There seems to be a lot of posts lately about Ts and Ps engaging in egregious violations of commonly accepted rules and boundaries of psychotherapy. I find this all really troubling.

In my opinion, your therapist - while he/she may, in fact, be the most important person in your life right now - nevertheless is not your friend, your mother or your father, and he/she should not insert themselves into your story with their own stuff.

All this business of hugging, exchanging gifts, therapists sharing details about their own lives, not recognizing their own counter-transference and getting involved etc...it all defeats the purpose of being in therapy.

Here is a good podcast about the importance of The Frame in therapy. I'm interested in hearing what people think of it.

Cheers,
Russ

While I agree that T's having boundaries and following ethical guidelines is extremely important, I don't think it is nearly as black and white as the podcast states or what your quote implies Russ.

My T uses touch in our therapy. It is an integral part of the training that she has received. We don't do typical "talk therapy". The typical talk therapy was not helpful for me in resolving my trauma, but the work that I do with my T now certainly is. She doesn't use touch every session and when it is used it is appropriate, permission is asked for and given and it is very therapeutic and healing. My T has very good boundaries and has never once made me feel like she was crossing any sort of boundary with me. She is extremely cautious about sharing any personal info and has only done so extremely infrequently and only when it served to further our work. I am also very clear about who she is. She is very important in my life and in my healing. She is my T. She is not my mother or my friend. I wouldn't want her to be any of those as it would completely disrupt the therapy process.

I think some differences in T's and the grey area of boundaries stems from their different backgrounds as far as training and the philosophy that they subscribe to. I think it is short sighted to say that one is always wrong or one is always right. I for one am happy that I have the choice to choose a practitioner that works at the body level and is willing to use therapeutic touch even though in some circles it is taboo.

I feel that the frame referred to in the podcast is the more strict psychoanalytical frame of working with a client. In my case, my T does not adhere to that frame and for me it works very well. While we do have the same day/same time appointment (unless vacations or holidays come up) and I feel that my T has good boundaries, he does blur them when he feels it's appropriate.

For example, he does use some self-disclosure when it fit into what we are discussing and it is always about me and not him. He self-discloses to make a point about what we are discussing if he feels it will help me. It always does. He also accepts small gifts from me. We have discussed both the particular gifts and why I have chosen them and also the practice of gift giving in general. Most of my gifts are small and relate to what we have been discussing or working on in sessions. Sort of private therapy jokes or serious symbols of my progress. For a trauma patient, self-disclosure helps us to better learn to trust our T and I personally believe it is very difficult to feel safe with someone who you know absolutely nothing about. And in working with trauma safety is priority number one. If you don't feel safe enough with your T you won't tell him/her anything important or traumatic.

He also uses safe touch. He will shake my hand (although it was a year before we got to that point), pat my shoulder or even hug if I ask for one. For me this has taught me that touch can be safe and asks nothing back from me. In fact, this has been quite healing for me as we discuss abuse issues.

I have also seen my T in places other than the therapy room, such as at seminars, or the camp that my son attends. We have used different rooms in his building (when his office was being rennovated) and none of this really had any impact on our therapeutic relationship. It has only grown stronger over the years and I have been able to go deeper and deeper into the issues with him because I know that he is safe.

In the end I think it depends on the judgement and discretion of the T involved. For some patients with an abuse history touch may be very threatening or harmful. For some patients knowing too much personal info could be difficult. Some patients need more boundaries than others due to the nature of the issues involved. I don't think it's appropriate to ever VIOLATE boundaries, but crossing them or blurring them with good reason can be appropriate and helpful in certain situations.

TN

quote:

Originally posted by monte:
Their approach - clinical, generic, detached – left me cold and unresponsive to the marvelous advice and insight they may have been able to impart upon me.

Thanks for the feedback, Monty. Of course, this is just my opinion, but I have to ask...is giving advice and providing insight really what a T should do? As much as it sucks, I thought the idea was to arrive at insight on our own, thus making it that much more meaningful?

quote:

Originally posted by monte:
He was (and still is) REAL.

I don't think there's anything in the podcast that suggests that having a clear set of boundaries precludes being real, but I think I know what you're saying. It's hard to connect with someone when they're "a blank slate." I totally agree with that. I'm not promoting the blank slate, and I don't the podcast is either.

quote:

Originally posted by monte:
I don’t believe healing from emotional wounds comes from one set rigid formula. Such an approach may suit some people of course, but only some. This man sounds as though he views his consulting room as a laboratory and his clients his lab rats. To limit therapy to cold, hard science is to limit healing possibilities for so many of us. It is ‘safe’ - it will never get messy or confusing - but it lacks the fullness of human connection...and that is crucial. Words are a fabulous tool, but the stability and warmth of the relationship is what is slowly healing my wounds. And those words of encouragement and wisdom carry so much more weight when delivered by someone willing to offer such a relationship. Like a child does with a good parent, you absorb their influence. Note I said, 'like' a good parent, because I agree with you, my T is not my father - though I do wish I had been fortunate to have someone like him to call Dad.

