The 5 Limits That Should Not Be Broken In Psychotherapy
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 it.
It is necessary that these red lines be known and respected from the first moment psychotherapy begins, both by the patient and his therapist.
And it is always There are some limits whose transgression is much more serious and detrimental to the therapeutic process. and the psychological and emotional improvement of the patient than others. Therefore, below we will see what they are.
Why is it necessary to clarify boundaries in psychotherapy?
It is not an easy task to define what the limits are in psychotherapy, since there are cases in which a chance encounter could occur outside of therapy (e.g., meeting in a restaurant or supermarket, meeting at a party, etc.). etc).
However, there are other types of encounters and relationships that are avoidable; For this reason, it is necessary to establish clear limits in the psychotherapeutic relationship, given that it is a type of relationship very different from any other, as it occurs in a space where the patient usually opens up emotionally with his therapist and, for that reason, another type of relationship outside of therapy could affect the course of it.
It is essential that the limits of psychotherapy are marked and clarified by the psychotherapist from the beginning, since in this way it can be facilitated that the therapeutic process is carried out in an environment that transmits security to the patient and, with this, they feel trust. precise enough so that the sessions can be fluid and benefit from psychological therapy.
Differences in limits between different therapeutic approaches in Psychology
There are various approaches to psychological therapy and, although in most there are common limits, there are also limits that exist 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 office where the sessions are held.given that to work with certain phobias, the most efficient method is through exposure to the feared stimulus in a real context.
Something similar happens with physical contact, an act that, if justified, may occur during therapy sessions from a gestalt approach, while in other psychological therapy approaches, such as psychodynamic, physical contact does not occur. is recommended.
Another example of the difference in limits that exist in the various models of psychotherapy are lThe self-disclosures that the psychologist makes during therapy sessions about some aspect of his or her personal life that is related to the patient’s issue that is being addressed at a given moment, this being allowed in therapy that follows a person-centered approach; However, in other therapy models it is prohibited for the therapist to share information with the patient about 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 being carried out. However, there is no doubt that from the first moment the therapeutic process begins these limits must be clear, so that both the therapist and the patient respect them.
With all this, for the therapy to be beneficial, the psychologist must actively listen to his patient in order to understand, from a broad and impartial perspective, what is happening to him and in addition, he must use therapeutic techniques of a appropriately and use the best clinical judgment possible, maintaining professional secrecy at all times through confidentiality with your patient.
On the part of the patient, it is necessary that he attend all the scheduled sessions that he has agreed upon with his psychologist, respecting the schedules and punctuality, and strive to follow the guidelines that he has received in session to carry out in his daily life. It is also important to 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 one that It occurs when the psychologist or psychiatrist and his patient maintain, in addition to the therapeutic relationship, another type of relationship.. This other relationship they have could be social (whether 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 ended.
There is no doubt that maintaining intimate relationships would be, among all the variants of dual relationships, the most inappropriate. The fact of transgressing the limits of therapy, reaching these types of relationships outside of therapy, would cause 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 his former patient to maintain any other type of relationship since the image that patients have with respect to their therapist is still important. and, by extension, mental health professionals in general; Furthermore, this could impact a possible psychological therapy process that may be needed in the future, even if treated by another professional.
The main limits in psychotherapy
In research on the topic of limits that should not be broken in psychotherapy, a series of dimensions that could put the development of the therapeutic process at riskpromoting the transgression of limits: the place where it is carried out, the fees and gifts that the patient could offer to his therapist, among others.
1. Clarify from the first moment what the place of therapy is
It is convenient that all sessions carried out throughout the entire therapeutic process be carried out in the same placewhich is usually the therapist’s office.
There are exceptions regarding this point, such as the live exposure techniques, already mentioned above, where the patient needs to be in the real context of the phobia to be treated for the treatment to be more effective.
Another exception would be if the therapist has considered it beneficial accompany individual therapy sessions with group sessions, in which you must go to another room; In which case, as long as the patient has accepted it, it is possible to change the place of therapy during these sessions and other therapists may also intervene.
Except in cases like these, the therapist and the patient should not have any contact outside of therapy sessions and all sessions should take place in the same place.
2. Referral to the therapist’s private office
It could be the case that the patient is receiving psychological assistance from the public healthcare system, where the frequency of sessions is usually lower, given the high demand, than in private healthcare; Therefore, the patient could ask the therapist to come to his or her private consultation in order to receive psychological care more frequently and with longer sessions.
In cases like this, so that the therapeutic framework is not affected, It is advisable for the therapist to advise the patient to continue with their sessions in the public systemalways respecting the patient’s right to decide to go to a private consultation in the event that the frequency with which they receive 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 healthcare, but it is not legal if it is the therapist who recommends changing, in order for him to go to his private consultation.
3. Gifts
The therapist must reject any gifts that the patient might offer as a form of gratitude.unless these were small gifts with a symbolic price, in which case I could accept them.
However, the therapist must also assess whether accepting that gift, even though it has a negligible economic value, will have an impact on the therapeutic relationship.
In the event that the therapist feels, in some way, the obligation to reciprocate his patient by expediting the delay between sessions or similar favors, it would be more advisable for him to politely reject the gift and correctly explain to the patient that these types of gifts could harm the process of your psychological therapy. This way the therapist would take off that pressure of having to be grateful and this would not have a negative impact on the therapeutic process.
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In the case of private consultations, Patients must respect the fees stipulated for each therapy session and try to pay them within the deadlines agreed with the therapist.without haggling or trying to negotiate.
You should never give a gift in order to pay the price of the therapy, thus replacing the payment with money for the fee corresponding to the sessions.
5. Physical contact and personal disclosures from 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 his therapist, such as the context of psychotherapy, it can sometimes happen that the patient, without bad intentions, , go so far as to break certain boundaries (e.g., asking the therapist personal questions about whether he or she has children or is married, about his or her hobbies, etc.); also being able, in some cases, to give the therapist a hug, as a way of thanking him or her at the end of the session.
In the face of these types of events, even if they are well-intentioned on the part of the patient, the therapist must resolve them by positioning himself in the role that corresponds to him, as a mental health professional, and thus stop giving rise to misunderstandings, in which the patient could feel so confident that they think they 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 her private life are not appropriate in therapy.
However, there are therapeutic models, such as some found within the humanistic current, where the therapist’s self-disclosures can be used as a therapeutic resource at certain moments in order to facilitate the therapeutic alliance with the patient.
Also, Sometimes, they are necessary as a therapeutic resource with children and adolescents who show reluctance toward the therapist. so that they feel more confident and this facilitates the therapeutic process
Regarding hugs, it will not have a negative impact if, at a specific moment in which they need it (e.g., when they are going through a grieving process), the patient gives a genuine hug to the therapist; However, the therapist must make it clear to the patient that this should not become a habit in the sessions, nor a way to say goodbye after each session.
The most convenient way to say goodbye and greet at the beginning of each session is through words, accompanied by gestures that show openness and serenity, on the part of both; also it’s okay to shake hands.
Making the limits clear in cases like those mentioned recently is not comfortable for the therapist, but it is necessary because if it is not done from the first moment, the limits could be broken on more occasions, making it increasingly difficult. stop them. Therefore, it must always be clear to both that their relationship must be exclusively therapeutic.
