Navigating the Unspoken Rules of a Therapeutic Relationship

Mannequins posed to appear as if they are having a chat over a fenceThe relationship a person has with a therapist is unique. Some people question why they should seek professional guidance when they can talk to their loved ones for free, while others who are already in therapy wonder about the unspoken etiquette, ethics, and rules of this special relationship. It is critical for those in or seeking therapy to understand the dynamics and boundaries of the therapeutic relationship. The distinction could mean the difference between a deeply healing experience and wasted time and money or, worse, retraumatization and new relational wounding for the person seeking help.

Dynamics That Bring About Healing, Change, and Growth

Unlike relationships with friends or family, the therapeutic relationship is a professional one that happens to be based on deeply personal material. Much like other health or medical professionals, therapists are bound by codes and ethics that not only lay out rules about confidentiality, but also ensure the relationship maintains the emotional safety and best interests of the person seeking help. This is different from the relationship with family and friends in that therapists have nothing to gain personally from the relationship. Any advice, questions, and even opinions expressed by a therapist are based solely on the best interests of the person in therapy. In return, people in therapy owe therapists only a sincere willingness to work toward their goals, basic relational courtesy, and previously agreed-upon fees. Although loved ones typically have your best interests at heart, they also often have their own biases based upon family traditions, cultural understandings, personal history, and the effects various outcomes may have on their lives.

Additionally, while those closest to you may know you better than a professional therapist (at least at the beginning of a therapeutic relationship), this can be a drawback when it comes to getting clear or unbiased feedback. Those who have known you over a period of time may have preconceived notions of who you are, what you should do, or how you should behave.

In contrast, therapists endeavor to see people in therapy as clearly and objectively as possible, allowing for growth, change, and healing to occur in a way that best serves a person’s needs and well-being. Specifically, therapists are trained to maintain a nonjudgmental stance with unconditional positive regard for the basic humanity of the people who seek their services. Through skill, expertise, and their own self-awareness, therapists hone their ability to support and guide people so they may achieve their highest potential. Through the therapeutic relationship, people in therapy can experience a nurturing presence that helps them feel they are being seen, heard, and responded to appropriately.

Why Boundaries Within a Therapeutic Relationship Matter

In order for the therapeutic relationship to work, it is important the therapist maintain an unprejudiced stance by setting orderly boundaries. In the absence of such boundaries, it may be challenging for the therapist to maintain neutrality and for the well-being of the person in therapy to remain the priority over the duration of the therapy. Additionally, without clear boundaries it can be harder for people in therapy to feel safe, build trust, and focus on their needs.

Boundaries are based as much on judgment as they are on guidelines set forth by various professional codes of ethics. As such, it is less helpful to describe specific dos or don’ts here, as those can be found elsewhere. What should be understood here is the intent and effect of boundaries. Yet, anytime a person in therapy feels uncomfortable about boundaries, whether they consider them too strict or too lax for their needs, they should address their concerns with their therapist. In turn, therapists should respond to conversations about the therapeutic relationship in an open and non-defensive manner so the person in therapy feels their concerns or questions have been heard, answered, and addressed fully and respectfully.

When Boundaries Are Violated or Cause Relational Disconnect

Through the therapeutic relationship, people in therapy can experience a nurturing presence that helps them feel they are being seen, heard, and responded to appropriately.

While therapists are bound by codes of ethics, and must carry state licenses and malpractice insurance, some therapists may exhibit behavior that disregards best practices and violates boundaries to the point it can be harmful to the therapeutic relationship or to the emotional well-being of the person in therapy. If you have experienced therapy in which you felt misunderstood, upset, or used in any way, it is important that you tell your therapist. It may be a simple misunderstanding or feelings that are being projected onto the therapeutic relationship, providing a tremendous opportunity for a breakthrough conversation that leads to growth and healing.

However, if you do not get a genuine and satisfactory response from your therapist or your feelings continue over a period of time, you may choose to find a therapist who better meets your needs. Ultimately, the therapeutic relationship should be nurturing, fulfilling, healing, and reparative for you, the person in therapy, within the context of professional boundaries and mutual respect.

A Professional Relationship That Comes from the Heart

Finally, I want to make a note about the therapeutic relationship from the therapist’s perspective. Although it is a professional relationship and there are clear boundaries and parameters, the connection and desire to help is no less heartfelt or genuine than in any other relationship that exists outside the office.

