I've been thinking about friendship and boundaries in therapy.
BY RICK THYNE
Richard was a wealthy business man with a wife and two teenage children. He was very bright and also very broken. In the first few sessions of our therapy relationship, he told me of his impulsive sexual behavior. Two or three times a week he would pay a prostitute $500 for an hour in a high-end hotel room in downtown L.A. It wasn’t that difficult to help him see how this behavior was tied to his difficult childhood, and three or four months into our sessions he delighted in persuading me that his dalliances were over, so we moved on to focus on his family of origin, his marriage, and his relationships with clients and colleagues.
Two years into our relationship, he called in an emergency. It seemed his impulsive behavior had never slowed down, and his recklessness had finally undone him. He had never stopped the liaisons, had spent most of his children’s college funds, his wife found out and was filling for divorce, his children refused to speak with him, and his job was in jeopardy. He asked me to help him get admitted to a psych hospital because he feared he might hurt himself.
Richard was complicated for me because I couldn’t get a direct emotional connection with him. When I’d think we were finally making a solid, consistent connection he’d take off on something that led me off path.
He was very bright (obviously not smart about his life, but very intelligent), and his sociopathy made him brilliantly deceptive. I’ve known for decades that, for me, intellect is the great aphrodisiac; I thrive in the presence of smart people, because it makes me feel better about myself when I can hold my own in their company. From the start, Richard drew me in with conversations about politics and literature, films and sport, all of which I’d been a student of my entire adult life. Whenever we’d get close to his pain, whenever we’d approach his shame about his impulsivity and his rage at his punitive father, he’d find a way to talk about his business or his children’s soccer skills or, or, or: anything but the dark swirls in is soul that terrified him. If this was his way of controlling our conversations, detracting my attention from his deeper pain, it often worked.
I felt then and feel now, two decades later, like a therapeutic failure for allowing myself to be so deceived by him. The good feelings I had from our intellectual discussions numbed me to the seriousness of his wounds. I didn't see him clearly, fully, perhaps because I didn't want to disrupt our friendship. I carry a sense of responsibility towards his family for my failure to see the damage he was doing to himself and to them. It's a difficult lesson I’m aware of still whenever I have a complex client like Richard.
My therapeutic relationships with most clients through the years have been relatively easy to keep on track. Our mutual open-mindedness and open-heartedness stay focused on their broken places and my empathy and understanding that often lead them to more constructive ways of managing their lives. There is a version of therapy that says that the therapist should avoid self-disclosure, so that the conversation can be about the client's needs and doesn't get derailed by the therapist's personal story.
I think differently about this. I believe that therapy, at its best, is a healing friendship. We're in a conversation whose purpose is the well-being of the client. As a therapist, I am deeply engaged in this conversation on the client's behalf. Sometimes the pain and confusion a client feels calls forth my own history of pain and confusion, and there are moments when sharing this deep connection between us enhances the opportunity for healing.
Therapy, at its best, is a healing friendship.
However, there are circumstances where the relationship is fraught with complexities for both of us. Deep therapeutic relationships always stir up in the therapist and the client fears and expectations that took root in our pasts and have been nourished, for better and for worse, throughout our history of relationships. Not surprisingly, these past experiences often show up in both the client’s reactions to the therapist and the therapist’s reaction to the client. The technical language for these processes in therapy is transference and counter-transference.
Transference is about the feelings, often unconscious, that a client projects onto her therapist. Transference involves ancient emotional connections with a parent, sibling or other significant person that are deeply etched into a person and that remain, unacknowledged, in their unconscious. In the intimacy of a relationship with a therapist, these ancient emotions are stirred and directed now not at the person they originated with but at the therapist. This process of projection becomes a part of the client’s experience of the therapist.
Karen grew up in a family where she learned to get along by pleasing everyone and never challenging them, so she initially invested much of her share in our conversations pleasing me as her therapist, thanking me for my brilliant insights into her emotional world. What she would never say about one of my insights is I think you’re full of shit, since such direct talk in her family would have led to the worst kind of punishment, the loss of her parent’s love and approval. She was structuring our conversations around the experiences she’d had as a child. That’s transference.
