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.