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I would say my own issues are extreme and am talking from that point of reference. Obviously if therapy done the usual way works for you then that is awesome. But in some cases people may need more which may stretch boundaries but not break them.
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I don't think this is a case of the most "extreme" issues needing the greyest areas. Sometimes people who have been hurt need ultimate safety - for me, that involves knowing that my therapist will act in a predictable and controlled way. So, yes, I agree that it is ultimately about the best interests of the client.