Boundaries

bound·a·ry n. pl. bound·a·ries

1. Something that indicates a border or limit.

2. The border or limit so indicated.

 

Boundaries are important. Boundaries are healthy. In mental health, this is a big issue. Many of our patients are here because they have violated boundaries in some way, and most of our patients have had their boundaries violated at some point in their lives, often traumatically. It's no surprise that many of them have difficulty maintaining and building appropriate boundaries in their own lives. 

Therefore, it is important for clinicians and mental health care workers to initiate and maintain firm boundaries with their clients. Boundaries are ethical. Maintaining boundaries is important for everyone's safety, especially with clients who are vulnerable or "at risk". But what does it look like to have good boundaries? It's not the same for each clinician, nor is it the same for each client. 

 

There is no book I can read that outlines the proper boundaries that work for EVERY client in EVERY situation with EVERY practitioner. I don't want to treat every client the same way, nor do I want to be less authentic with clients (authentic meaning real, or genuine - this does not mean I'm going around self-disclosing to clients or treating them like peers, just that I treat them like real people). 

 

I thought I had been mindful about these issues with clients and that I had created and maintained these boundaries. However, this past week, a client talked to me about some feelings he has developed towards me, about a whole slew of misconceptions he had made about our relationship. I talked to him about boundaries: our relationship is therapeutic, not anything more; our relationship will never be more than therapeutic; I think you're a good person but you are my client and I will never reciprocate those feelings; etc. 

This was totally unexpected for me and out of the blue. At first, I kept racking my brain to try and figure out what I had done wrong, how I had caused this, what I had done... and after processing with my supervisor, writing up a note in the client's chart, and talking to this client's IDT, I know that it's not something that I did wrong. I didn't cause this, and I didn't see it coming. However, it's a good wake-up call to continue to be mindful of boundaries and parameters to set with people. It's also a good reminder that this job is full of surprises, and that working with this population is about expecting the unexpected.

In conclusion, I haven't really come to any final conclusions. This is an issue that will consistently be a part of my job and that I'll probably deal with for the rest of my life. I have no concrete, take-away message from this post, except for this: all therapy is about what the client needs; "the welfare of the client is of the utmost importance".

As of 10/28: ~670 hours complete