Professional boundaries are important in therapy and counselling. But there are times when we need to make choices. What is in the best interest of the client and the therapy? Allow me to share a bit of my personal experiences.
In April 2012 I found a lump in my right breast. At the time I was working as a self-employed psychotherapist in the Primary Care Service for 2 London NHS Trusts. I offered short-term support to clients who had been referred by their GPs and work out of GP practices.
In the week between tests and diagnosis I prepared a contingency plan, not for me but for my clients. My intuition told me this was cancer and, if so, I would need to stop working with immediate effect.
The day after the diagnosis I agreed with my then employer (an agency) a hand-over plan, and what I would tell clients. Therapists are encouraged not to disclose information about themselves to clients. Professional boundaries are essential to avoid anything that might distort and take away from the story of the other, who is seeking support.
Over the next days I met all my clients informing them this would be our last session, and what was in place for the continuation of their counselling.
I started each session with the same statement:
“I have had some news, which means I will no longer be able to continue seeing you or any of my clients.”
There was a common assumption that I had found something better, another job, been promoted; and disappointment that I did not honour my duty of care and finish the work we had started.
Yes, I had found something else and, yes, I would not stay on. I felt the hurt I had caused and we talked about it, how it might repeat past experiences and expectations of rejection, but I chose not to disclose more. I stuck to my professional boundaries.
I did not want to cause concern about me. But instead it appeared I had torn into existing wounds.
I left the two GP practices where I had been working without telling the practice staff why. I thought I was protecting my clients and did not want them to find out the real reason from a third party.
I felt like a thief at night with an unsavoury secret. I had put professional boundaries ahead of my clients’ best interests.
A key support in my life was my own therapist. Three months into my cancer treatment I received an email telling me that due to health reasons, there would be no more sessions until further notice. Would I like to be put in touch with someone else?
No, that would not do. I was shocked and worried for my therapist.
My cancer treatment continued and was increasingly debilitating – physically, mentally, emotionally. Doubts started to set in about everything in my life, including my therapist. Perhaps dealing with my cancer had been too much.
Perhaps I, my cancer, was too much. He no longer wanted to see me…
Part of me knew it was not really like this. I had trusted this person with my life story for years; but the nagging remained.
Some months later, at the start of a new year, between my chemotherapy and radiotherapy, an email arrived with my therapist’s name in the subject heading. The email had been sent to all current and former clients.
My therapist was dead. No more explanations.
We were invited to get in touch with a named contact if we needed support with what had happened.
I was distraught and angry. I wanted to know what had happened. Initially, the request for further information was turned down. I was at the receiving end of professional boundaries. Eventually, I got the news I had expected: cancer.
I don’t know what it would have been like, had I known the diagnosis, while I was going through my own cancer treatment.
Perhaps my therapist had been trying to protect me. Perhaps they had been too ill to do anything different.
I would not have been in a fit enough state to converse with clients while I was undergoing my first cancer treatment.
But, on balance, I wish I had been told. The not knowing and fear of abandonment was tormenting.
Telling me would have taken away that uncertainty and stress. The truth would have frightened me, for sure. But if I had been told calmly, that may have also calmed and steadied me at a time of my own crisis and uncertainty over life and death.
These are all complex situations and assumptions, and I do not doubt for a second that my therapist did their best and acted responsibly, just as I did with my clients.
But professional boundaries can be a double-edged sword.
Life’s experiences shape us. When I was diagnosed in May 2018 with a local recurrence of the original cancer, I knew what I had to do. By then I had been running a private practice in West London, started writing and doing YouTube videos on a range of topics and most including some aspects of self-disclosure of my cancer experience.
I knew instinctively that this time I was not going to hide the reality from my clients. I knew that trusting them with my news and with the knowledge that they would be able to cope – that was a tremendous healing and growth experience.
I had to be prepared, of course. And in some ways I had always been prepared for this eventuality. But when it happens, well, it was tough, to say the least.
I had to take time off work again, and did not know how long for. I agreed to email updates as appropriate. As I also wrote about my experience at the time and I am active on social media. Therefore, I had to ensure that no communication duality arose. Any relevant updates had to be shared with my clients, first.
A few months later, I started to gradually return to work. The first session/s reviewed how my clients had felt about how we had handled my cancer news. Did they want to continue working with me, or therapy in general?
I had to scale my work down, and a mutually agreeable schedule was found.
From July 2020 until February 2021 (ie during COVID 19) I needed further treatment (surgery and chemotherapy). Again I decided to share the reality of my circumstances with my clients. This time the chemotherapy regime was far more tolerable and I was well enough (with adequate supervision) to continue a reduced client schedule. I would like to believe this worked well for my clients and I.
In order to provide meaningful and safe therapeutic support it was essential to be open, honest and transparent. We needed to address:
- What has happened? And why I have chosen to share.
- What is it like for you that I have told you? Would you rather I had not?
- Acknowledgement of where this news may relate to the client’s own material (of grief, abandonment, health issues, anxiety …).
- Practical steps, what next?
Overall, the feedback was that entrusting my clients with my news and my own vulnerability, keeping them informed and most of all, openly talking about such difficult topics like illnees, uncertainty, grief and mortality, helped reduce anxiety. Of course there had been concerns and some pain. But this is unavoidable. And pretending otherwise is not therapeutic or helpful.
We all grew in courage that we can face up to difficulties.
And even now, we all know about the uncertainty that cancer brings. But then again, life has been and remains uncertain – always, cancer or no cancer.
And for now, we continue our work and life to the best of our abilities.
I believe that there are moments in therapy when not shying away from our own truth and our very human story can be of real value.
It is therapeutic for all of us not to lose sight of our humanity, vulnerability and mortality, therapist or no therapist.
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