Most therapists have been taught to set boundaries with clients. This emphasis on setting proper boundaries, especially with clients with BPD, reflects the commonly held belief that the illness pre-vents them from being able to act “appropriately” (or, even worse, makes them to want to act “inap-propriately”) and results in clients crossing other people’s boundaries, including the therapist’s.
In DBT, neither the client nor the therapist is viewed as disordered; in other words, if a client calls her therapist daily, she isn’t too needy and isn’t trying to manipulate. Likewise, the therapist isn’t too tolerant for taking the client’s phone calls, nor is the therapist having countertransference issues. Rather than pathologizing the client or the therapist for having poor boundaries, in DBT the assumption is that there is simply a discrepancy, or poor fit, between what one individual wants and what the other is willing or able to give (Cardish, 2011).
Of course there are some hard-and-fast limits that, as therapists, we don’t cross: sexual relation-ships with clients or other relationrelation-ships in which clients could possibly be exploited in some way.
(See the guidelines of your profession’s regulating body if you’re not sure what I’m referring to.) But other than these, it’s important to realize that everyone’s limits are different and that they vary depending on a variety of factors. For therapists, those factors include your relationship with the client, other stressors in your life at a given time, the flexibility you have given your job and the setting you’re working in, and so on.
Let’s look at an example: In my practice, it’s fairly typical for me to get text messages, emails, or phone calls from clients outside of session. I generally find that clients don’t use this privilege very often or without good reason—for example, when needing assistance with skills because they are feeling highly anxious, having suicidal thoughts, or trying not to act on an unhealthy urge. But I do have certain limits: All of my clients are aware that I turn my cell phone off when I go to bed, so I’m not available in the overnight hours. Nor will I take phone calls or look at texts or emails while I’m with other clients, so I may not be able to respond immediately.
But some limits are more individual. For one client I’ve been working with for about two years, I have a limit that she isn’t to contact me about a problem until she’s used some skills to try to help herself. I wouldn’t have this limit for someone I’ve just begun working with, since that client wouldn’t
have learned the needed skills yet. On the other end of the spectrum, I have a client I’ve just started seeing who’s been having difficulties completing homework outside of session. I send this client a text message every other day to remind her to do her homework. I wouldn’t do this with the client I’ve been working with for two years, as she doesn’t need that kind of support at this point in therapy.
Clearly, our limits as therapists should vary to reflect the client and the context. While you don’t want to be arbitrary and unpredictable, it’s important to recognize that limits shouldn’t be static and unchanging. You might be willing to do something one week that you aren’t willing to do the next week. You might be willing to do something that another therapist isn’t willing to do, and vice versa. That doesn’t make it right or wrong, or good or bad; it’s simply a fact of life that every-one has different limits.
SETTING BOUNDARIES VS. OBSERVING LIMITS
If you think about the term “setting boundaries” versus “observing limits,” it seems much less flexible. A boundary is more concrete and immovable than a limit. In addition, if you set a bound-ary, it then becomes the client’s responsibility to not cross the boundbound-ary, and any behavior that crosses that boundary is pathologized and considered inappropriate. On the other hand, if you observe your limits, the responsibility falls on you to maintain your limits when client behaviors might exceed them. This recognizes that it’s not about the inappropriateness of the client’s behav-ior, but about your own personal and professional preferences. Observing our limits also calls for more communication with clients. Keeping in mind that everyone’s limits are different and change-able (unlike a boundary, which is more of an immovchange-able barrier), whether in therapy or in day-to-day life, how on earth can we expect our clients to know what our limits are?
HOW TO OBSERVE YOUR LIMITS
The first step in observing your limits, as with anything, is to become aware of them. This means monitoring your level of burnout with clients and checking in on your willingness in ses-sions. If you’re judging or blaming the client, reflect on your limits: Is there something you need to change? If so, it’s important that you be honest with the client about this. If you don’t express this limit, you’re going to burn out, reducing the likelihood that the client’s therapy will progress effec-tively. Although expressing a limit to the client might be difficult, remember that it will reduce your feelings of burnout and make you more effective in the therapeutic relationship in the long run.
Don’t mistake this to mean that observing your limits is for the good of the client. It’s for your good.
Observing your limits is your responsibility, not the client’s, so be sure to make this about you (Cardish, 2011).
While of course, you need to observe your limits and communicate them to clients, it’s also important to extend your limits sometimes. For example, if you don’t typically take telephone calls on weekends but you have a client who’s struggling with a difficult situation and needs some extra skills coaching, you might tell her that she can call you on one particular weekend. However, don’t extend your limits in response to behavioral escalation (Cardish, 2011). I’ll explain this when I
Preparing for the Individual Session: What You Need to Know
27 discuss reinforcing behaviors in chapter 3, but for now just be aware that extending your limits because a client is threatening suicide, for example, is not helpful and will actually make it more likely that this will happen again in the future. Instead, if a behavior is escalating, continue to observe your limits while also validating the client’s distress and helping her find other ways to cope with the problem (Cardish, 2011).
WHAT TO DO WITH YOUR LIMITS
First and foremost, it’s important that you communicate to your clients what your limits are.
That’s not to say that you should give each client a list of your limits in the first session. For one thing, it’s impossible to foresee what situations will arise with a given client that will cause you to set limits. Some limits might need to be expressed immediately. For example, it’s a common prac-tice that if a client doesn’t show up for an appointment and doesn’t give you twenty-four hours’
notice, there will be a fee; that’s a limit. Here are some other common examples. Think about what your limits are in these areas:
• Frequency and number of sessions: Do you see clients once weekly? Once every two weeks? As often as they would like to be seen? Do you have a maximum number of sessions, or can a client be seen indefinitely? In addition to being a matter of your pref-erences, these may also depend on your employer’s policies.
• Length of sessions: How long are your sessions? Are you flexible with this? For example, if a client is in a crisis, will you extend the length of the session? Again, this may depend on your workplace.
• Phone calls: Do you take telephone calls from clients between sessions? If so, how often? Do you have a time frame for phone calls? For example, do you accept calls only during business hours, or at other times as well?
These are just a few examples, and the question of what your limits are will arise in an infinite number of ways. The key is to communicate to clients what your limits are as these situations arise.
Allow yourself to be flexible, and give yourself permission to change. It can help if you think of situ-ations in your day-to-day personal life: If a friend is twenty minutes late for dinner and doesn’t call you, is that okay, or do you let her know you would have preferred a phone call? If you prefer a phone call, that’s a limit. If a friend calls you in the middle of the night, will you answer the phone?
If not, that’s a limit for you. Maybe you have a rule that one weekend out of the month you stay at home with your partner to just spend time together and that nothing can interfere with that couple time. That’s a limit.
Of course, maybe you typically don’t like a phone call in the middle of the night, but when you find out that a friend’s mother just died, you bend that rule. Maybe you usually don’t let anything interfere with your couple time, but on a weekend when your best friend is moving and needs some help, you’re more flexible. These kinds of things happen in therapy, as well.