Wow, we see this so differently. I don't think there's anything in the podcast that suggests that it should be some kind of lab rat situation. I think the idea is precisely to draw out emotions and, just as importantly, bring what has been missing in our lives into full, high relief and into the light of awareness. It sounds whacked, but not getting what you're dying for from your T is one way of achieving this.

If you find yourself hating your T because you feel he gives you no warmth or encouragement, isn't that exactly the information you need? You may feel like you already no what you never got, but I think there's more to it than that, such as feeling guilty for wanting it, and hating yourself for it. Any good T should point this out to you regardless of what their approach is.

It's interesting. For a long time, I HATED my T for exactly these reasons...he never gave me any encouragement or any kind of "warmth" whatsoever...or so I thought. But in time I came to see that by not being the person I wanted him to be, I discovered the truth about what I never got from my father, and that was critical to me. Yeah, I knew I hated my dad and thought he was an asshole, but I didn't understand the other dimensions of this, and it was my T that helped clarify this for me.

I sat in session once, balling my eyes out, telling my T just how much of an asshole I thought he was, how I hated his face and his stupid clothes and his "know it all bullshit" and how I hated how he never said whether or not I was making progress...then it hit me; all this anger and hatred, it had nothing to do with my T...it was all about my dad. Every bit of it. I knew I hated my dad, but I never knew what it was that made me hate him.

Once I composed myself, I was able to announce that I could actually see what all this was about, and he said, "what you're doing is the result of YOUR hard work, not mine. It's YOUR mind working like hell to reach down into the muck and pull up the truth, whether it's in here or in your dreams or wherever, whenever. I've told you what I see based on what you've told me, but it's YOU doing the work and getting results."

That to me was the best kind of encouragement and warmth I could ask for, and I don't think it would've happened had he given me what I'd been demanding from him.

But again, just my experience. Clearly there are other approaches that work.

quote:

Originally posted by monte:

Having said all that, there still must always be boundaries that reflect decency and care for the clients well-being. Too many people get screwed by dodgy, unprofessional practitioners...

Perfectly stated.

Russ

quote:

Originally posted by dragonfly:
just want to ask Russ,as a matter of interest,why you think it defeats the purpose of therapy?
If the end goal is the same(healing)why does it matter? perhaps someone should start a new therapy that includes all these things........i'd sign up! Because its real.Sometimes i think all this blank canvas stuff is horrendously cruel.
dragonfly

hi dragonfly,

I don't understand what you mean by "because it's real." Do you mean things like hugs or gifts or a T self-disclosing?

I'm not promoting some kind of zero-affect, blank canvas cruelty, and neither is the podcaster I don't think. I'm just suspicious of the value of some of the things I see get posted here about therapists' behavior.

Russ

TN,

Thanks for your (as always) thoughtful reply. Reading your feedback has really made me see how variable every situation is. I'm not a victim of sexual or physical abuse. My abuse was emotional, which isn't to say that it doesn't effect things like touch and intimacy, etc, but obviously it's different.

Also, I'm a guy. I'm a white, educated (and for many other cultural reasons) privileged guy. Obviously, gender, race, ethnicity, etc, present their own large set of variables. All this is wrapped up in how one experiences, well, everything I guess, including therapy.

It sounds like your therapist really understands how to do therapy, and how to work with you in particular. I'm glad for this, because we all benefit from your good therapy here.

I sure hope people don't think my T is some Freud look-a-like who sits stonefaced in the other direction from me. While he is very serious, he's also very connected to my thinking and my feelings. He smiles and laughs like any other human being, and he can also be hysterically funny and sardonic. He just doesn't insert his story into mine.

Anyway, thanks for your thoughts.
Russ

Russ, thank you for the thought provoking topic and discussion. My T does work well with me but it has not been without some major disruptions over time. We do always manage to repair them and move on. Part of my commitment to him is probably because of my attachment to him. It keeps me going to therapy despite the rough patches. And when I tell him that he knows me so well he responds with "that's because you allow me to know you". He never takes credit for anything that I do and makes me see that it is me who has done the work. Beyond that, it has taken over a year for us to get to the point of touch (so he knew my history and was able to make a judgement call on that) and for him to self-disclose on certain issues we are working on. So I really do believe that each T/patient relationship is different and the T needs to adjust his boundaries and his style for whatever works best for the patient.

I am so glad to hear that your T is connected to you and your feelings and that he has a sense of humor. I find that humor is very important in therapy. It's another good way to get that connection. In the end what really matters is that we are comfortable with our T and that we feel we are making some progress, even if it's infintessimal... it's still progress!

