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Psychotherapeutic Boundaries

One of my lifelong priorities has been to demystify the language of psychotherapy. Academic terms and jargon more often make the therapist sound impressive rather than help the patient get better. “Make it simple and down-to-earth for me,” is something I say a lot – to fellow therapists and to my patients, as well. Vague confusion doesn’t do anyone any good.

So today I want to demystify two terms in the psychotherapy profession. These thoughts come straight out of my thesis of 38 years ago. The terms I’m talking about are the external boundary and the internal boundary.

Part of a psychotherapist’s job is to set and control the external boundary for their patients. This means – as simply as I can put it – that it’s my responsibility to create and maintain a safe and beneficial space for my patients. This setting will give them the best chance to understand and resolve their challenging personal issues. Part of the space is my office. Patients must be able to feel physically safe. This includes the promise to complete privacy and confidentiality.

The other “space” that’s part of the external boundary is the structure of the therapy I provide. Working within their budgets as best I can, I determine how many sessions, lasting how long, and happening how often, are needed to give my patients their best chance for success. I also set up scheduling and payment methods to help my patients be more accountable for their progress and success.

The internal boundary of psychotherapy, however, is less directly under my control. It is more like a delicate partnership with my patient. Patients cross the internal boundary to reveal to me their pain, wounds, struggles, and fears. They reveal their traumas from the past and the present and their hopes for the future. These revelations allow me to get to work – helping them address issues, resolve pain, and create a better life and relationships.

But crossing the internal boundary can be complicated by many, many things. Patients can feel shame and have trouble being honest. Patients can want to blame others or events and deny responsibility for themselves. Patients can be in denial, or disconnected, or just plain don’t know how they feel or why they keep making a mess of their lives.

Over my years in practice, I’ve developed ways to help people cross the internal boundary, discovering and revealing their most deeply held pain and secrets so that they can heal. I believe this is where psychotherapy goes beyond having a toolkit. Yes, tools are necessary, but there is an art to using them. In this area, I can always improve.

Trauma Therapist Podcast

Townsend Article Pictures 001Last week I had the very great pleasure of being interviewed by Dr. Guy MacPherson. Guy is a clinical psychologist and the moving force behind the West Coast Trauma Project, a website dedicated to raising awareness of trauma and helping trauma therapists thrive. “My goal with the West Coast Trauma Project,” Guy explains, “is to help other trauma therapists thrive – through providing actionable information, community building, inspiration and support.”

One of the resources Guy offers on his website is the Trauma Therapist Podcast, a series of recorded interviews with therapists in the field of trauma. My conversation with Guy provided me with an opportunity to share from my heart about my life and work. Follow here, to listen in.

Trauma/Healing I

Trauma . . .

. . . is a visible or invisible wound.

Healing . . .

. . . repairs the wound, but there will always be a scar.

 

Reparenting

I think the best description of how I approach being a psychotherapist is to say that I “re-parent” my patients.

When I was training in psychotherapy in the 70s, reparenting was part of the classic model. I believe our profession has moved away from taking on this role but I can’t imagine doing what I do in any other way.

The people who come to see me usually have significant problems. Their traumatic issues and experiences cut deeply into who they are and disrupt their lives and relationships. I would say that every one of them suffers from seriously flawed parenting. Growing up in their families of origin included either harsh discipline, neglect, alcoholism or drug use, or some type of physical, emotional, or sexual abuse.

The people my patients loved and trusted and depended on for their lives – their parents – significantly betrayed them in some way.

There are important things they didn’t learn; they weren’t able to grow up in the right ways. They want their lives to be good but things keep going wrong for them in ways they sometimes understand and sometimes are completely confused about. They need to be reparented.

And I want to say, right off, that this role is a huge one to shoulder. To do it right, with integrity and humility, is very, very hard. The burden of responsibility to reparent my patients is as awesome a responsibility as being an actual parent of a child.

It was in the role of a parent with one of my patients last week that I needed to share one of the most difficult experiences of my life. My patient was at a critical turning point and needed to be able to learn from my example, like a good father helping his kids learn from his mistakes. Believe me, I thought about this very carefully. I don’t like sharing this story and I need to be absolutely sure that by sharing it I’m really going to help someone.

I decided to go ahead. As usual after telling this story, I ended up sweating, drained, and shaking inside. I had trouble sleeping that night.

I hope my patient heard me. Now I’ll see where he goes with it.