I’m Just Fantasizing
Fantasizing about your patient is not a crime. But it is a great opportunity for self-observation and introspection. We can become aware of our attraction to our patient by our small behaviors such as refreshing our makeup or wearing our favorite tie. Sometimes our attraction can be puzzling to us. Almost as if we’re under some spell by the patient who may not be our typical type. In situations in which we feel confused by our attraction, the therapist may become projectively identified with the patient’s disowned attraction to the therapist. Here, the patient unconsciously disowns or represses their attraction to the therapist, which can be linked to deeper, unresolved issues or unmet needs. This unconscious attraction is then projected onto the therapist, who may, in turn, unconsciously identify with or respond to these feelings—this is where the concept of projective identification comes into play. The therapist might begin to experience or “own” the feelings that the patient disowns, potentially leading to the therapist feeling attracted to the patient, or experiencing discomfort, confusion, or even guilt.
I’m Crossing boundaries
In therapy, crossing small boundaries can sometimes occur subtly and unintentionally. These might not involve clear ethical violations but can still impact the therapeutic relationship. Here are some examples of small boundary crossings:
1. Self-Disclosure:
Example: The therapist shares personal information, like talking about their own experiences with similar issues the patient is facing. While some self-disclosure can be beneficial, over-sharing or making the session about the therapist rather than the patient can blur boundaries.
2. Extended Sessions:
Example: The therapist consistently allows sessions to run longer than the scheduled time. While it might seem like the therapist is being generous, it can create expectations and dependency, leading to blurred professional boundaries.
3. Physical Contact:
Example: A therapist gives a supportive touch on the arm or a hug without ensuring it’s within the patient’s comfort level or considering the therapeutic context. While not inherently inappropriate, physical contact in therapy should be approached with caution.
4. Overstepping Professional Limits:
Example: Offering advice on matters outside of the therapist’s scope, such as giving financial advice, or getting involved in the patient’s personal life in ways that are not directly related to therapy.
5. Gift Exchange:
Example: Accepting or giving small gifts. While this might seem harmless, it can complicate the therapeutic relationship by introducing elements of reciprocity that aren’t part of the therapeutic contract.
6. Language Use:
Example: Using overly casual or informal language, jokes, or slang that might reduce the sense of professional distance. While establishing rapport is important, too much informality can blur the therapeutic boundaries.
7. Social Media Interactions:
Example: Accepting a friend request from a patient on social media or following them on a personal account. Even if there is no direct interaction, it can lead to boundary confusion and privacy issues.
8. Talking About Other Clients:
Example: Mentioning other clients in a general, non-identifying way. Even though confidentiality isn’t broken, it can create discomfort or a sense of competition or comparison for the patient.
9. Responding to Personal Questions:
Example: Answering questions about the therapist’s personal life (e.g., marital status, beliefs) when the patient asks. While it may seem like harmless small talk, it shifts focus away from the patient and can affect the therapeutic dynamic.
10. Accepting or Offering Favors:
Example: The therapist might offer to drive the patient home after a session or accept an offer from the patient to perform a small favor, like fixing something in the office. This can create a dual relationship that complicates the professional boundaries.
11. Communicating Outside of Sessions:
Example: Engaging in non-urgent communication via text or email outside of scheduled sessions, such as casual check-ins or chatting about personal matters.These boundary crossings can seem minor in isolation, but they can accumulate and potentially lead to larger boundary issues if not addressed. Therapists need to remain vigilant about these small crossings and reflect on their potential impact on the therapeutic relationship.
I crossed the boundary
Engaging in any form of sexual relationship or activity with a client is a clear boundary violation. This includes both physical and emotional sexual involvement during or after the therapeutic relationship. You will likely be feeling confusion, guilt and shame and these feelings can make you feel very hot and cold toward the patient. If you have crossed a sexual boundary in a therapeutic relationship, it is a serious and ethical breach that requires immediate action. Addressing this situation involves a combination of personal accountability, professional responsibility, and legal considerations.