One of the most important lessons a parent can teach their child is about setting and respecting boundaries. Something that sets a limit or defines a line that is not crossed. Most often boundaries are a way of creating safety and for children to learn the importance of the words stop and no. Some parents are able to navigate this with ease, for others, setting boundaries is not something they really know how or choose to do. Many parents struggle with being consistent in setting boundaries and so children learn ways of being able to push and manipulate them. This has the potential for them to find it challenging in navigating the rules and boundaries they encounter when they become adults and enter society at large. 

Without sufficient and reasonable exposure to rules and boundaries at home, a child may well struggle in knowing what their boundaries are and maintaining them. There are times when not having boundaries in childhood may have served to keep some of my clients safe as they learned that resisting could mean more pain. Often adults who have problems respecting or setting boundaries have developed these patterns early in their lives. These patterns are often taken into their adulthood causing problems in their relationships. Inevitably these often emerge in the therapy room.

For me, creating a place of safety for my clients and myself is of utmost importance as I have a duty of care for the both of us. I see one of the most important building blocks to that is the ability  to have a synergetic dialogue between myself and my client, that helps to create a psychologically safe setting, from which they can explore and express all they need to. Boundaries are a vital part of this conversation as they set the basic guidelines of how both of us want to be treated and ensures that the relationship is mutually respectful and appropriate. 

Setting boundaries is not something that I do to my client, but something that we create and agree on together. They are put in place to not only protect my client, but also myself. These are vital conversations, especially as many of my clients have had their boundaries violated, whether it be emotionally, physically, sexually or spiritually. As a result therapeutic perimeters are of significant importance in supporting my clients in feeling contained, supported and safe. They protect clients from being taken advantage of, especially as most people come to therapy when they are at their most vulnerable.

Although in some ways therapy may resemble an intimate relationship, boundaries offer a structure that enables my clients to experience the therapeutic relationship as one where there are defined roles This makes it different to that of a relationship with a family member or friend. They remind the both of us that, by being therapy, there are things that our relationship will never be, but what it is can be is totally trustworthy. As a result of the inequality of power between the two roles of therapist and client not only are boundaries necessary to structure the relationship, but to protect the client from the possibility of a therapist’s unfair abuse of power.

There are some boundaries that are never to be crossed. Beyond these fundamental limits, it is also important to be flexible enough to acknowledge that, within a proper structure and purpose to the therapy, there can be some fluidity to others. Always at the forefront of my mind is the welfare of my client. Hence I take into consideration their history, culture, personality and the issues that they bring to therapy. This can allow for us to create an agreement that can, when they emerge, incorporate beneficial boundary crossing interventions that fall on the cusp of ethics and technique. These are tailored to my clients needs in order to support the therapeutic process and the healing.’Boundaries are like fences; they are man-made and are designed to separate. Their function is to “fence in” and “fence out” to include and exclude. Being man-made, they can be constructed or dismantled, heightened or lowered, and made more or less permeable.’ (Zur, 2018)

Therapy is a delicate and mysterious relationship with intense feelings and often intimate encounters that can surface during sessions. There are moments when disproportionate emphasis can be placed on small things in psychotherapy. Boundaries can assume all sorts of symbolic meanings triggering the clients sometimes childlike vulnerability in the relationship. Many times these gravitate towards the boundaries and friction about them. Each client matters enormously to me and I am clear that by having boundaries it does not mean that I have to be emotionally distant or unrealistically rigid. I believe that I can be warm, compassionate, and authentic whilst still maintaining a watchful frame around the work we do together. 

As a therapist there is a fair amount of pressure to be able to hold strong no matter what. As I can never be sure who will walk through my door and what they will bring, I have to be aware of the potential for my own personal issues to be impacted. With the help of supervision I have worked through unsettling times when dealing with erotic transference, projection, transference, counter transference and my clients unresolved attachment issues that have pushed up against boundaries. As a result I am better able to manage the moments where I feel marooned on the rocky ground of intense emotion. I like to think of myself and my clients as fellow travellers, with therapy being instinctive, the relationship dynamic and ever-evolving. I see the work that we do together in negotiating and creating therapeutic boundaries, although not always straightforward, as a privilege. I watch as my clients starting to give themselves the gift of taking care of themselves and, in turn, their relationships. I take a moment to celebrate the miracles that appear.

