Good boundaries?

I have to use core forms but I don't find them useful or accurate. In fact, where I work statistics show the results are significantly better in summer as opposed to winter. With that level of variability I can't see how they can be used as an accurate measure of client outcomes.

I agree - as I said I think they're very far from a reliable system. I just thought Skies might be interested to know about them.

Yeah, not arguing, just mentioning that statistic which shocked me!

Fair enough! It doesn't surprise me actually - I think the seasons affect my mood quite a bit. The spring sunshine recently has really done me good!

I have finally realized, months after processing my last therapy, that I have lived in a fantasy most of my life -- the female relatives in my family of origin did not care about the other female children, but pretended they did, and so I did, too, believing the pretense because it was pleasant and tolerable rather than the reality.

I don't see how a 60 second questionnaire could have helped me come to this realization earlier. But maybe -- if it helped identify how I was picking uncaring, snobby female therapists like the women in my family of origin, to reenact, so that I could erupt in anger at the disrespect and then they could put me down, over and over again. As I have written before, I had that anger cut off and shut down in order to get along in my family of origin. Therapists early in my 50 year journey with therapy encouraged me to "get in touch" with my feelings, and I worked very hard and did, only to have the therapists react like the women in my family growing up.

This is insanity. Well, yes, mine "doing the same thing over and over again and expecting a different result." But here's the thing -- I went to the professional "experts" in insanity, among other things, for help and just got re-treatment like the way I was as a child. This may, in many people's view, be "normal" female-to-female behavior but IT SUCKS. I don't want to live in a world where people treat each other like this.

This is a SYSTEMIC problem, because many professionals, in my experience, are living in their fantasy world, too. "Wounded healers", only they aren't -- they are perpetuating the toxicity of their own growing up life on other people who are living in denial but don't know it, of course.

There's an analogy I have mentioned before. Before the discovery of the germ theory of disease, physicians in Vienna were going to examine women in the hospital who were about to or right after giving birth. They examined them with THEIR BARE HANDS, UNWASHED right after doing autopsies, again with their bare hands. And many more of the women cared for by the physicians got ill and died, in contrast to those cared for by midwives who did not do autopsies. A doctor named Semmelweis noticed this and instituted the procedure that examining physicians had to wash their hands before each exam. The death rate dropped.

We need some science here, folks! Not just "empathy" -- which is a word coined in 1909 by a psychologist who was trying to develop a scientific psychology. It's a useful term, but if it's that necessary for social life, how did we get along without it for so many centuries?

When I point out the hypocrisy of therapists presuming to "model good boundaries" because they avoid trashing certain boundaries while stomping over many others, that is not an invalidation of the whole system. I'm picking apart a specific plank in their dubious marketing. If you perceive this as an invalidation of the entire system, that's in your head.

But it still models bad boundaries. It models lack of respect for personal integrity to just plow into someone's personal life without bothering to have a conversation about what that might mean. I've been to therapists where barely a meaningful word was said before they basically said: ok start vomiting up your miseries and misfortunes. I think this teaches people to disregard their normal boundaries, not to build better ones.

I realize I'm coming into this thread quite late... but as an almost-doctor (55 days until graduation, not that I'm counting), I think that some boundaries (especially with respect to the non-reciprocal nature of the therapeutic relationship) make sense.

My patients get mostly naked and I touch their faces, push on their bellies, examine their genitals. They don't do the same to me because that's not the purpose of the encounter. It's not that I am perfectly healthy and don't need to see a doctor myself--I have a body subject to change and disease just like everyone else. But I spent four years of college and four years of med school learning about human bodies and what can go wrong with them; in order to maximize my ability to understand and heal sickness and pain, I have to listen to and look at and touch their bodies (and ask them questions about how their pain feels and when it happens and things like that, not to mention the awkward stuff like who they have sex with and what kind of sex they have with them). It would be weird for my patients to examine me back, because that's not what their expertise is (plus, during an appointment I am being paid to help them; talking about my crap on their time is a waste of their time/money). I'm not saying they're dumb or lacking in knowledge about bodies/science--that's not it at all. But the typical lawyer, brick-layer, barista doesn't know as much as I do about bodies and what goes wrong with them (just like I still have to ask my dad to help me file my taxes, haven't the foggiest idea how to build a wall, and can barely make a cup of coffee without burning something).

