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Setting Clear and Ethical Boundaries with Clients

Section 4
Therapist Comfort

Question 4 | Test | Table of Contents

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We have explored your attitudes and how they are linked to learned behaviors and gender culture.

Now let's increase your self-awareness of the impact of your personal needs in light of defense mechanisms, security versus growth, and middle-class values.

♦ Defense Mechanisms
Regarding defense mechanisms, the nature of life's demands are such that there are times when it is constructive to make temporary use of defense mechanisms like denial, projection, regression, fantasy, and so on. As you know, this helps us to guard against anxiety and pain that would otherwise be overwhelming.

For example, I treated a client, Jane, who used denial as a reaction to her husband's physical abuse. Only when it extended to her daughter was Jane able to overcome her fear, face reality, and make use of help and resources.

As you know, you need to be able to recognize the presence of defense mechanisms both in yourself and in your clients. Ask yourself whether your uses of defenses are constructive or destructive, whether consciously or unconsciously aware at the time. As you know, your selection of a particular defense mechanism is strongly influenced by your background.

For example, do you have a family member that uses humor to deal with painful feelings? If not, what coping mechanisms did your family use...denial? projection? regression? Think for a minute…when a client uses these mechanisms, do you become uncomfortable because they mirror your issues? Do you need to more consciously set a boundary between your feelings about a client's use of a defense mechanism and the ones you employ?

♦ Learning to Use Yourself More Effectively
To assist with this process of learning to know and use yourself more effectively related to your awareness of setting ethical boundaries with your clients, ask yourself the following questions:

5 Questions to Know Yourself
-- 1. How do I think and feel about myself? Answer in one word or a short phrase.
-- 2. What is my self-image?
-- 3. Do I feel I am physically or intellectually handicapped in some area, or do I feel I am whole?
-- 4. Do I see myself as old, middle-aged, or young?
-- 5. Am I fat, thin, or average?

I feel one of the most important factors in self-awareness, and thus in setting ethical boundaries with clients, is how you feel about yourself. I know when I feel I like myself, I usually relate in a more open, receptive manner to my clients. Let's explore this further.

♦ 4 Factors in Rating Your Ability to be Ethically Comfortable with Yourself
According to Brems, in "Dealing with Challenges in Psychotherapy and Counseling,"
Your ability to be comfortable with yourself is based on the following four factors:

Factor #1. Awareness of and ability to accept yourself as a fallible person and therapist with strengths and weaknesses. We have already covered cultural role expectations placed upon males being the "white knight," so to speak and having all of the answers, and females to being submissive. How are you at self-acceptance?

Factor #2. Development of a flexible adaptive pattern that does not demand perfection of yourself, and hence, does not expect it of others. We as therapists always strive to accept our lack of perfection, but where are you right now? Rate yourself, on a scale from 1 to 10. One is low, being a total lack of acceptance of your imperfection, and 10 is high, being a total acceptance of your imperfections.

Factor #3. Regarding your ability to be comfortable with yourself, how would you rate your capacity to recognize and deal with the impact of negative attitudes? Are you a female who feels discriminated against regarding the last promotion or special privilege handed out to a male in your agency? Or are you male, who feels he is the victim of reverse-discrimination?

Factor #4. Acceptance of the fact that self-liking is not static or unchanging. Self-acceptance and liking involves a continuous process of awareness, assessment, and flexibility.

The point to be made here is, setting ethical boundaries with clients begins with your comfort level with yourself as a basis for making objective treatment decisions.
Reviewed 2023

Peer-Reviewed Journal Article References:
Franeta, D. (2019). Taking ethics seriously: Toward comprehensive education in ethics and human rights for psychologists. European Psychologist, 24(2), 125–135. 

Glebova, T., Foster, S. L., Cunningham, P. B., Brennan, P. A., & Whitmore, E. (2012). Examining therapist comfort in delivering family therapy in home and community settings: Development and evaluation of the Therapist Comfort Scale. Psychotherapy, 49(1), 52–61.

Nissen-Lie, H. A., Orlinsky, D. E., & Rønnestad, M. H. (2021). The emotionally burdened psychotherapist: Personal and situational risk factors. Professional Psychology: Research and Practice.

Schwartz, R. A., Chambless, D. L., Milrod, B., & Barber, J. P. (2021). Patient, therapist, and relational antecedents of hostile resistance in cognitive–behavioral therapy for panic disorder: A qualitative investigation. Psychotherapy, 58(2), 230–241.

Slone, N. C., & Owen, J. (2015). Therapist alliance activity, therapist comfort, and systemic alliance on individual psychotherapy outcome. Journal of Psychotherapy Integration, 25(4), 275–288.

QUESTION 4
Your ability to be comfortable with yourself is based on what four factors? To select and enter your answer go to Test.

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