Zur, O. To Cross or Not to Cross: Do boundaries in therapy protect or harm. Pyschotherapy Bulletin, 39 (3), 27-32. Posted by permission of Division 29 (psychotherapy) of APA (updated 2018).

Sixteen weeks has passed and the United Kingdom is still in the midst of a partial nationwide lockdown, in response to the COVID-19 pandemic. Although the daily numbers of deaths in the UK has fallen significantly, which is good news, it is hard to forget that there have been 45,119 deaths from the coronavirus in the UK, so far, with a reported 587,000 deaths worldwide, since the onset of the pandemic. We are going through a period of confusion as England loosens its lockdown restrictions, with the Government giving conflicting messages, resulting in no one being really clear as to what we are emerging back into. There is much pressure to get the economy back up and running and for people to get back to work amidst the whisperings of an expected second wave in the autumn. We are having to make snap judgements about what is safe and what is not when, actually we haven’t really got a clue. Most of us are struggling with the confusion, unpredictability and lack of control that is permeating every aspect of our lives and that is, indeed, challenging.

Countless peoples lives have been deeply impacted by this pandemic, leading to losses of things that were previously taken for granted. There are many aspects that have rocked our sense of security and pose a significant threat to our way of living and structure. We are being challenged to be creative and re-evaluate our lives. Several of my clients talk of their lives being ‘totally thrown off course.’ For them they had felt they were on a path and whether it be as a result of losing their job, the death of a loved one, emergent problems in a relationship or just many weeks in isolation with much time to think, lives have shuddered to a stop and they perceive themselves to be totally unprepared for the next step. They no longer feel safe and secure in their external world, and suddenly their internal world is preoccupied with questions of meaning and purpose. It feels as if their sense of self has shattered and they are exhausted by feelings of loss, as they experience losing the secure footing on the path of their life, along with their joy.

Most of us will experience times of stress, anxiety and depression at one time or another, and for most, these emotions pass through quickly, without having a debilitating impact on our lives. With an existential crisis the problem lies in us starting to question our entire existence, which often means that for a period of time we lose the feeling of being grounded and secure in who we are along with our purpose. Although it is fairly common to think about life’s profound questions, the crisis occurs when in asking ourselves these questions we experience breathtaking feelings of fear, loss, sadness and frustration as we struggle to find any satisfactory answers. 

Anyone can experience an existential crisis. The common triggers are age transition, a life-altering or life-threatening event. Any of these affect all dimensions of our lives, the physical, personal, spiritual and social. Irvin Yalom an American psychiatrist, was a pioneer in the area of existential psychotherapy. He stated that mental health problems are often caused by struggles with existence. He identified four main themes that many people struggle with; meaninglessness, Isolation, death and freedom. With the trigger of existential crises often happening after something causes a person to realise their mortality or lose an ideal, it is no wonder that some of my clients are feeling a personal conflict from within, in the midst of this global pandemic. Experiencing an existential crisis is an deeply unsettling experience as it makes us question how we have lived our lives, the decisions we have made, the relationships we have chosen, our values, routines and habits and is often accompanied by questioning the point of life which can rock us to the core.

Each of us will deal with the experience of an existential crisis in different ways and as a therapist I believe we need to have faced our own dark night of the soul in order to be able to fully support someone as they travel through theirs. Yalom poses; “We cannot say to them you and your problems. Instead, we must speak of us and our problems, because our life, our existence, will always be riveted to death, love to loss, freedom to fear, and growth to separation. We are, all of us, in this together.’ (Yalom :14). Suicidal thoughts and feelings are often part of an existential crisis, where we realise that we are not the person we thought we were and will probably never be the person we wanted to become. The feelings can take us to truly dark places as time feels suddenly of the essence and the prospect of recreating the life we truly want for ourselves impossible.

David Wagoner in his poem ‘Lost’ reminds us that when we feel lost in the forest that is our life we need to stop and stand still; 

“Stand still

The trees ahead and the bushes beside you are not lost.