If transference is about the client’s emotional dynamics, counter-transference is about the emotional dynamics of the therapist. Like my clients, I grew up with emotional habits that kept me safe and got me loved; whatever complicated feelings I had about Mom and Dad were etched into my unconscious in just the same way.
Transference and counter-transference issues are a constant reality for therapists. Because they are unconscious, neither of us is necessarily aware of their presence. One of my responsibilities in the dynamic is to constantly seek that awareness for both of us.
With Karen as a client, I was particularly attracted to her need and gratitude for my help. It stirred unconscious memories: being a seventeen-year-old boy when my mother asked me for advice about what to do about my brother. My father was recovering from a coronary episode so she couldn’t rely on him; she turned instead to me, the oldest of her five children.
I just heard from the school that Steve (my seventh-grade brother) has been sniffing glue and I wonder what you think I should do about it. At seventeen, I hardly knew how to manage the complex world of my own emotions and impulses, and was certainly unqualified to function as a young drug abuser’s parent. As crazy as this now sounds, I thought I should and therefore could come up with an answer. After all, this was my mom asking so of course I could figure it out and, once again, make her proud of me. I easily transferred this same emotional habit to Karen. Unlike my seventeen-year-old self with my mom, I was qualified to help Karen; what was familiar was my secret delight in the pleasure I got from her need for me and the pleasure she expressed when I helped her.
Transference and counter-transference issues are a constant reality for therapists. Because they are unconscious, neither of us is necessarily aware of their presence. One of my responsibilities in the dynamic is to constantly seek that awareness for both of us.
I’ve been a licensed Marriage and Family Therapist for forty years and, at eighty-two, continue to see about twenty-five clients each week. I have four colleagues with whom I meet for two hours every Thursday, to catch up personally and consult with about particularly difficult cases.
Since I choose to be personally engaged with my clients, it's helpful to consult with other experts in discerning the edges of transference and counter-transference, and where selective boundaries might be helpful for both of us. Professional codes of conduct for therapists are very clear about boundaries, mostly to protect the client from being taken advantage of financially, sexually, or simply by gratifying the therapist’s need for friendship. My instinct, like my colleagues’, is to be careful about crossing these lines, both to protect my clients and to protect myself as a therapist from charges of misconduct.
This issue of therapeutic boundaries is doubly difficult for me. I was a pastor for fifteen years before I was a therapist, and during those years I learned to have deep affection for and often intimate friendships with members of the parishes I served. I was constantly in people’s homes, knew their children, visited them in the hospital, counseled them about their marriages. Forty years after leaving the ministry, I’m still close friends with people from that era. So the boundaries therapy requires were not natural for me; I still struggle at times to mark the differences between pastoral intimacy and appropriate therapeutic distance.
There have been a few occasions when I’m certain I crossed therapeutic boundary lines and reverted to my instincts for pastoral care, though I knew what I was doing and why. On half a dozen occasions, someone in the family of a client I’ve been working with dies suddenly, often tragically. The surviving client asks if I’ll come to the service and, on those occasions when I’ve been seeing the partner who died, if I’ll speak. You know us better than anyone does, and we need your help to say goodbye to him. So I go and speak, and I’m always glad that I did.
Several clients, mostly individuals but sometimes a couple, have fallen in love or decided to get married during our therapeutic relationship. If I’m asked to attend or, on more than one occasion to officiate, I agree to their wishes. Who better to celebrate the relationship I’ve helped facilitate? And again, I’m always glad that I did.
These are exceptions I made to the boundary rules, intentionally and without regret. But I’m generally rigorous in maintaining my boundaries with clients about money, gifts, physical contact, and seeing one another outside our professional settings (all bad ideas). That’s part of the bargain in therapy, even when deep and genuine feelings arise.
Therapy begins as a formal professional relationship between emotional strangers, and often it remains just two people talking and listening and trying to help the client figure out whatever is creating their pain and what to do to relieve it and live more happily.
But if the relationship goes on for months or years, a clear friendship sometimes develops. When you spend an hour or two per week in intimate conversation, you develop a closeness that is ripe with affection and pleasure. Both of us are glad to see one another each time we meet. It’s an odd kind of friendship, since the dynamics are about the client’s needs and the therapist’s ability to help sort through the maze. But despite this imbalance, the friendship is deep and full of affection.
