ABSTRACT
Together with an ethical attitude we also need knowledge of what therapeutic boundaries are needed within the therapy relationship. In cricket a boundary is something that marks the farthest limit of the playing area, likewise a therapeutic boundary serves to contain the event that takes place within it. Boundaries hold the therapeutic relationship in place and once the therapeutic relationship ventures beyond those boundaries it becomes something other than therapy. Although the client does carry some responsibility for adhering to therapeutic boundaries it is the responsibility of the therapist to provide a safe container for the work by outlining the therapeutic boundaries and ensuring that the relationship is held within these boundaries. To provide a safe container for therapy we need to be clear around the following areas:
Confidentiality – Essential in forming and maintaining a therapeutic relationship is holding confidentiality and being clear about the limits of confidentiality. These limits relate to safety; should the client become a danger to themselves or others, confidentiality would need to be broken. The therapist also needs to take material from the session to their supervisor (see Point 94) and may wish to gain the client’s permission to record sessions for this purpose. For a fuller discussion on
confidentiality I suggest perusing the UKCP23
websites. Limits of the relationship – Clients new to therapy do not always understand why we cannot meet outside the therapy space. Many clients have had experience of having had their personal boundaries crossed or violated; to meet outside therapy would cross a boundary. Although we work to equalize the therapeutic relationship, there is a very real power imbalance. This is one of the reasons that the therapeutic relationship should be limited to precisely that. Contamination can take place, even long after therapy has finished. Sexual boundaries – To me it goes without saying that any sexual advance by a therapist is gross abuse of their power and that a given therapeutic boundary is that sexual feelings will not be acted upon. It might seem that this goes without saying, but sadly there are examples of such transgressions throughout the history of psychotherapy and not only our distant history. Although these individuals damage the whole profession through their actions, thankfully they represent a tiny minority amongst a group of honourable practitioners. ‘Business’ matters – Be clear around fees (if these apply), the length of sessions, the amount of notice required for cancellation of a session and the number of sessions you recommend should the client wish to end therapy. Length of therapy contract – If there is a set number of sessions available, as in brief therapy, be clear about this from the beginning. Aside from exceptional circumstances I do not recommend extending the number of sessions with such contracts. Also ask yourself if the number of sessions available is appropriate for the presenting issues. In long-term therapy I recommend a review after a few sessions before establishing an open-ended agreement. Explain something about the process of gestalt therapy – Give a simple and concise account of the way you work. Be careful not to get too technical, there are enough invitations to do so with some of the gestalt terminology.
