Listen to the audio version of this article:
Addiction treatment constantly uses the term ‘Boundaries’, as it is relevant across much of behavioral health care. People often comment that they need to hold better boundaries as a family member, co-worker or romantic partner. It sometimes is easier to see the absence of boundaries than the presence of strong ones. This topic usually comes up for people who are struggling, experiencing drama in their life. They may have a series of fractured relationships. When boundaries are poor, people can feel generally unsafe. They don’t know what to predict in any given relationship.
How would we define a boundary? A boundary is an explicit or implicit set of rules by which we live. It involves a sense of closeness or distance and through that the spectrum of intimacy. It also can involve issues of trust and the greater theme of individualization. Many people who struggle with boundaries describe a poor sense of an individual self and can also feel somewhat ‘enveloped’ by others. They can feel as if they have lost freedom and are deferential to the wills and desires of their close relationships.
A healthy person holds different boundaries for different sorts of relationships. For instance, a boundary for a healthy romantic relationship would be different than one with a co-worker. The person has a general sense of what is appropriate to share or not share. This can also occur on an abstract level. Those who hold healthy boundaries have a general sense of what they give and receive in any given relationship, even if it’s as brief as a smile and ‘hello’ at work. People with poor boundaries seem to get this wrong. They can excessively seek approval or closeness from their co-workers, creating an awkward work environment.
A sports analogy can be useful in discussing boundaries, as such limits within a sport or game help people to feel safe, know what to expect and essentially maximize performance. The boundaries accept some conflict as part of the game but ultimately prevent the most extreme, escalating conflicts. A good way to describe this is through the game of basketball. All the players have a sense of the rules and what constitutes a foul. This keeps those players safe and allows them to compete with intensity amidst certain limits. Violence is grounds for ejecting a player from the game; the expectation is that all players will handle physically rough conflict within the rules.
Boundaries are necessary for the game of golf, tennis, chess – you name it. All games and sports use rules to help us enjoy the activity and to excel. When people repeatedly violate the rules of the game, the sense of emotional safety and enjoyment often plummets. Such breakdowns happen in relationships with the same degree of frustration.
In a therapeutic context, we start by helping a person understand how they have personal boundaries, as do others. We look for subtle ways in which a person conveys such boundaries and what to look for of other people articulating theirs. It also can be therapeutic for a person to realize if they struggle more in defining and holding boundaries of their own or acknowledging and respecting the boundaries of others. The therapeutic meaning of these two cases can be very different.Do you or your loved one need rehab?
If a person finds it difficult to hold personal boundaries, this may connect back to childhood trauma or complex patterns with parental figures. They may have learned that other people step over their boundaries (sometimes in highly abusive ways), hence there is little reason to expect anything different from others. The therapeutic goal is through what we call a ‘corrective experience.’ The therapist, through a clinical lens, is respecting the person’s boundaries over time while maintaining a good therapeutic relationship.
Sadly, there are therapists who struggle with their own poor boundaries, and this can actually cause harm to patients who are seeking the safety of a quality treatment relationship. In a way, the therapist is not delivering what the patient actually requires and the corrective experience doesn’t actually occur – more of the same poor boundaries, more of the same relationship frustration.
People who step over other people’s boundaries may struggle with issues of anxiety and control. They find it difficult to allow other people to make their own choices, and tend to dominate relationships because they ultimately feel that their way or choice is the best path. We often see this pattern when working with the loved ones of our patients at CeDAR. This over-stepping can be rooted in fear of the unknown, especially with family systems and repeated relapses on substances. We work with many patients who have overbearing parents, ones who have been so rattled by relapses or mental health issues that they give little control back to the struggling child. Their fear stifles the family from healing.
We try to help the family see that rebuilding of trust helps the identified patient heal on a greater level. We can also empathize with them and validate that by being so over-involved in their loved one’s recovery, they aren’t in themselves free. They are held hostage by the progress of the other person. This is no way to live and healing for these families is desperately needed. Family therapy in this context can make a sizable difference in how a family system operates, respects individual decisions and builds trust.
If we are working with an individual therapy patient who steps over the boundaries of others, we once again work towards a corrective therapeutic experience, just in the area of holding our own boundaries as clinicians. The therapist’s duty is to hold a firm boundary and tell the person ‘no,’ both through words and actions.
In many situations, the overstepping of the boundary by the patient can be quite subtle. This can include such acts as a patient asking many questions of the therapist, devaluing the therapist’s time or making the therapeutic relationship feel too ‘personal.’ A skilled therapist will quickly realize that these patterns play out in the person’s everyday life and cause repeated problems.
The most extreme version of a patient who doesn’t respect others’ boundaries (including that of the therapist), is a malignant narcissist. This is a personality disorder which can be highly difficult to treat, and some clinicians would say it is not actually treatable. As the therapist holds a firm boundary, the patient feels slighted or upset and terminates the treatment. In this way, nothing was actually achieved through the therapeutic time, other than two frustrated people. Once again, a small snapshot of the narcissist’s everyday life!
Good therapeutic work will always identify patterns and areas for potential growth in the realm of boundaries. Healthy boundaries involve an awareness of the rules of life, just like the rules of a sport. Poor boundaries can be through a patient not holding personal boundaries or not respecting the boundaries of others. Family systems often times struggle with good boundaries, often based on themes of fear.
Therapeutic healing is through a corrective experience by a therapist who is mindful of boundary patterns. This helps build trust and instill safety within a relationship, both ingredients necessary for stable recovery.
COVID-19 Testing Keeps Addiction Treatment Safe at CeDAR.