by Judy C. Roberts, MA, LMHC

What is the appropriate role of the therapist? The dynamic view of psychotherapy includes the assumption that when clients enter psychotherapy and the transference relationship emerges, the client struggles with the unconscious wish to view the therapist as an ideal parent who will gratify all the client's childhood wishes. The struggle manifests itself in a variety of situations and it is the responsibility of the therapist to recognize that struggle and respond to it in clinically and ethically appropriate ways. We as therapists must find a balance in responding to our clients that optimally meets their needs in a way that facilitates growth without falling into behaviors that attempt to gratify childhood fantasies of a "perfect parent," and which violate clinical and ethical standards of practice. That balance is generally defined in terms of role boundaries. The following are boundary issues that periodically cause confusion for clinicians: Time The therapist must define the limits of the session, a clear beginning and ending time. This provides structure and containment for our clients and when adhered to serves as a reassurance to clients that they will only have to endure the stress of the treatment process for a set time. Place It is generally accepted that therapy takes place in the office of the therapist. Exceptions are usually boundary crossings, although not always harmful. There may be appropriate circumstances in which a therapist might accompany a client to court, make a home or hospital visit, etc. All such exceptions to the recognized norm should be documented in detail. It might be wise to consider having another individual present in a client's home should you decide to do a home visit. Sessions held during lunch frequently precede sexual misconduct on the part of the therapist. While clinicians might assert that therapy is actually going on during lunch, it seems clear that the lunch also routinely contains social behaviors. Lunch doesn't look like therapy to a jury. In the same way, conducting therapy in a car has the appearance of something else and is definitely a boundary crossing. However, the theoretical orientation of the therapist may significantly determine whether a certain circumstance is a clinical boundary violation. Under certain circumstances a behaviorist might accompany a client in a car, an elevator, an airplane, or even a public restroom when treating specific phobias. Money It is the payment of money that defines the business nature of the therapeutic relationship. We must keep in mind that this mysterious stuff we do with clients is work, not love. When a clinician appears indifferent to making a living, ethics committees and the courts wonder whether the client is paying in another form of currency. We might make a decision to see a client for a reduced fee or on a pro bono basis. Consciously making such a decision and discussing it with a client is a very different matter than letting a bill lapse or a debt to accumulate. Generally a therapist's reluctance to discuss payment owed the therapist is the therapist's own unresolved money issues. Once the therapist begins experiencing resentment or anger over an unpaid bill, it becomes very difficult to disengage from the counter-transference feelings. All therapy conducted for the client's benefit ceases. Although ethics codes do not strictly prohibit bartering, they all caution against it. Bartering blurs the boundary between payment and a gift and creates a situation that is ripe for misunderstanding and confusion. Clinically and ethically it is much safer to agree to take a case for a reasonable fee or to make a decision to see a patient for a low fee (even $2), than to enter into a bartering arrangement. Favors If a therapist accepts favors from a client, i.e., running errands, financial or investment advice, providing lunch, access to discounts, etc., the situation easily begins to feel exploitive to the client and destroys therapy. Self-Disclosure Self-disclosure is always a boundary crossing. However, it might also prove useful in strengthening the therapeutic alliance when a therapist acknowledges having shared a similar painful life experience. Any self-disclosure should trigger careful self-scrutiny regarding one's motivation for a disclosure. We must be certain that our reasons are not related to unfulfilled needs in our private lives, even if that need is for our clients to see us as a "real person." Self-revelation of personal fantasies or dreams; social, sexual, or personal financial details; specific vacation plans; expected births or deaths in the family, etc., is usually burdening the client with information. If charged with misconduct, how would we explain our client's knowing so much about our personal lives? Physical Contact Given the legal risks we take in providing therapy behind closed doors, it would be prudent of us to limit our physical contact with clients to a handshake. If you touch your clients in other ways, such as an occasional hug, you should be considering the question of "Why?" There certainly may be times when a touch or hug are OK for a particular client, under certain circumstances, but clinically and ethically we must be acting on a conscious choice. Often times we hug clients as an attempt to make up for the absent physical contact normally offered by a parent. If this is the reason, are we, in effect, short-circuiting the normal grieving process regarding childhood deprivations? Or perhaps we hug our clients as a way to dispel our own discomfort with their pain and loss. Finding the appropriate role of the therapist can be a challenge. In general you are likely on solid ethical ground if you can identify a body of professional literature that supports your boundary practices, if you can provide a clinical rationale for your behaviors, and if you include risk-benefit documentation in the client's treatment record.