Be well,
TN

quote:

Originally posted by monte:
Russ, you may be far wiser and braver and further along the path to healing than I...

Monte,

Nothing could be further from the truth. Trust me.

I have a LONG way to go yet.

Russ

Thanks for the interesting thread. I suppose what I feel is that we are all going to therapy for different reasons, have different experiences, hopes and fears and relate better to certain types and methods.

STRM

quote:

My T uses touch in our therapy. It is an integral part of the training that she has received. We don't do typical "talk therapy". The typical talk therapy was not helpful for me in resolving my trauma, but the work that I do with my T now certainly is. She doesn't use touch every session and when it is used it is appropriate, permission is asked for and given and it is very therapeutic and healing. My T has very good boundaries and has never once made me feel like she was crossing any sort of boundary with me. She is extremely cautious about sharing any personal info and has only done so extremely infrequently and only when it served to further our work. I am also very clear about who she is. She is very important in my life and in my healing. She is my T. She is not my mother or my friend. I wouldn't want her to be any of those as it would completely disrupt the therapy process.

Once again, I totally relate to what you have written so beautifully. I feel very similarly about my T and that makes the boundary stretching a bit easier, so for me the touch is not a problem but an important lesson that I am learning, that touch can indeed be safe and nurturing. I would not express any emotion or shed a tear (and have only shed a couple) with someone who just sat and looked at me, however empathetically, that would be soooo triggering; likewise someone who was too sympathetic or too overpowering with their physical comfort would do likewise. So it the balance that is important and the T knowing you well enough to know where the individual boundaries lie. I think it is different with opposite sex relationships in therapy, can understand the need for less elastic boundaries there.

starfish

Russ,

I'm just wanting to say that my T has her faults, but she does help me in her own way with her own 'style' of doing therapy. While she doesn't stick to the generally accepted rules of the therapeutic frame and does give hugs, does touch my knee to connect while talking about deeply emotional things if need be, has held my hands during a really rough emotional corrective repair between us, and even teared up during that experience, has shared a few personal experiences that relate to what we were talking about that had to do with me, and has accepted a small gift and a thank you card from me, I do not think that her behavior has been detrimental to me. I think she has been very helpful to me in many ways. No she is not perfect, and yes there are things I have questioned. But I have needs that she has met, and continues to meet, and my healing is underway because of her care and the ways she shows that she supports me as my therapist. I don't expect her to be my mother, my friend, or anything more than my therapist. I have crossed boundaries with her and she has accepted that and helped me lose that desire to continue to do so by giving me more of what I was seeking, in a healthy way. It seems contradictory, but some of us actually seem to do better with a T that isn't a 'blank slate' type. I know I would drop out of therapy if I couldn't 'know' my T on some level. Like True North said, it comes down to trust for me, and if I didn't have some knowledge of who my T is, if she didn't show me a level of care that allowed me to feel important enough to her to trust her, therapy and healing wouldn't happen. It's a good thing there are a variety of Ts out there and that some Ts are willing to adapt their style and do what they need to in order to suit each individual patient's needs for the optimum benefits to the patient.

MTF

MTF and starfish,

Thanks for your replies. The more responses I read, the more I think that being a guy - seeing a male T - has a lot to do with our different experiences. But then again, I'm thinking that, as you all have said, our particular issues are what influence what actually happens in the experience.

So, if you're someone with a really clear trauma that you're trying to address, that's going to be totally different than if you're someone with a raging unconscious conflict that is causing horrible symptoms (this is more my situation). Of course, the situations probably include a bit of both to some extent.

What's interesting is that I have a major attachment to my T, more than I even would like to admit. If he somehow didn't exist starting today, or I couldn't see him anymore, it would destroy me.

It sounds like most everyone who has a dynamic with their T that involves touching, hugging, etc, find it positive and even critical. I'm curious to know if people ever become frustrated because, for example, the light touching and/or hugging may be the limit of the contact. What happens if the client demands (or expects) more and becomes upset and confused when it doesn't progress to something deeper, like it might normally do under ideal circumstance with a parent or partner? Or if the contact is not consistent?

Thanks again for all the fantastic thoughts.
Russ

Russ

I can only reply from a trauma perspective, but totally agree that

quote:

as you all have said, our particular issues are what influence what actually happens in the experience.

I think trauma has it's own difficulties, partly because trust is such a big issue. It can take years to trust another with your past, to share information and believ they will not hurt you as others have previously done. So touch then for me, and I can only speak for myself, as given in a safe and affirming way, becomes more powerful. It is more than the physical comfort that I never knew, shows that I am not too bad to touch, and is an sign of empathy, understanding and solidarity with me on my journey.

