"Was this the Right Choice?"

If I had a dollar for every time I have asked myself this question as a therapist, I'd be very rich... and I'm sure my fellow mental health professionals feel the same way. Especially being relatively early on in my career, the self-doubt runs deep when things get tense. These past few weeks were a prime example of that. Collectively, clients are going through a lot right now, which sometimes translates to a bit more pressure on us. We need to be more compassionate and more present than ever. Our clients are coping with their own conflicts and mental health issues, as well as dealing with collective trauma after collective trauma as the world goes through its own sh*t.

So where do we draw the line with our clients and learn when to meet them with extra compassion and when to hold boundaries?

This question was raised for me after multiple incidents with clients pushing the boundary of respect and of the therapeutic relationship. As a therapist, I have always kept it calm and professional. But honestly y'all, sometimes as a human I am exhausted.

After one of these incidents led to an early discharge, I made sure I covered all my bases to ensure I had made the right decision. But the doubt certainly crept in and I had a moment that I'm sure many can relate to where I began to obsessively ask myself "Was this the right choice?" Fortunately, I have an incredible management team to rely on and consult with and a wonderful supervisor who never holds back in challenging me. So here is my reminder to you:

Just because we are in the middle of a global pandemic and dealing with collective trauma, that does not mean boundaries can be tossed aside. Enabling is not equivalent to compassion.

We are not doing our clients any favors if we don't provide them feedback on the ways in which their behavior self-harms and harms others. And we are not doing them any favors if we allow them to direct harm towards us without understanding consequences for boundaries crossed. If we don't model healthy boundaries in our therapeutic relationships, our clients may struggle to experience/apply/respect healthy boundaries in their own relationships.

Is a client pushing the boundary with you in session? Are you feeling disrespected or like a professional line is being repeatedly crossed?

1. Point out the behavior to your client.

2. Explain how that behavior has impacted you and/or the therapeutic relationship.

3. Explain the consequences for that boundary being crossed again. In my case, with certain clients who begin using insults or curse words directed towards me as a method of releasing their anger, I have had to come to an agreement with them that if a session takes a turn in that direction and they are not receptive to feedback, the session will need to end early.

4. Follow through with the discussed consequences if the boundary is crossed again. Discuss and process in next session.

5. If this is happening repeatedly and client is not progressing, consider a higher level of care or a transfer.

6. Don't ever discharge a client without making some kind of referral or ensuring that they will have continuity of care elsewhere.

Sending love and empowerment to all of the mental health professionals out there. You are heroes.

Your hustler,

Karina G.

MSW