Last week I said that I wanted to write about how the boundaries in counseling make the therapeutic relationship possible and so here I am! Writing about it!
The first time I really got the value of those boundaries was when I was driving away from a particularly tough session with a particularly tough client who also happened to be one of my very first clients. Without going into specifics that would compromise confidentiality, I will tell you that this was a client who seemed to have a black cloud of gloom and disaster following her. It always seemed like if a rotten thing could happen to her, it would. Some of this was of her own making but some of it was simply bad luck.
It made me miss being a case manager because as a case manager I’d have clear directives for her. We would be working a program together and I’d be bossing her around a little bit. I’d also have bus tickets and other program directors on speed dial to hook her up with other agencies (there’s an insider thing to case management that doesn’t seem to exist in community mental health agency work unless there’s a case management program there, too; like I can’t get a client free furniture but as a case manager in Portland I had access to those kinds of programs).
But I wasn’t her case manager (she had case managers), I was her counselor. And as her counselor I felt so helpless because I’d see her and she had so many challenges and I couldn’t do much but listen. I would meet with her and pay attention and help her make decisions and help her consider her options and help her process her emotions and I gave her all the unconditional positive regard I had at my disposal but it didn’t always feel like enough. I sure missed being able to hand over those bus tickets.
Unconditional positive regard is at the heart of counseling. When I am with a client, I am with them. I’m listening hard. I’m loving their humanity no matter what they’re saying. I’m seeing the human being that they are and I am accepting who they are even as I’m trying to help them to be their better selves.
So back to my tough session with my tough client.
I was driving away and I was thinking about something she’d said to me. We were talking about a pretty big barrier she was facing and I was itching to be the person in her life to be able to give her bus tickets and referrals and feeling pretty damn helpless to be just sitting there listening. I was having to work hard to not get lost in my feelings and instead stay there with her, present in her struggle, remembering that it was her struggle and not mine to fix. And she said, “This hour when we meet, it’s special to me because it’s the only time that’s all mine, all about me. It makes it so I can get through the rest of the week.”
That really brought home to me the value in “just” listening.
As I drove away I was thinking about how having nothing but my therapeutic self to give her — because counselors ethically can’t do the things case managers do. Ethically, counselors need to be very very very careful about handing out transportation or free furniture. Sure, we can give referrals to programs that do these things and there are times that stretching beyond ethical guidelines on gift giving is appropriate. But with this particular client, it was clear to me that any impetus I had to go beyond those limits would be about me and my fervent wish that her life be better and my feelings of helplessness in the face of her struggle.
I realized, too, that unlike the other helping people in her life (of which there were many), I was the only one who wasn’t asking her to do things. Well, that’s not entirely true — I did ask her to keep her appointments or at least call to cancel. And I did ask her talk to me. But these things happened more or less on her terms. She made the appointments at her convenience (within the bounds of my schedule). She talked about the things she most needed and wanted to talk about. We had a dialogue; I didn’t lecture and I didn’t make demands. She wrote her own treatment goals and we worked towards the things that mattered most to her with the context of her beliefs and values.
Because the boundaries of counseling dictated our relationship — that I not give her bus tickets, that I see her at this prescribed time in this prescribed way — I was able to fully be there with her.
If I had been her case manager I couldn’t have been with her as freely. Case management is all about moving someone through a case plan. I also would have had to answer to the limits of our funding sources, which dictate which people a program can serve and how that program may serve them.
If I’d been her friend, I surely would have become fed up with the way her own decisions made her bad luck worse.
But as her counselor, I only had to be with her.
Our counseling relationship ended sooner than either of us would have liked due to some practicalities in her own situation but in the time we saw each other I did see real change in her attitude toward herself and towards her circumstances. Which is what cemented my faith in the value of the therapeutic relationship. Even if it doesn’t come with bus tickets.