And when patients ask me stuff about myself like where I'm from or what I like to do in my free time, I don't mind telling them. But I don't usually disclose about my own health problems (including my severe, often-debilitating depression) for a few reasons: first off, it's exhausting to get all up in your own vulnerability all day long. Also, patients are NOT bound to laws about confidentiality--while I can (and should) get sued for telling the grocery store clerk that Barry the produce guy has the clap, Barry could write about my depression on the front page of the NYT and I would have no recourse. And there are other risks about revealing myself to my patients--maybe if they learn about my depression they will be worried that I am incompetent/weak, or will neglect to bring up sad/difficult things for fear of upsetting me. (I know it's a cliche, but I've learned the hard way that at least a bit of distance is required for objectivity.) Furthermore, while I want to have good relationships with my patients, I don't want to get too close because I just don't have the emotional energy to take phone calls at three in the morning about their rash or whatever. (Some docs are "concierge doctors," and are able to do this, but they have tens of patients instead of hundreds, and they are paid waaaaaay more per patient.) I wish I could provide such wonderful wraparound services, but if I did this for all of my patients, I would not have enough time to sleep (or would see so few patients that the hospital would fire me for being I sufficiently productive).

This unbalancing of the relationship doesn't mean that I feel superior to my patients--I don't. I likely know more than they do about how Western medicine diagnoses and treats disease, but they know more about themselves and about whatever it is that they're expert in (law, brick-laying, scrumptious-coffee-making, parenting, etc.) It also does not prevent me from loving them, especially when I've known them for a long time or been with them during an especially difficult time. Granted, it is a different kind of love than what I feel for my parents or SO or friends... but my parent-love is very different from my SO-love too, and that doesn't mean that one of them is somehow superior. Just different, due to the fact that they have different roles in my life.

I do not intend to invalidate your experience BudFox, because boundaries can be extremely difficult to navogate, and when therapists mis-handle things it can be excruciating. (To me it can feel like gaslighting, or like "why didn't you just tell me up front that this therapy crap has a weird effing set of boundaries because I did not see that coming and now I feel ashamed/needy/crazy?!!?") This often isn't as hard for physicians because people are used to the doctor-patient thing where one person gets naked and the other doesn't (and many of us have been going to doctors since we were kids, or are at least used to seeing doctors on TV). But therapy is harder... certainly because it is more emotionally intimate, maybe also because therapy sort of feels like just two people talking (which is something we all do all the time, and are used to certain patterns and assumptions of reciprocity), even though it tries/claims to be more than that.

I'm sorry you're hurting, BudFox

The other part is of course that clients have boundaries also. I certainly do. I do not use western medicine except in extremely rare cases - and since my person's death, I don't see that I will have any reason to do so in the future at all.
But I don't let an md or a therapist run roughshod over me. I don't answer questions or give them information unless I want to do so. I am not all that curious about them - why would I be? They are tools for me to use and they are acting. They are not real to me and I am not real to them.
Plus - from what I have seen, many if not most, are bat **** crazy themselves, often touchy and unpleasant to deal with in real life, and have a great deal of trouble if someone does not roll over and submit to their persona. I have no need to feed their need for love, approval, admiration etc.

Stopdog, I feel very sad for you.
If you truly believe all that what you've said is true, I question why you'd spend any money or time on therapists at all.
And then, if your actions belie your words, I wonder why you feel the need to say those words.

I do agree with you, that it is a danger to go into personal depth without that sort of conversation. In terms of my therapy specifically, we were having that conversation, because that's what brought me to therapy with him. I was trying to come to terms with poor therapy. So we were discussing the impact of poor therapy, but it wasn't a warning as such, it was part of the work.

