(and why I still have to set them)
In my opinion, therapy is "weird" for so many reasons. I love therapy. I love being a therapist and providing therapy. I also love going to therapy. But it's weird. You sit there and talk about yourself. It's totally focused on you. And you create this super intimate relationship with someone that you otherwise don't interact with. Yep, weird. And the boundaries sometimes make things a little awkward even though they're necessary.
I speak to clients OFTEN about boundaries but it's still uncomfortable at times for me to set them. Even with the people that I have taught boundaries to. I think a lot of this is connected to therapists being in a helping profession and so it may be assumed that we need to help at all costs. Here I share a few boundaries that come up in therapy by your therapist that they may be uncomfortable setting, still need to set, and why they do it. (They're not just being a jerk.)
What's up with this rigid cancellation policy?
Most therapists have a cancellation policy so that if you miss a session or cancel last minute, they have steps that they take or expect you to take. My policy is that cancellations and reschedules need to happen at least 24 hours before your session. If that doesn't happen, you are charged the fee for the session. Even if it's 23 hours and 40 minutes before your session. I know, super awkward. This is one of the policies I hate doing the most!
Many times, in these cases, I want to help! I don't want to take money for a service I didn't "provide". But it's also a business. Since I blocked off the time to make myself available, still am available, and made it where no one else could meet with me during that time, I expect that you're also going to show up and that I will be compensated for the time I reserved. What you do in that time is what you choose to do in that time. So therapists have to hold their clients accountable for showing up to commitments that we've made to be present.
If there's a specific issue that's making it hard for you to show for that day (financial, schedule, family, etc.), I suggest you talk to your therapist about it. These topics may be things that are connected to your treatment goals that may be important for you to make your therapist aware. It also may mean that you might need to consider making a change to your services like finding therapy closer to your budget and your therapist may be able to give you some resources on ways to do that.
But can you meet a little later?
Coordinating schedules is tough. This is especially true with all of the things we are balancing in our lives- school, work, family, travel, etc. Wouldn't it be nice if your therapist was a little bit more flexible with their hours? Absolutely, it would be nice. But just like you, they're balancing their life as well. I'd also love it if a few other businesses matched up with my schedule. This is why it's so important to find out your therapist's business hours and make sure that they match up with your own.
I know when I returned from my maternity leave, it was really important for me to have more realistic hours when balancing my changing family life. I no longer wanted to do weekend or evening hours because I wanted to devote that time to being a mom. I alerted my clients and some were able to adjust their schedules to be able to see me but it wasn't possible with everyone. And although I was sad to see them go, I understood just like I hoped they understood for me. It just was no longer a good fit. But it was important for me because I wasn't going to be a good therapist and definitely wasn't going to model what I was talking about regarding pouring from an empty cup if I didn't hold this boundary. I needed to prioritize myself and my self care.
You deserve to have a therapist that you feel comfortable with, that can address the concerns you want to tackle in therapy, and matches (at least most of) your logistical needs. So my suggestion? Be real with yourself about if the therapist's schedule actually matches with yours. Or reflect on how to prioritize your mental health differently than you have been to show up for yourself during that hour.
Wait, how much?!
I've got a lot more comfortable with this one but initially it was horrible to have this conversation about my rates. I had so much negative self talk about what the person must be thinking. As it is, I've still had clients make comments about my rate. I get it. I have a hard time sometimes accepting the bill for my own therapy. Add in that many therapists don't accept insurance or only a few insurances. It's tough! And coming from a non-profit background, this was a hard adjustment for me to also make as a therapist. I also had to recognize that there's no way I could keep my business afloat, pay for business fees, provide for my family, and keep myself sane by charging the rates I wished I could charge.
Many therapists don't accept insurance for a number of reasons. A few reasons for me is that I don't agree with the idea that everyone should be diagnosed. I'm not for pathologizing everyone to get paid besides not embracing other cultural ideas around behaviors and experiences. Sometimes... many times... the label is just not necessary. But it is a requirement to be paid by insurance companies. It's also known that you may be spending additional hours fighting with insurance companies to get them to pay for your client's session and those are hours that I could be spending with clients or recharging myself. Additionally, insurance companies don't pay therapists their full rates which can also lead therapists to work more hours to provide for their families. More hours working means more likely to burn out. Not a good quality in someone you need to be present and help you with your burn out.
So that means that you end up paying out of pocket for your therapy appointments at a rate that can be hard to swallow. One thing that helps me with the mental part of the money I'm spending for weekly sessions is recognizing the benefits I receive from attending therapy regularly and prioritizing it. I really don't know how I would have made it through the past few months without one so it's worth every penny. For those who feel similarly, I also encourage others to do are adjusting budgets to allocate funds to your mental health, finding health care in your budget, tapping into free or low fee resources like support groups, and researching resources such as Loveland Foundation Vouchers, sliding scale, or companies that offer mental health memberships.
Just tell me what I should do!
Therapists should not be advising you on how to live your life. Instead, our job is to assist you with determining the life you want, working with you to develop a plan on how you may be able to get there, and pointing out when you are on or veering off that path. But ultimately if you want to make a sharp right and you're not harming yourself or others, the choice is yours and I'm here for the ride. I have my own life that I'm in charge of and I recognize that this is yours. This boundary isn't as hard for me but can be for some of clients who, in that moment feel a bit lost.
But if I tell you where to go or what to do, I'm basing this off my perspective. And my perspective is not your reality. My job is to help you to trust yourself, not to rely on me or anyone else to do that for you. That may mean sitting in some uncomfortable limbos for a few sessions as you determine what's best. That's okay with me and I hope to encourage you to recognize that even though it's not fun, it is normal and necessary at times. We'll work on strategies to assist along the way and techniques for you to grow but I know you can do it. Trust me- you don't want your therapist determining your life for you.
So what's going on with you?
I ride the line on self disclosure. Some therapists are very strict about not sharing about their life with clients. Others may share too much. I hope that my clients recognize that I share when I think it's appropriate but it can be a blurry judgment call to make. It also greatly depends on the client and the situation.
Here are a few aspects that a therapist may reflect on when deciding to share, what to share, or who to share information with in a therapy session:
Is the client able to hear this information and not assume additional or inappropriate things about the relationship?
Will the client use this information in an inappropriate way?
Will the client have a difficult time continuing to focus on themselves and their treatment?
Is this information even relevant to what is going on?
Does it change the focus of the session on to the therapist rather than the client?
Will it assist or detract the client with getting to their treatment goal?
Will it negatively impact the therapeutic relationship?
Does it cross professional boundaries?
If you want to clarify where this line is in your therapy sessions, it doesn't hurt to just ask. Your therapist will have no problem providing some information on this topic for you. Depending on the question, it may also help them to assist you with therapeutic goals.