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Developing boundaries as a therapist

Developing boundaries as a therapist
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It is likely that you will have some boundaries that keep your friends, family and working relationships healthy. For instance, would you be happy with a friend phoning you at 3am for a chat? A family member not turning up to an event you had previously agreed to attend together? A colleague being abusive to you because they were in a bad mood? Probably not, but usually these things won’t happen as you likely have pre-arranged boundaries that would help you avoid these situations. In the same way, it can be good to have therapy boundaries. These are not just for the benefit of the therapist, but also for the client. They help both parties understand what is expected of them, how they will conduct themselves and even what to do when things don’t go as planned.

Some therapists will have formal boundaries in the form of a ‘code of conduct’ or ‘terms and conditions’ on their website, or in a format that can be sent to a client prior to a session. Others will have perhaps a more flexible approach and discuss these verbally or informally. So, if you are working (or wish to) as a therapist, what types of therapy boundaries might you have?

The first boundary that many therapists will think of is in regards to therapy session attendance and notice periods for cancellation or changing a session time/date. It is a good idea to have a standard cancellation policy, having at least 24 hours margin between any costs you incur for a therapy room and a client cancelling. For example, if your therapy room has a 24-hour cancellation policy, meaning you can cancel your room up until that point without paying a fee, then your client cancellation policy may be 48 hours, so that you have time to cancel your therapy room without incurring charges. With late cancellations, you might charge the client all or a percentage of the therapy session fee.

Also related to your cancellation policy is the topic of payment. Do you have a policy for when a client needs to pay for their session? For example, do you require payment a minimum of 48 hours in advance? If so, and the client doesn’t pay, how do you address that? Cancel their session? Go ahead anyway? In order to avoid ‘no shows’ and very late payments, having a payment policy and sticking to it can save you a lot of time and frustration.

Also, as well as addressing cancellations and late payments, your boundaries may include how you deal with clients who arrive late to sessions (e.g. just giving them the remainder of time for that session, rather than extending the session at your cost), and how to deal with those clients who simply don’t attend.

Even once the client has successfully paid and arrived for the therapy session, how they conduct themselves will benefit from clear boundaries – this can also be applied to how you conduct yourself with them. For example, it is commonly considered reasonable to expect a client to be appropriately dressed for therapy, e.g. perhaps not attending in a bikini or bare chested. Your boundaries may include the use of a blanket or cover to ‘cover up’ a client if they arrive unsuitably dressed. ‘Dress’ boundaries may also address how you present yourself to your clients. Perhaps avoiding low cut tops, short skirts or shorts and focusing on appropriate professional dress for the setting.

In addition to dress standards, personal conduct is another area that benefits from having defined boundaries. It is reasonable to expect a client to behave in an appropriate manner. Whilst getting upset or tearful or expressing their anger about a situation may be a relevant part of the therapy, physical or verbal abuse directed towards the therapist may not be acceptable to you.

In any talking therapy, including hypnotherapy, clients will disclose personal information. It may go without saying (but we are saying it anyway), clients will expect confidentiality. Your therapy boundaries are likely to reflect where, when and how you might have to breach confidentiality and also how you will respond to a client who breaks their own confidentiality. For example, you might do some great work with a client for smoking cessation and they talk about it later in an interview and mention your name. Do you consider yourself then free to talk about this? Or maintain your originally stated confidentiality?

On the topic of disclosing information, some therapists share their own personal life experiences. This may be to show to a client that all humans, even therapists, have failings or challenges; a concept sometimes associated with humanistic and existential psychotherapy approaches. However, other theoretical perspectives, including psychoanalytical (Freudian, Jungian) consider therapy a mirror for the client, so don’t generally promote self-disclosure. Apart from the clinical approach perspective, there is also an ethical component, including whether it is appropriate for the therapist to be using the client’s therapy time to talk about themselves. Furthermore, there is a business point to also consider. A client may not respect session confidentiality, nor is there any obligation for them to do so, unless perhaps it is explicit in your therapy contract. Therefore, if, as a therapist, you disclose something of a personal nature, it could end up spread across the media or social media. Do you really want the world (including your peers) to know that you too had erectile dysfunction?