Well you wouldn't be the first. I have found a use for therapists that works for me. I definitely do believe what I wrote. I have not found a use for mds that was worth the cost for me. Believe me, there is absolutely no need to be sad for me. But if you enjoy it have at it. I sue those people for a living and I have had them as clients. They are not super special and some are mean and petty and so forth. I have dealth with them in probate court where they have been greedy and dysfunctional. I watch their children Dislike them and complain about them and refuse to take care of ones who have become incapacitated. They are just like everyone else and sometimes worse. I have personally not dealt with any who are better

Truth. IMHO, Western medicine has a niche of stuff it can do really well (curing many kinds of infections, keeping reasonably healthy people from dying when they've been in a car accident, using empirical evidence to figure out which drug/intervention can prevent the most morbidity/mortality). And then there's a whole bunch of stuff that it is total **** at addressing and claims to be able to fix... and then when the "fix" doesn't work, blames the patient for being crazy/lazy/aberrant and still charges them lots of $$$ even though all it has done is waste time and cause even more suffering than the disease/condition itself (many autoimmune disorders, most chronic pain, mental health stuff, some chronic diseases like diabetes and COPD).

Stopdog, a question (dunno where this question lies wrt your boundaries, so do tell me to f*** off if I've crossed them): you say you've found a use for therapists, but you also seem to have a lot of distain for therapists-in-general and also your particular Ts. And you don't seem like someone who tolerates bulls**t, and SO MANY THERAPISTS employ bulls**ty tactics in their practice. In what way are your therapists useful to you? (And how the hell did you find two Ts who don't say insipid things all the time?)

I interviewed over 30 of them and kept the two who were the least offensive. I don't let the therapists I hire talk very often. It is horrible when they talk, so I tell them not to and they do not.

Thanks so much, stopdog. I like what you write, you don't tell others what to do, just tell it like it is for you. Seems like an example of pretty good boundaries, to me.

Sorry about the loss of your person. I don't know the specifics or how you feel about it, but I still want to extend my sympathies. That's just what I feel about it, inside my own boundary.

Not seeing the point of the medical exam analogy. Therapy is not medicine. Not really even close. More like faith healing. A medical exam is carried out for a specific purpose. Both parties are presumably clear why it is taking place. It is of short duration. The professional has known expertise in anatomy and physiology that justifies it. I can't say this about any therapy "exam" I've had.

Therapy is a complex and murky psychological relationship with a paid voyeur who is scrutinizing you at your most vulnerable, and interpreting your thoughts and emotions. Therapy is unique in its potential to cause deep and lasting psychological harm. If one cares to look, the evidence is out there. Most people don't care to look.

Therapy ethics documents make obsessive reference to sexual transgressions. Why? Because the basic arrangement of therapy is uniquely conducive to abuse and manipulation and exploitation. Boundaries can get weird. Some therapy clients go into serious regressive and dependent states.

Hurting?

Where would anyone get the idea that therapy successes are under-reported? The whole profession fawns and slobbers over a select few success stories, and bends over backward to massage outcomes in their favor, while systematically avoiding even the topic of serious failures.

Just to clarify, I consider the system flawed independent of whose hands it's in. Thats the whole point. A pathological system cannot be made well by putting it in the right hands. Though I can see how its pathologies can be somewhat mitigated or overcome in some cases.

Hi again BudFox, Is there something you need from your PC community, something we can do to help you? Or do you just need to be heard about your therapy experience?

One of my therapists had very messy, confusing and unpredictable boundaries. The other one was quite good with it: consistent, predictable, non-intrusive, professional. I've learned some great lessons from both therapies but liked the consistent, very professional one much better. None of them harmed me in any way but would not say any of them changed my life or made me discover entirely new things about myself. I always felt very free to use them as I wanted to, take what I found useful and leave the rest, never felt they had power over me or something like that. One of them tried for a while but it only led to my dumping him.

I gave the example of a physician performing a physical exam because it's a situation where boundaries are non-typical but not necessarily harmful or immoral; an example of how in some situations, for the work to be done, some boundaries have to be removed and others have to be set in place (e.g. you tell me about your sexual partners so I can figure out what's going on with you, but I don't tell you who I'm banging because it's not relevant to the problem at hand... and if I tell anyone else about any of this, you can sue me). I guess I'm trying to make the point that un-equal or non-typical boundary arrangements do not always equal exploitation.

