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The Therapeutic Relationship

This rant was triggered by a friend's retelling of an earlier experience with talk therapy.

The relationship between a client and a professional talk cure person (therapist, counselor, psychologist, whatever label) is not one of equals. One of the ways that it's not equal is that the professional has most of the responsibility when it comes to maintaining boundaries between the two # people in the room.

If the client already had good boundaries and could easily and appropriately enforce them with an authority figure whose good graces they are dependent on, they likely wouldn't be in the room to begin with*. Maintaining both their own and the client's boundaries is one of the things that professional training prepares the professional talker for.

This is also one of the reasons why talking to an average pro yields more healing than simply talking to a friend. Talk therapy can be frightening and painful but it's the pain and well-supported fear of opening up to healing. It's not supposed to be the pain and fear of fending off codependent mothering, rescuing or sexual advances.

Really all that's required of the client is that they try to engage with their own process and that they don't get aggressive or threatening toward the talking cure pro.

#=In group or family therapy the pro also needs to keep an eye on the clients' boundaries with each other.
*=Doesn't necessarily apply to supervision, ie when two or more pros talk to each other.
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This is an Enlightening point of view. May I bookmark this and potentially use this in my research? I'm looking at the effects of early childhood abuse in pregnant women, and how a midwife may be of support.

Sure. It's public for a reason.

Did you see the research on bullied mice, published recently?

Spontaneously, a useful skill for midwives to have is to be able to see when somebody with PTSD has been triggered. There's a pretty good chance that the expectant mother, partner or family members can be triggered during a birth.

Also, regarding midwives... :-)
It's not supposed to be the pain and fear of fending off codependent mothering, rescuing or sexual advances.

I agree with you there.

I think if the therapist got into any of that, or felt a pull to do that, they'd be better off taking themself to supervision to explore what's happening. Supervision can be a good container for that, rather than just acting something out with the client without awareness, and compromsing the work as a result. Sometimes there may be useful information for the therapist about the relationship with the client, if the therapist has those feelings towards the client. And sometimes that is basically about the therapist's stuff more than it has to do with the client. Good supervision will help the therapist to figure out what's going on, and to hold the boundaries.

I'd add that even in supervision, there has to be attention to the boundaries. I have, sadly, heard of cases where supervisors misbehave with supervisees, have an inappropriate sexual relationship with them, or otherwise mess them about. Supervision with bad or non-existent boundaries can also be damaging for everyone. Not least because that may leave supervisees with a messed up sense of what good boundaries are, which they may then take into their own work with clients.

Re: equal, I would see that slightly different. I think of it as a horizontal relationship, in that both parties have responsibilities, AND those responsiblities may not be the same on either side. For instance, the client pays the therapist for his/her time. The client agrees not to physically assault the therapist, or damage the room, agrees what to do about cancellations or breaks, and so on. The therapist is there to attend to the client's process, rather than to expect emotional gratification from the client, or trying to exploit the client for their sexual gratification, or to work out their issues on the client, and so on.

I like how one BACP paper on ethics put it: the therapist is responsible for attending to the therapeutic frame, and the client is responsible for making any changes in her/his own life.

So the therapist has to carry out a clear process of contracting with the client.

I've had clients who come wanting me to wave a magic wand and make it all better, or to tell them what to do - and it's my job then to say I can't do that. And then we explore what it's like for them that I can't do that. If they really want that from someone, they'll have to look for it elsewhere. If not, then maybe what I can offer by way of therapy is a joint exploration in which we both play an active part (and again, may have different responsibilities.) That's one way I feel it can be more equal.

And also, sometimes we may have moments of existential meeting, where we're primarily two human beings sitting together. If that happens, those moments are supported by the therapeutic frame, by attending to boundaries, being committed to maintaining a non-exploitative presence with the client, and so on. We can't have one without the other. If the therapist starts exploiting the client sexually (or financially), or inappropriately rescuing them, or acting out some kind of codependent behaviour, then that destroys the possibility of those more equal moments of meeting in the relationship.

Anyway, that's my take on it. I think even with variations between different kinds of therapies, I would, as a client, be wary of a therapist who cannot carry out clear contracting, or who cannot or will not discuss boundaries when that is appropriate.
Thanks for contributing, Mae. It's good to hear what the experience is for people who have several roles in this context.

The supervisor/supervisee situation you describe sounds prone to ethical missteps.

Really like the concept of clear contracting between client and professional.