Appropriate boundaries allow therapists to do good work in a safe manner, but they should not be a barrier to meaningful relational connection within the therapeutic setting. Ultimately, finding a skilled therapist with whom you feel safe and connected can provide the foundation for a powerful and life-enhancing therapeutic experience.

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Tai Pimputkar, LCSW, therapist in Norwalk, Connecticut

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Monica

    Monica

    June 8th, 2016 at 9:34 AM

    My daughter’s therapist has been such a blessing to our family. She is always available but has also taught my M to stand her ground and become strong all on her own. I don’t know how we have made it through all of this turbulence without her help.

  • travis

    travis

    June 8th, 2016 at 2:56 PM

    Isn’t it so much easier when everyone is aware of the boundaries and they are willing to respect them?

  • Cassidy

    Cassidy

    June 9th, 2016 at 1:49 PM

    What can make this even more difficult is when you try to maintain those lines and then you start to feel like the therapist is the one who is overstepping and blurring them. That could be confusing to almost anyone, and especially when the person who is supposed to be the professional is the one messing things up. I think that they have to be reported and then have to be held seriously accountable for that kind of behavior.

  • Tai

    Tai

    June 10th, 2016 at 4:39 AM

    Yes, I fully agree, and that’s what motivated me to write the article. Too often, I hear from clients who have been hurt by former therapists who have blurred or crossed lines. I’m hoping to bring awareness to what constitutes helpful and appropriate therapeutic boundaries. Thank you for your comment.

  • Cindy B

    Cindy B

    June 10th, 2016 at 10:43 AM

    You would think that they are unspoken because they are mainly common sense!

  • Tai

    Tai

    June 11th, 2016 at 6:18 PM

    Yes, they are definitely common sense to some. But to others, who are unfamiliar with therapy or who have had experienced where these boundaries have been blurred, it may be less obvious. I’m hoping this may be helpful to anyone who may be wondering or wanting to hear more.

  • cade

    cade

    June 13th, 2016 at 3:50 PM

    You have to hold the therapist responsible. They are the ones for who there should never be any question, they should immediately establish clear boundaries and stick with it.
    Or if they are finding that they can’t. they should say so and help the patient find another who can.

  • Bridget

    Bridget

    June 14th, 2016 at 2:14 PM

    I have not for one moment experienced anything negative with my therapist. I feel that she is very mindful of what is going on in my life but without ever making me feel that she is being nosy or intrusive. She is letting this whole thing go at my own pace, my speed, and while she may challenge me to look at some of the harder stuff, it never feels like there is any pressure there or that she is going to force me to do something that will make me uncomfortable.

  • Jayne

    Jayne

    July 9th, 2016 at 12:52 PM

    I, too, believe in boundaries in the therapeutic relationship. However, the problem I have is that boundaries sometimes create aloofness. For example, I have been seeing my therapist for one year. In that time, she has never touched me physically. She has never even touched my hand. I am a “touchy-feely” person. I like to hug and/or touch people. I grew up in a family who never touched or hugged. I crave touch to satisfy a desire for closeness. Although my therapist exhibits empathy and compassion, sometimes it’s not enough. I feel embarrassed to bring this up in our sessions because I don’t know how she would respond. Are therapists taught to not touch their patients?

  • Tai

    Tai

    July 9th, 2016 at 9:33 PM

    Hi Jayne,
    Thank you so much for your comment. That’s a really good question, and an entire area within the topic of therapeutic boundaries that I neglected to mention. The simple answer is yes, therapists are generally taught not to touch their patients. There are several reasons for this, and they all generally stem from protecting the safety and boundaries of the person in therapy. Many people have had their boundaries violated physically and sexually, and the limited-touching by therapists helps keep the intension of the relationship clear. Touch is also generally considered to be outside the scope of training and licensing for most therapists. While it is considered to be a “best practice,” I can see how it may seem aloof and overly professional to a person who prefers friendly touch as a means of communication. Knowing this, it still seems appropriate to bring the topic up with your therapist. Though it may not change your therapist’s behavior, it may start a discussion that allows you to express your thoughts. With regard to touch, you may also want to consider seeking body-based healers (somatic experiencing, rolfing, acupuncture / acupressure, etc), or massage therapists to fill that need beyond what your therapist may be able to provide.

    I hope this is helpful. And thank you, again, for your comment. It brings up a very good point, and one I definitely forgot to address above.

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