Wherever you are is called ‘Here’,

and you must treat it as a powerful stranger.

Must ask permission to know it and be known.

The forest breathes.

Listen. It answers,

I have made this place around you.”

The value of an existential crisis, although deeply uncomfortable, allows us to re-evaluate our lives. It is important to let go of the too big questions and break them down into one step at a time. For those willing to explore all the emotions that emerge it can lead to a revitalised way of being. By addressing our mortality we have the chance to stop and look at our lives in a way that perhaps only a crisis forces us to do. By living existentially we see how life continues on with pain, death, sadness, regret and joy no matter what happens and that there is little point in trying to avoid this truth. Living alongside this, we can start to appreciate the blessings that come from the freedom to make changes and do things differently.

With support we can lean into the fear and loss and breathe life back into our lives knowing that it is up to each of us to give meaning to our lives. As we are all connected in one way or another I receive the gift, as a reminder, that by stretching ourselves in new and creative ways our sense of self and subsequent well being grows. “In choosing to enter fully into each patient’s life, I, the therapist, not only am exposed to the same existential issues as are my patients but must be prepared to examine them with the same rule of inquiry. I must assume that knowing is better than not knowing, venturing than not venturing; and that magic and illusion, however rich, however alluring, ultimately weaken the human spirit.”  (Yalom : 13).  I feel thankful

Yalom, I.D (1989) Love’s Executioner and Other Tales of Psychotherapy. London: Penguin Group

Although having sex is a perfectly natural part of life what I see in my practise how difficult most people find it to talk about. I have witnessed how sex is far more prominent now than when I was in my formative years. I recognise how the portrayal of sex in the mainstream mass media provides increasingly explicit and frequent images that keep sexual behaviour on public view and on personal agendas, yet rarely do we see sexually responsible standards represented. Perhaps not as prevalent for today’s younger generation, but in the private lives of my generation, many are still held hostage by old religious and cultural taboos.

What I see is just how much the images of sex so widely and explicitly available impact us all in one way or another. Overtly or subliminally, sex now appears to pervade everywhere: in magazines, and newspapers, erotic and romantic narratives about sex are found in abundance. Casts of films and characters in print and TV advertising appear naturally comfortable with sex that has no consequences. So what fate for those who lack strongly positive sexual self-images and beliefs? Can an individual be simultaneously sexually competent and sexually dysfunctional? Negative body image, lack of desire, the inability to lubricate or be orgasmic, erectile dysfunction – these issues are rarely touched upon and if there are, it is usually to the detriment to the person struggling. The media message is that sex makes you happy and healthy – and if it doesn’t there is something wrong with you.

My original training as a psychotherapist didn’t cover sex, sexuality, gender or relationship structures as topics. As I started out I noticed that it was rare for any of my clients to bring these topics to our sessions and that I never did. My upbringing tells me that sex is a private affair, something we do not talk about, not with family, friends and often not even with our partners. Reflecting back I see how my original training confirmed to me what my cultural and familial messages had been. Sex is a taboo subject.

My wish to broaden my practise meant that I had to take responsibility and do additional training to become a psychosexual & relationship therapist. I wanted to gain a much greater understanding of gender, sexuality relationship structures, along with psychosexual issues, knowing that It is not for my clients to educate and inform me. I took the opportunity to explore my own sexual shame and embarrassment, along with my fears and assumptions. I see how my additional trainings have served me well over many years. I have been able to develop a language that enables me to support my clients in sharing and learning about their sexual selves. Having faced my own shyness I am able to see my clients through unbiased, non-judgemental and tender eyes. 

Even though media portrayals of sex reflect an impractical, stereotypical, often commercial viewpoint, they are repeated so consistently that, for many, it is difficult to hold on to what’s real and not compare themselves with such unrealistic relationships and sexualised images, whether consciously or unconsciously. I work with clients addressing the comparisons made that result in an overwhelming sense of anxiety, shame and feelings of insecurity about self and partners, which inevitably filters through into sexual experiences and relationships in a negative way. 

