The 5 boundaries not to be broken in psychotherapy

These are the limits that must be respected as therapists and as patients.

It is common that many people who come to psychological therapy for the first time do not know certain limits that should not be transgressed during and around the therapy.

It is necessary that these red lines are known and respected from the first moment that psychotherapy begins, both by the patient and the therapist.

The fact is that there are always there are always certain limits whose transgression is much more serious and detrimental to the therapeutic process and the psychic and emotional improvement of the patient. and the psychic and emotional improvement of the patient than others. For it, next we will see which they are.

Why is it necessary to clarify the limits in psychotherapy?

It is not a simple task to define the boundaries in psychotherapy, since there are cases in which a chance encounter could occur outside of therapy (e.g., meeting in a restaurant or supermarket, coinciding at a party, etc.).

However, there are other types of encounters and relationships that are avoidable; therefore, it is necessary to establish clear limits in the psychotherapeutic relationship, since it is a type of relationship very different from any other, since it takes place in a space where the patient usually opens up emotionally with the therapist and, for that reason, there are other types of relationships that can be avoided, other type of relationship outside the therapy could affect the course of the therapy..

It is essential that the limits of psychotherapy are marked and clarified by the psychotherapist from the beginning, since in this way the therapeutic process can be done in an environment that transmits security to the patient and, thus, he/she feels the necessary confidence so that the sessions can be fluid and benefit from the psychological therapy.

Boundary differences between different therapeutic approaches in Psychology.

There are different approaches to psychological therapy and, although in most of them there are some common limits, there are also some limits that are present in some but not in others, as we will see in some examples that will be discussed below.

It is true that some modalities of psychological therapy, such as behavioral therapy, may use exposure techniques outside the usual consultation room where the sessions are held.The most efficient method for working with certain phobias is through exposure to the feared stimulus in a real context.

Something similar happens with physical contact, an act that, if justified, may be given during therapy sessions from a gestalt approach, while in other approaches to psychological therapy, such as psychodynamic therapy, physical contact is not recommended.

Another example of the difference in the limits of the various models of psychotherapy are the self-revelations made by thehe self-revelations that the psychologist makes during therapy sessions about some aspect of his or her personal life that is related to the patient's issue. This is permitted in therapy that follows a person-centered approach; in other models of therapy, however, it is forbidden for the therapist to share information with the patient about his or her private life.

These examples make it clear that there are limits in psychotherapy that can sometimes be somewhat diffuse and that depend, to a large extent, on the therapeutic approach that is being carried out. However, there is no doubt that from the very beginning of the therapeutic process these limits must be clear, so that both the therapist and the patient respect them.

Therefore, in order for the therapy to be beneficial, the psychologist must actively listen to the patient in order to understand, from a broad and impartial perspective, what is happening to him/her and, in addition, he/she must employ therapeutic techniques in an appropriate manner and use the most accurate clinical judgment possible, maintaining professional secrecy at all times through patient confidentiality..

On the part of the patient, it is necessary that he/she attends all the scheduled sessions that he/she has agreed with his/her psychologist, respecting schedules and punctuality, and making an effort to follow the guidelines that he/she has received in session to carry out in his/her day to day life. It is also important that you open up emotionally during psychotherapy sessions so that your therapist can help you find your strengths.

The dual relationship in psychotherapy

A dual relationship in psychological therapy is the one that occurs when the psychologist or psychiatrist and his patient maintain, in addition to the therapeutic relationship, another type of relationship.. This other relationship could be social (friendship or even more intimate), professional or business, and both types of relationships can occur simultaneously. It could also be the case that the extratherapeutic relationship could be forged after the therapeutic process has been completed.

There is no doubt that the maintenance of intimate relationships would be, among all the variants of dual relationships, the most inappropriate. The fact of transgressing the limits of therapy, arriving at this type of relationship outside therapy, would lead to the patient, in addition to the fact that he/she would not only be the most inappropriate one, but also the most inappropriate, would lead the patient, in addition to not benefiting from psychological therapy, to have an erroneous conception of the context of psychotherapy..

Even when the psychological treatment has concluded, there is consensus among experts in the field that it is still inappropriate for the therapist and the former patient to maintain any other type of relationship, since the image that patients have of their therapist and, by extension, of mental health professionals in general, is still important; in addition, this could have repercussions on a possible process of psychological therapy that they may need in the future, even if they were treated by another professional.

The main limits in psychotherapy

In research on the subject of the limits that should not be broken in psychotherapy, a series of dimensions have been found that could end up putting the patient at risk. dimensions that could end up jeopardizing the development of the therapeutic process.This is a way of transgressing limits: the place where the therapy takes place, the fees and the gifts that the patient may offer to the therapist, among others.

