relationship can develop from here.

These are not rules, set up by one person to be adhered to by another, such as in school, in a workplace, or even in a home environment. They are the collaboration between both participants which enables effective therapy to take place. This is often called the 'Therapeutic Alliance' and the overarching requirement for the alliance to function healthily is a mutual respect.

Psychological boundaries

Psychological boundaries can be what a client might unconsciously use to protect themselves from perceived external threat, which a part of the brain recognises as demanding a safety barrier. These boundaries can be more like blocks to progress, perhaps because the perceived threat is no longer real and the boundary doesn't have to be there.

They can manifest as resistance within relationships, or in such low self-esteem that no effort is made towards achieving any successful outcomes. A lack of self-worth can also lead to boundaries against the acceptance of positive feedback or compliments. 

However, although not necessarily appropriate for the here and now, the process is actually inbuilt to help and protect. As sophisticated and highly evolved organisms, human beings are actually lucky to have this ability within their brain structure. But, sometimes it is as if the key is stuck in the lock, and the focus of the work might be on how to release the key and open up the boundary.

Alternatively, a lack of psychological boundaries may evolve out of a learned response to the demands of others and can lead to allowing exploitation, risky behaviours, or abuse and even self-harm. In this case, the work might be focused on how to firm up the boundary, and on how to gain the confidence to say 'no' more often. A sense of self-worth and an ability to 'own' emotional responses is the ultimate goal in learning to develop a comfortable boundary or personal space.

It can be quite helpful for a client to visualise a psychological boundary, in terms of how the boundary might feel or what it might look like, whether it is solid or fragile, and whether it could be easily breached or easily maintained.

To feel that there is some control over their boundary can enable a client to develop a sense of empowerment, and this can help to develop a sense of value which might have been hard to find. 

The agreement to enter into the Therapeutic Alliance, to feel trust in the therapist and to feel encouraged to own their own sense of personal emotional space and to be enabled to maintain it, can feel wonderfully empowering. For a client whose sense of self as a valuable, effective and unique individual has been blocked, this can feel like permission has been granted to shift that boundary. Either way, permission has been granted for a client to claim their right to be a complete human being!

So some really positive outcomes can arise out of the setting of achievable boundaries, both within a client’s life experience and within the therapeutic setting.