Jeff Levy, LCSW
Mental Health, Relationships, Trauma, Identity
Jeff Levy, LCSW
(originally posted on Branching Out: The Live Oak Blog, February 2014)
Marty consistently talked about his garden each time we met for therapy. It was his greatest source of pride and, since he retired, where he spent most of his time. He described it in great detail, often telling me about new plants he had bought or perennials he had transplanted. He brought in pictures of his garden frequently and eventually asked me directly if I would come see it.
Rob had been in therapy several times before seeing me. He was insistent that it had helped, but he wanted to work on some very specific issues that he read were areas of expertise for me. In our initial phone conversation, he shared that he lived several hours away and it would be extremely difficult to see me weekly. He also shared that he lived in a small community and he didn’t want to see anyone with whom he may have contact in his daily life. He asked if I would consider seeing him for two-hour sessions, once per month.
Erica was 13 when she first came to see me. She had experienced some physical trauma as the result of a car accident. Medical complications arose and when she returned to school, she endured excessive teasing and ostracism as the result of a limp. This quickly developed into anxiety and depression—ultimately escalating to a phobia around school. We worked to develop skills to manage the anxiety. As the anxiety abated, so did the depression. We also worked with school social workers to provide support for Erica when she returned to school. After several months of therapy, she returned to school and completed the year. Her family called and asked if I would attend her eighth grade graduation.
And there was Paul. He had a significant history of loneliness and alcohol use to medicate his sadness. He was court ordered to see me after a urine drop for work revealed he was inebriated. He saw me for weekly therapy and despite his reduction in drinking, he was scared to attend an Alcoholics Anonymous (AA) meeting. He said he knew no one, was concerned he would feel as isolated in a meeting as he did in his life. We worked for several months on developing strategies for him to attend a meeting. He left his apartment on a number of occasions but couldn’t get himself out of the car when he arrived at the meeting. Exasperated and depleted by his efforts, he asked if I would be willing to attend one open AA meeting with him.
Being Asked to Cross a Boundary
While each of these people was seeing me for a different reason, each was asking me to do something that on some level seemed forbidden. They were asking that I cross a boundary.
Early in our training as therapists, we are taught the importance of maintaining professional boundaries. Many ethical codes talk about avoiding “dual relationships” with a client. “Dual” is defined as having some type of relationship with our clients outside of or in addition to the therapy relationship. We are also taught about setting clear limits about what we can and can’t do as therapists. We are taught to start and end sessions on time. We are taught to be cautious about any kind of physical touch in a session with a client. I am a proponent of professional boundary setting, though I’ve come to believe there is a difference between crossing a boundary and violating a boundary.
The Real Reason We Have Boundaries
I remember talking with my colleague and now Live Oak partner, Bruce Koff, about this very subject about 20 years ago. I was facilitating a men’s psychotherapy group that had an explicit boundary about contact outside group sessions. All the men had signed a document agreeing they would not have any purposeful contact with another group member outside of the group meetings. Through a discussion in group one day, I had come to learn that some of the group members were socializing outside of the group. Some had attended several movies together. Others had gone to lunch. This came out in a session while reiterating the agreements of the group with a new group member.
While I’d like to think I handled the session with grace, I was having a frantic internal dialogue: “How can this be happening? Why are the men doing this? What am I doing wrong? This group is doomed!” These were thoughts I shared with Bruce as I asked for feedback. I remember him very kindly looking at me and with a great sense of calm he said: “Jeff, we don’t have boundaries so they are never crossed. We have boundaries so when they are crossed, we have a context within which to discuss the crossing.” This wasn’t taught in graduate school, but it made complete sense.
The next group session we had a very explicit and intimate conversation, without judgment or shaming, about the boundaries in the group and how/why some of the men had chosen to cross them. Some expressed loneliness as a motivator. Others expressed feelings of such safety and intimacy that they couldn’t only relegate these to an hour and one-half weekly. And still others who did not cross boundaries talked about feeling betrayed and left out, and how this resonated with other experiences in their lives. It was no surprise that at the conclusion of that session, the group felt stronger, more cohesive, more intimate, and more capable of discussing their relationships.
Making the Decision for a Crossing
I’m still a proponent of clear boundaries. I’ve learned that having boundaries creates a sense of safety and predictability. And I’ve learned that there are times when crossing a boundary is a reasonable choice. It is one that, with discussion and clarity, can strengthen a relationship, expedite treatment, and punctuate change.
I went to visit Marty’s garden. It was an extension of him. Seeing his garden with him was like seeing into the most vulnerable and unguarded parts of himself. I agreed to see Rob monthly for two hours each meeting. Instead of feeling disjointed by monthly sessions, we found that in two hours, we were able to move at a relaxed pace, and he was able to feel safe coming and going from our sessions, not worrying about being seen. And he engaged in considerable reflection in the weeks between sessions. I attended Erica’s graduation—though I only attended the ceremony and not the party afterward. Through attending, I acknowledged the changes she had made through some very painful and trying times. And I attended an open AA meeting with Paul. I could have continued to talk for several more years about developing strategies for attending a meeting, or I could simply go with him once—with the understanding that it was a one-time event. I was there to support him as he exposed more of himself to a room full of strangers which had previously seemed both formidable and impossible.
Crossing Without Violating
Over the years I’ve come to understand that what I was taught about boundaries served as a context through which to talk about crossing boundaries. Crossing a boundary does not automatically mean a boundary has been violated. After all, who discovered that 50 minutes was the ideal amount of time for a therapy session? Who said therapy should occur only in an office? What makes weekly sessions the norm, and those who ask for less frequent or longer sessions suspect? Of course I have parameters about how I do my work, but I am more open to experimenting with alternatives; crossing boundaries that result in better work for and with my clients.
And crossing a boundary is different than violating one. At a minimum, violation implies malice, a lack of consent, and a motivation to benefit the person who steps over the boundary than for the person who is on the other side. Crossing a boundary occurs when the parameters are clear, a discussion ensues, options are explored, and the choice to cross the boundary is explicit. Ideally this conversation occurs before a boundary has been crossed. Though sometimes it comes after the crossing. Either way, the crossing has, at its core, a therapeutic intention or outcome.
I remember many years ago I was in a piece of performance art at a small local theatre. It was my first (and only) venture in this type of art. I was extremely nervous. All of my family lived out of state and couldn’t attend any of the performances. My therapist attended though. It was one of the most powerful interventions she had ever “planned.”
“Think of your head as an unsafe neighborhood. Don’t go there alone.”
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