As I write this I am aware that others do not receive touch in their therapy, if I had a T with a no-touch policy I am sure I would have made equal progress, it's just that this particular aspect is different for different people - neither being right or wrong. I just wanted to say that.

[QUOTE] [I'm curious to know if people ever become frustrated because, for example, the light touching and/or hugging may be the limit of the contact. What happens if the client demands (or expects) more and becomes upset and confused when it doesn't progress to something deeper, like it might normally do under ideal circumstance with a parent or partner? Or if the contact is not consistent?

/QUOTE]

Russ, good question. Again I can only answer from my experience, which is that I never feel frustrated if there is or isn't touch, because it only ever happens when it is appropriate. I don't see my T in the same light as a parent (ooo definitely not!) or my partner, she is my T in her own role in my life. I need her right now to help me through this, and as much as I wish I didn't need any help, she is happy to walk with me and help all she can.

I hope that explains a bit how it is for me at least. Everybody will be different, and other relationships and dynamics will have their equally different and important dynamics and ways of conducting their particular therapy. That's what makes us all different, although we strive for similar goals.

starfish

quote:

Originally posted by Russ:




It sounds like most everyone who has a dynamic with their T that involves touching, hugging, etc, find it positive and even critical. I'm curious to know if people ever become frustrated because, for example, the light touching and/or hugging may be the limit of the contact. What happens if the client demands (or expects) more and becomes upset and confused when it doesn't progress to something deeper, like it might normally do under ideal circumstance with a parent or partner? Or if the contact is not consistent?

That is a good question Russ. Once again I feel like Starfish and I are sharing a brain (and perhaps the same T). I also come from a trauma background so I can only answer from that perspective.

I have never become frustrated with the amount of touch or type of touch that my T gives. Like starfish said, it is because it only ever happens when appropriate. I suppose that there are times that I have wanted that, but didn't ask for it, but it was more out of fear of not having my needs met. This was primarily before I had really allowed touch in the first place. For me, the touch is essential at times in keeping me grounded and in the present day. When we are processing a serious trauma and I start to get sucked completely into the past, having my T sitting with me and touching me in a safe and comforting way helps me to stay present enough to not be retraumatized by what I'm processing.

I agree with others that we are all different and what works for one isn't necessarily going to work for another. I think the most important thing in T is that there is mutual respect and trust, a feeling of safety and a manner of relating which continues to fuel forward progress.

Russ,

As fas as not getting the touch/contact is concerned, I have had a problem with it a couple of times because my T has always put her arm around me while we walk down the hallway to the exit (this started as 'routine' at the 3rd session with her) and there has been I think 2 times she hasn't done this in the now 20 sessions I've had with her. It's a bit hard for me because it's a disruption in the 'routine' and feels strange, but I think it's just my need to deal with change rather than needing that from her. Don't know exactly. The last time this happened I had a pretty good session with her and left feeling good, but ended up spinning about the lack of touch. Guess I need to ponder on that one.

Sorry to hear you really do understand the attachment-to-your-therapist bind. It isn't the funnest ride, is it? Sometimes I think it might be better to not have any of the stuff I have from my T and to have more of the 'blank slate' type T. Who knows, maybe some day I'll get me one of those!

Thanks for opening up the subject, Russ. It's been interesting food for thought.

MTF

quote:

I'm curious to know if people ever become frustrated because, for example, the light touching and/or hugging may be the limit of the contact. What happens if the client demands (or expects) more and becomes upset and confused when it doesn't progress to something deeper, like it might normally do under ideal circumstance with a parent or partner? Or if the contact is not consistent?

Hi Russ,
I am late to the game, but I waanted to post because I found this topic very interesting.

While reviewing the Good list vs the Bad list, my T and I have something in the bad list in many (not all) of the catagories.

It seems my relationship with my T most closely resembles TN 's situation. I too am a trauma patient, and feel that having a T model appropriate relationships is important. However, like TN trust is HUGE. to a real and large degree, I need to know the person a bit before I can trust them. Naturally this needs limits, but it also requires the expertise of the T to know these limits- based on our individual needs. this sense of "attunement" is how a T avoids what you have described- above.
Speaking from my own experience, women that have experienced childhood trauma - sexual or otherwise, are usually afraid of themselves to a degree, and greatly fear rejection, so what you described is unlikely.

There are consistant boundries ( and I believe consistancey is more importannt than rigidity), but they may be tailored to the needs of the patient, as it should be. (needs vary from person to person)

Thanks for the topic Russ, I find it to be very thought provoking.

Hele
ps- on the boards- we talk, we fantisize, but if anything was a miss, - for me, I would be the first person to run very fast. I am not a brave trauma survivor, and not a psychological risk taker. I am a scardy cat, and believe others may be too. You would not see that kind of bold behavior from us. (just my opinion - I am not generalizing)