As well as boundaries relating to client’s information, therapists may also wish to have boundaries regarding the types of clients who they will or will not work with. This may be certain personality types, such as those with narcissistic behaviour, or poorly controlled anger, or even certain conditions, such as psychosexual disorders, addictions or fetishes. Remember, you don’t have to work with every single client that contacts you for a session – you’re in charge of which clients you choose to work with, and which you might choose to avoid working with.

How you interact with your clients is something you are also likely to consider within your therapy boundaries. Do you have defined ‘office hours’ during which you answer/return client phone calls and emails? Or do you tend to reply whenever you have a moment. If you reply to client emails at 11pm at night, they may come to expect it, and even become upset when you do not respond immediately. An additional point to consider here, particularly if you work from home, is whether you will accept clients ‘popping in on the off-chance you are free’, or calling round whenever they want to tell you something. Do you really want someone knocking on your door at 2am because they have had an argument with their partner? Having boundaries here can help you to avoid unwanted situations, and will ensure that you are able to maintain distance from clients when you are out of working hours.

Taking a positive perspective for a moment, perhaps your therapy sessions have been so exceptional and wonderful that your client wants to give you a gift or gratuity. Do you accept gifts from clients? If so, is there a limit? Would you be okay with a box of chocolates, some flowers, or maybe a cash tip, such as an extra 20% of your session fee? How about a brand new £1,000 phone? Or a £100k car? Does the client’s motive for giving you the gift get factored in? If they are doing it to ‘buy’ your silence (even with a stated confidentiality policy), is that as acceptable as if the client is just truly grateful you helped them overcome a significant problem? Whether you accept gifts or not can be worth thinking about, just so you know how to respond if and when it happens.

Finally, where (if anywhere) are your boundaries regarding personal relationships with clients? How would you respond to a client who invites you to a party? Or the theatre? How about a week on their yacht, or in their European villa? Would it make a difference if you are no longer seeing them as a therapist? Then, beyond a friendship, how would you feel about engaging in a potentially intimate relationship with a client? Can a client (or ex-client) relationship ever truly transition from client-therapist to an equal romantic/sexual partnership, or does the client-therapist relationship exist, in some form, in perpetuity? Is it a case of ‘once a client, always a client’? These relationship-related conflicts of interest can be even more broad than just friendly or romantic relationships. For example, imagine that you work with a lovely client who is a surgical consultant, and you help them to deal with an addiction (successfully). Then, a couple of years later, you are referred to a consultant for surgery and find it is your ex-client? Can you change relationships then? Would you be comfortable swapping roles? Would you want to even if you could?

You may find that as you develop as a hypnotist or hypnotherapist, limits and rules you set yourself for how you deal with therapeutic relationships, may change. You may start off with very loose boundaries, perhaps oversharing personal information, finding it hard to tell clients when their behaviour is unacceptable (e.g. rude, not paying, late arrival). Alternatively, you might start with overly rigid boundaries, where you might seem distant or detached (emotionally, physically). However, over time and with experience, you will begin to refine, develop and tweak your healthy and flexible therapy boundaries, knowing and understanding your professional needs and being able to communicate them effectively. When you do this, you will find the results make your therapy business much easier to manage, and you will feel secure in the knowledge that your boundaries are there to support you (and your clients) just when you need them.

 

We hope that this blog about developing boundaries as a therapist has been helpful. If you have any questions about this topic or anything else for that matter, do please get in touch, because we’re always happy to help!

– written by Dr Kate Beaven-Marks
(HypnoTC Director)

Dr Kate Beaven-Marks HypnoTC the Hypnotherapy Training Company

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