Boundaries between client and therapist are necessary for a healthy and productive therapeutic relationship. While there is no consensus as to how strict or lenient boundaries must be, and each client-therapist relationship requires modifications specific to the people involved, institutional bodies like the American Psychological Association (APA) do provide mental health professionals with an outline for what is permitted, what is explicitly forbidden, and what to consider when navigating the grey areas. APA guidelines— which cover the ethical boundaries applied to psychologists and their clients— allow for substantial discretion to be exercised by therapists when determining what their personal and professional boundaries will be. Only sexual relationships are completely off limits during treatment (and are heavily discouraged after treatment).
Boundaries are designed to ensure that the treatment aims for the client are paramount; that treatment aims are not compromised; that clients are not exploited by their therapists; and, once treatment is completed, that clients don’t become overly dependent on their therapists. Much of what is advised in ethics codes involves the perception and interpretation of individual therapists, meaning few things are explicitly forbidden in any and all circumstances. For example, dual relationships—where a client and therapist have a relationship that extends beyond the primary therapeutic relationship—are only verboten if they are considered exploitative of the client, harmful to the client, or compromise the therapeutic needs of the client. This leaves much to the discretion of therapists and their clients. So long as the client-therapist relationship remains primary and all other roles are subordinate to treatment aims, dual relationships are generally deemed acceptable in therapy.
In my case, the boundaries that were laid out by my therapist included: no contact with her friends or family members; no socializing outside a clinical setting (in vivo exposures aren’t considered socializing); no personal contact information given to clients other than her cell number; and no friending at her private Facebook account. She was open to allowing me to do work for her clinic and non-profit organization as my treatment progressed, in part because it served my needs as a client. The first two years of my treatment were slow and plodding; I lacked motivation, was heavily medicated, and exercised procrastination with a meticulousness and dedication that was lacking in my commitment to overcoming what hindered my mental and emotional development. The dual relationship that developed was, essentially, a subset of my overall treatment, created to facilitate my recovery, build my confidence, and further my independence. Rather than compromise my treatment, it allowed me to achieve experience and growth in areas that had been dormant most of my adult life and were in severe need of kindling in abundance. It was during this time that I first began to delve into the issue of client-therapist boundaries.
For me, someone diagnosed with borderline personality disorder (among many other diagnoses, both confirmed and contested), boundaries have long been a source of frustration and a trigger for deep-seated paranoia. While I reluctantly accepted my Facebook friend request being denied by my therapist several years ago— when online social media was just starting to be addressed in relation to client-therapist ethical boundaries— there was a tinge of hurt over being excluded from the private world of someone I had gotten to know to a insubstantial degree over the course of the eight or so months we had been working together. When I friended her, I knew there was a possibility she would deny my request for ethical reasons. Not knowing what the ethical boundaries were, I gave it a shot. I did not view my Facebook account as an exclusive online society, nor did I think of Facebook accounts as particularly personal or private online entities. Privacy settings were not as advanced as they are now, and most—if not all— Facebook accounts were more open to the public than they are now. These were the Wild West days of online social networking, when anyone could be friended at any time by anyone for any reason.
As my time working with this particular therapist grew from months to years, being entirely excluded from her personal life, as well as those of other therapists I was working with, began to sow seeds of angst and resentment inside me. I had spent nearly my entire life as an outsider, feeling marginalized by and segregated from those I wished to interact with most, and here were those same feelings being triggered in a setting that was supposed to address and—ultimately—help alleviate them. While I understood and accepted that boundaries related to her being a therapist and my being a client needed to be in place during my treatment, I became obsessively fearful that those boundaries would remain after—long after—my treatment reached its conclusion. To be labeled, if not branded, a client for the rest of my life by people I had come to love dearly was a heart-wrenching sentence, one handed down for no other crime than having once been a client in their care. Certainly, maintaining client-therapist boundaries after termination of treatment is the best course of action for some clients, and possibly a majority. From my vantage point, however, to maintain such boundaries more than the rule of thumb two-year recommendation would be nothing short of infantilizing, undermining what good was done while I was in therapy. It was not my goal when seeking treatment to be ghettoized as something different from “normal” people, tainted and restricted without hope of recourse.
I ceased treatment with this particular therapist three months ago, as well as all other therapists I had come to work with at her clinic. We have had a few phone conversations since then and I text her and two other therapists on a fairly regular basis. The walls that existed between them and me have not been raised since my treatment was terminated, nor have they fallen. I am not friended at her professional Facebook account, nor am I friended at her personal account, which—unlike her professional account—is off limits to the public. I haven’t met face-to-face with any of my “exes” thus far, though such meetings are neither prohibited nor discouraged. It’s simply that I would feel awkward attempting to arrange a visit to a clinic I am no longer being treated at to meet with people whom I am no longer being treated by. Should I have a valid reason to return to my haunting ground [B1] of yore, I will gladly do so. My former therapists are adhering to the aforementioned two-year standard, whereby the boundaries applied to our client-therapist relationship remain in place for two years following cessation of treatment. This has been difficult for me, as I now have come to view them as more than therapists, even though they still view me a client— albeit one they are no longer treating. Allowing me to achieve further independence and avoid becoming overly reliant on people I was very reliant on until just a few months ago requires a balancing act that comes with no clear roadmap or directive.
Given that the psychological profession was created and exists to this day to serve the mental health needs of those seeking its services, it would be cruelly ironic for mental health professionals to contribute to the stigmatization of the people it’s supposed to aid in liberating. The mental health industry has an obligation to those whose needs it serves to address their problems in ways that are neither exploitative nor counterproductive; that expand opportunities rather than diminish them; that protect confidentiality without creating unnecessary barriers in the process of doing so; and which affirm the client’s dignity in ways that are respectful and validating. Treating clients like personal friends during treatment most certainly doesn’t facilitate this objective. Maintaining barriers infinitum for all clients no matter how many years have passed since treatment was terminated could be just as sabotaging to the goals of recovery and self-determination.
By Greg L.