1. Clarify from the very beginning where the therapy is to be held

It is advisable that all the sessions carried out throughout the therapeutic process take place in the same place, which is usually the therapist's office.which is usually the therapist's office.

There are exceptions to this point, as in the case of live exposure techniques, already mentioned above, where the patient needs to be in the real context of the phobia to be treated in order for the treatment to be more effective.

Another exception would be if the therapist has deemed it beneficial to to accompany the individual therapy sessions with group sessions.In such cases, provided that the patient has agreed to it, it is possible to change the place of therapy during these sessions and other therapists may also be involved.

Except in cases such as these, the therapist and the patient should not have any contact outside the therapy sessions and all sessions should be held in the same place.

• You may be interested in "What to expect on a first visit to a psychotherapist".

2. Referral to the therapist's private practice.

It could be the case that the patient is receiving psychological care from the public health system, where the frequency of sessions is usually lower, given the high demand, than in private health care; therefore, the patient could ask the therapist to go to his or her private practice in order to receive psychological care more frequently and with sessions of longer duration.

In such cases, so that the therapeutic setting is not affected, it is advisable for the therapist to advise the patient to continue with his or her sessions in the public system, always respecting the patient's right to decide to go to a private consultation in case the frequency of psychological treatment is insufficient.The therapist should always respect the patient's right to decide to go to a private consultation in the event that the frequency with which he/she receives psychological treatment is insufficient and the delay between sessions is long.

In these cases, the patient has the right to decide to change from public to private health care, but it is not lawful if it is the therapist who recommends the patient to change, so that he/she can go to his/her private practice.

3. Gifts

The therapist should refuse any gifts that the patient may offer him/her as a way of thanking him/her, unless they are small tokens of appreciation.The therapist should refuse any gifts that the patient may offer as a form of thanks, unless they are small gifts with a symbolic price, in which case the therapist may accept them.

However, the therapist should also consider whether accepting such a gift, even if it is of negligible financial value, will have an impact on the therapeutic relationship.

In the event that the therapist feels, in some way, an obligation to reciprocate by speeding up the delay between sessions or similar favors, it would be more convenient to refuse the gift politely and explain correctly to the patient that this type of gift could harm the process of his or her psychological therapy. In this way, the therapist would take off the pressure of having to be grateful and this would not have a negative impact on the therapeutic process.

4. Fees

In the case of private consultations, patients should respect the fees stipulated for each therapy session and try to pay them within the deadlines agreed with the therapist.without bargaining or attempting to negotiate.

Never make a gift in order to pay the price of the therapy, thus substituting the payment with money of the fee corresponding to the sessions.

5. Physical contact and personal disclosures by the therapist

There is no doubt that in an environment in which very personal aspects of the patient are treated, where the patient opens up emotionally and feels trust towards the therapist, as is the context of psychotherapy, it can sometimes happen that the patient, without malicious intent, breaks certain limits (e.g., asking the therapist personal questions about whether he/she has children or is married, about his/her hobbies, etc.); he/she can also, in some cases, give the therapist a hug, as a way of thanking him/her at the end of the session.

In the face of this type of events, even if they are well-intentioned on the part of the patient, the therapist should resolve them by positioning himself in his proper role as a mental health professional, and thus avoid misunderstandingsThe therapist should resolve them by positioning him/herself in his/her role as a mental health professional and thus avoid misunderstandings in which the patient may feel so confident that he/she thinks he/she can treat the therapist as a friend or family member. These situations can be resolved by the therapist reminding the patient that revealing aspects of his or her private life is not appropriate in therapy.

However, there are therapeutic models, such as some within the humanistic current, where the therapist's self-disclosures can be used as a therapeutic resource at certain times in order to facilitate the therapeutic alliance with the patient.

Also, sometimes, they are also necessary as a therapeutic resource with children and adolescents who show reticence towards the therapist in order for them to feel more confident and this facilitates the therapeutic process.

With respect to hugs, it will not have a negative impact if, at a specific moment when it is needed (e.g., when going through a grieving process), the patient gives a genuine hug to the therapist; however, the therapist should make it clear to the patient that this should not become a habit in the sessions, nor a way of saying goodbye after each session.

The most convenient way to say goodbye and greeting at the beginning of each session is through words, accompanied by gestures that show openness and serenity on the part of both; it is also correct to shake hands with the therapist. it is also correct to shake hands.

It is not comfortable for the therapist to make clear the limits in cases such as those mentioned recently, but it is necessary because if it is not done from the first moment, the limits could be broken on more occasions, being more and more difficult to stop them. Therefore, it should always be clear to both of you that your relationship should be exclusively therapeutic.