A lot of my work is in the undoing of what the mass media projects as models of masculinity, femininity, sexuality or what it takes to have the kind of relationship that supports and encourages satisfying sex. We live in a culture that dispenses unrealistic expectations – in particular of both sexual performance and body image, influencing how people relate to their body’s function, its appearance and, ultimately, how we utilise our bodies sexually.

Many of my clients have not been raised in families or cultures where clear, accurate information was available or allowed, and therefore an element of their primary problem may be that they are battling with sexual ignorance, confusion and anxiety and that is when my role as educator comes in. I play a role in my client’s education by supporting them in understanding the physiological aspects of their sexuality, while at the same time witnessing their expectations, beliefs and taboos. It feels important to me that I am able to continually challenge stereotypical assumptions and expectations related to gender differences and sex.

It is little wonder that the topic of sex and sexuality is often laced with guilt, shame and embarrassment. As a result clients find different ways of broaching the subject. They will use the telephone so that I don’t see their face. They send emails, texts and sometimes cover their face or look away when speaking to me. They close their eyes, ask me to look away. They struggle to find words and stutter over sentences. Some are so embarrassed they can’t speak of their embarrassment. I want to be able to guide my clients as they voice sexual concerns, confront physical problems and alter perspectives. Some of what they bring are recent concerns, and for others secrets shrouded in shame that they have carried for decades. As we work together they learn that,‘normal’ sex is varied and that sexual problems are not uncommon and can often be resolved. I hold space for them, trusting my unique personality combining experience, attitude and artistry. After a while, they start to relax, they can look me in the eyes and it is as if we are talking about the most natural of things.

It has taken decades for me to develop my own style and become the therapist I am today. I remember starting out with all the fears of a green therapist, wondering whether I was good enough, what my clients would think of me and above all, whether I would be liked. I had received explicit instructions from tutors that if I was to work from home or an office, it should have no reflection of who I was as a person. I remember a colleague saying to me that I would be advised to change the way I dressed as ‘it was too colourful and flamboyant.’ It was a confusing time, but I was clear that just fulfilling a role, and or being a carbon copy of other therapists was not going to support me in being the therapist I wanted to be. The demand to be false, which never goes away, is something I leave outside of my therapy room.

Today I still hold true to what felt important back then, that I bring my real self to the therapy room so as not to become stiff and unnatural. I see my job as a secure base to be a different sort of anchor that my clients have had before, and that in offering my client aspects of my authentic self, a trusting relationship can develop, for some, for the first time. For the most part, I am quietly confident in the knowledge that I am trustworthy, honest, compassionate and loving. In my view, in order to be able to benefit from the full therapeutic alliance that develops between myself and my client, I need to be able to hold both the professional and personal facets of who I am. I have incorporated my own self-development and self-awareness into my way of working, and although I have a toolbox to draw on, above all, I bring myself. After all, how can I encourage my client to be themselves if I am not willing to do the same?

The ‘blank screen’ therapist is a myth. No matter how hard I might try, it is impossible not to reveal myself in the same way my clients reveal parts of themselves, within the first few moments of our meeting. Whether on screen or in the room, I self-disclose the minute a client meets me. The way we speak, dress to whether or not we wear a wedding ring. Our gender, age, tone of voice, accent, gives our clients an imaginable insight into who we are. When we work from home there are extensive self disclosures, such as financial status, clues about family and pets, possible hobbies and habits. Informing clients about time away from the office or a forthcoming holiday are also self disclosures that are unavoidable. In addition, as a result of spending so much time together, our clients get to know us well. Like a child who watches her mothers face to get a sense of mood or reaction, clients look and listen for similar signs from me, and there are many. I have learnt over the years that there are times I give away more about myself than I realise, and that is before I have even said anything. So, with that in mind, there is no point in trying to hide.