I think an important difference between our stances on this issue is that I come from the assumption that good therapists (rare as they are) have both the intention and capacity to be of help if they have enough data. It doesn't appear that you believe that, though, 'cause you're talking about voyeurism and aggressive interpretations and therapy as faith healing, not to mention therapist in stark contrast to the physician with "known expertise." I also believe that psychotherapy is a fundamentally good practice that is often taken up by idiots, rather than a pathological one that has to be warped into functionality by its practicioners.

That said, I do agree with you above, and agree that there are many many many therapists who are incompetent and/or exploitative. I think those people should rot in hell.

Ah, that was my error. At the beginning of the thread you mentioned you had a therapist with a crappy approach to boundaries; I assumed that this would cause you pain. I must have been wrong, though, for you to write the above. My apologies for the assumption.

Sure, I get that a medical exam involves one-way exposure and unusual boundary dynamics. And so does therapy. But I think the similarities mostly end there. Therapy is a whole other thing, with very specific and (in my view) sketchy rules of engagement. And to my original point, loads of hypocrisy in their talk about boundaries (some are sacred, others are just knocked over).

Also I personally have found interactions with mainstream doctors to be almost universally unhealthy, lot of infantilizing patriarchal stuff, and too many other things to list. I would not hold out doctor-patient as a justification for the existence of therapist-client, or vice versa.

I'm actually not talking about whether good/bad therapists can be helpful. Was simply pointing out that therapists claim impeccable boundaries, but in reality they push a number of boundaries in what I find to be creepy and questionable ways.

I asked about the hurting thing because usually when a therapy consumer expresses criticism or discontent, it's presumed to arise from emotional distress and confusion, instead of well-reasoned examination. It's a built-in deflection to keep eyes off the sketchy stuff. So I tend to ask about this. No worries.

I know this comment is from some days ago but hoping you might still see my response!

I really relate to the feeling of not having an authentic self. From a few sample pages of Kohut's book I got the impression that it was highly theoretical and presupposed quite an extensive knowledge of the psychoanalytical paradigm proposed by Freud and successors. It also seemed as though it might be quite outdated. However, perhaps it is worth trying to learn the basics and then taking another shot at it.

I was wondering how you managed to use such theory to 'generate a sense of self'. Any pointers on this? (I'm open to meditation techniques, visualizations, or any other strategies that might help...) Or do you think merely immersing oneself in the text is helpful?

Thanks for your interest, SnowQueen. The basic ideas are in this section of the Wikipedia article on Self Psychology:

There are some good blog posts by a psychiatrist Dr. Sanity that explain Kohut's ideas about the 1st 2 groups, the grandiose self and the idealisized object. Here's a link to the 1st of 3:

Dr. Sanity: NARCISSISM AND SOCIETY: Part I - The Psychology of the Self

Once I got a "feel" for how those 1st two worked in myself -- I can feel my grandiosity and my tendency to idealize things -- principles, causes, etc. I could then also feel how they kind of function in my sense of who I was. Dr. Sanity doesn't discuss the alter ego function, but to me it's like there's the grandiose me, then the idealized other, then the alter ego comes into play when kids are working alongside parents or grandparents or other adults. It feels to me that it's like a bridge from all-about-me and the idealized other out into the community at large, of which one (hopefully) is and can be a part.

Neither Kohut nor Dr. Sanity discuss adolescence and peer relationships, but to me there was an adjustment that started to happen but got shut down when my aunt's husband made an inappropriate advance when I was 13. It was relatively "mild" and I ran off and he didn't follow, but it was traumatic because later I shut down the feelings involved, and what might have been the beginnings of an adult ego, certainly a form of "adult" excitement. So when I remembered some about that experience in trauma therapy an idea/feeling came up of what I HADN'T allowed myself to develop at the time and I have had a little progress trying to do some of that now (VERY LATE in life, but still. . .)

The key is a sense of self IN COMMUNITY. That's how primates and people evolved and that's what's wired in, for when families and communities are healthy. Lots of stress on that in current civilization but it's all still there in most of us. At least that's what I think. Don't know if it will work for you, maybe it will help.

will read up further. Thanks for the added detail and leads!

This thread is my gift to the community.