As a therapist, I am deeply sensitive and intuitive. I seek to create a connection with my clients whereby we can be real with each other. To be real does not mean that I have to answer or appease all or any of my clients questions or demands. However, I will be clear and direct with them, adhering to the code of ethics I work within. Many of my clients have little or no experience of feeling that important figures in their lives have really seen and understood them, and so my being real and honest allows for an authentic exchange of thoughts and feelings. I use transference and counter transference as a way of exploring my clients subtle emotional tendencies. By doing that, it allows me to use my own process as a valuable compass in exploring my clients tender spots. Depending on the length and strength of the therapeutic relationship, there are times when I deliberately choose to self-disclose by either self involving, whereby I share with my clients my personal reactions to them, and what occurs during our sessions or self revealing, by disclosing information about myself.

There are many differing thoughts around self-disclosure. I hear colleagues talk about self-disclosure in binary terms; you either do or you don’t. As I see it, it is not a question as to whether or not I should self-disclose, but more when should I self-disclose. In my experience, there have been many times when my self-disclosing has been beneficial to my client, and the therapeutic relationship. I am mindful of the when, why and how, as I don’t want my disclosure to have them feel they need to be concerned about me or burden them in any way.

For many clients, what happens in the therapy room acts as a microcosm of their relationships in the world. Very often, a client will respond or react towards me in a similar way they do with others in their lives.The client who can push the boundaries constantly, despite being asked not to. The client who becomes angry when I don’t behave in the way she wants. The client who reacts as if they have been attacked when they were only asked a question. The client who appears to use a barrage of words as a way of keeping distance. The client whose words and actions are not congruent. In the therapy room, all behaviours and ways of being are noticed, and there is the opportunity for me to explore, challenge, notice such behaviours, the impact on me and, being mindful, share that with my client. Not always comfortable or well received, but rarely has it happened that the awareness has not, in someway, facilitated change.

So often, clients come and share stories of tragic and traumatic events disconnected from themselves and their feelings. Through turning my awareness to my body and in turn my clients, I can gain valuable information about what might be happening in the moment with my client that she might or might not be in touch with. I can utilise this information to develop an awareness that complements the therapy. By sharing my feelings, it can be a useful way for my client to become aware of how detached she has grown from hers. 

Above all, I want my clients to see me as human. I don’t claim to have my life sorted, have all the answers or not to have made mistakes, that I have had to learn to live with. “Even if it is initially useful for clients to idealise their therapists, we must help them and ourselves to see a separate reality. Modelling takes the form of presenting not only an ideal to strive for but also a real, live person who is flawed, genuine, and sincere. Occasionally, the therapist can use self-disclosure to close the psychological distance between herself and the client. Such sharing can often lead to increased feelings of mutual identification, as well as build great intimacy and authenticity, many clients are greatly relieved to learn that their therapists have been the victims of the same self-defeating behaviours that they are now trying to overcome “ (Kottler. 2017:22)

As part of self-revealing, there are times that I choose to disclose the impact of what I have heard with my client. A moment when my client looks deeply into me, searching for some form of lifeline to understanding, calling for me to share my similar, or relevant, experiences, that allows her to see that survival is possible. I have learnt over the years that by revealing relevant personal information in an appropriate, controlled way, can have a powerful impact on my clients willingness to take risks. By sharing the feelings that emerge when my client discloses can be profound. When sitting with clients as they express their deeply held experiences, secrets and emotions, whatever they may be, and remaining open is not always easy. But by doing so, and acknowledging how it impacts me, they can sense that I too have experience of the powerful, gut wrenching feelings that can, at times, cause us to question life. At that moment they feel validated.

As a therapist, I hear things that are deeply challenging and, at times, can sense things that are invisible to others. I see my gift to my clients is to model what it is to be human, authentic and imperfect. I believe this allows for moments whereby my client and I can sit, without needing to say anything, reaping the benefit of the rare and precious intimacy we have created together, built on the foundation of being real.

Kottler, J.A (2017). On Being a Therapist. New York: Oxford University Press

I am always aware when clients first come to therapy that they bring with them the ways they have learnt to survive in the world, as a result of their upbringing and life experiences. So often, I see clients who are living with the consequences of having lost the ability to trust themselves and their reality. Clients who have been gaslit, as children, by their caregivers, and who, in order to be loved and cared for, had to disregard their own perceptions, ideas and experiences about themselves and accept their caregiver’s version. Gone are their own needs, hopes and dreams, as they have learnt to believe that they are deeply flawed and not entitled, even to their own minds. Their real self starts to hide away as they become on guard, always looking for the right thing to do or say, accepting someone else’s explanation of their reality. “Without a clear connection to our instincts and feelings, we cannot feel our connection and sense of belonging to this earth, to a family, or anything else.” (Levine, 1997:266).

As children we are totally dependent on our primary caregivers for survival. We are constantly looking into their faces for a sense of the world and who we are. All the power is bestowed on our caregivers, and from there we interpret our experiences and events. Through our early years we accept whatever is happening in our household to be normal, and learn to mould ourselves into the type of child that our parents want us to be, in search of their love. As a child whose brain and emotions are still developing, we don’t have the ability to see our parents behaviour as abusive. By the time we do, it is often too late as the patterns of behaviour and coping skills are deeply ingrained.

Gaslighting is a term used to describe a form of psychological abuse which is relatively common in dysfunctional families. It is, perhaps, the most appalling form of child abuse, as it can make a child feel as if they are crazy. When a person is gaslighting they use mind games often telling their victim that what they have seen, experienced or felt is not the truth. It is usually accompanied by aggression, either passive or overt and so fear becomes a regular companion. A lifetime of damage often occurs as children who have been gaslit, grow into adulthood with no real sense of who they are. They have no internal sense of self, their minds and sometimes their bodies controlled by someone else. They hold the secret of their lost self and often have a deep shame of their existence, with no place where they feel safe or people they can trust.

As a result of being manipulated into believing things that weren’t true, along with having to adapt to accept someone else’s narrative, they start to disconnect from their real self as they learn that the price in holding on to themselves is too great. They start to feel as if they are losing their mind, become submissive, and with no one to protect or support them, the journey into the dark pit of shame and loneliness begins.The vibrant, alive and trusting child they are born as, hides away believing itself to be deeply flawed. The very essence of who they are, shattered by those who are meant to embrace and inspire them to be all that they can be. They feel themselves slipping towards a world that no one else knows in order to keep safe, and what is left is a facade. The world carries on and no one notices that part of them has faded away. They become compliant or rebellious in order to hide their lost self, and become masters at fooling others, as well as themselves, into believing that they are okay. Although now protected from abuse they now struggle to survive emotionally, as in the darkest part of their being, it feels as if they are watching life from a distance and no one can reach them.

Taking the first step and coming to therapy requires enormous courage. Clients are facing their biggest fears. That their story won’t be believed. That the world is unsafe, and that no one is trustworthy. At their nethermost level they fear that they are forever lost. Their history has been one of betrayal, anguish and pain, with the roots of their problems running deep, and all the way back to childhood. Their relationship with their therapist is of paramount importance as, it is with this, that they hope to re acquaint with the part of themselves that retreated in order to survive. 

Clients talk of their real self living behind doors, in dark prisons or cages. Mostly physically dirty, dressed in rags and no longer verbal as they have withdrawn more and more into themselves. The therapist requires patience and a deep sense of compassion as the hidden self emerges to tell her story. Often feral she is on high alert, watching for anything that will prove to her that she is unsafe. My aim throughout is to be consistent, attentive, curious, congruent and respect my clients need to look for safety.

This work takes time as the journey is one of transformation. Moving from a traumatic state to a peaceful, integrated state requires repeated practise. As a result, I am often deeply moved as I have the privilege of observing my client recognise the indelible imprint of time gone by. By starting to re-connect with the suppressed feelings of fear, anger, shame and pain in the presence of another, and have them validated allows my client to cherish her hard won moments of intimacy. By slowly changing long entrenched patterns of behaviour she is able to emerge back into her life fully. She starts to experience life with a developing sense of trust and with the courage to shine brighter and brighter. “To resolve trauma we must learn to move fluidly between instinct, emotion and rational thought. When these three sources are in harmony, communicating sensation, feeling and cognition, our organisms operate as they were designed to.” (Levine, 1997:265).

I believe her every word.  

Levine, P. (1997). Waking The Tiger. California. North Atlantic Books.