Explore the challenges behind the healing curtain of helping others as psychotherapists and healers, from codependency and poor boundaries, transference & countertransference, & offending clients and navigating confrontations. With over 13 years of experience in human services, I share insights, personal experiences, and practical tips for fellow healers to navigate sticky situations that we often do not consider when embarking on these careers of being of service. We discuss embracing the highs and lows, learning from mistakes, and finding resilience in the rewarding journey of supporting others. After you have joined us in this conversation, be sure to check out Pt. II to this next!
Disclaimer: I am no longer licensed and do not work in the field of clinical social work any longer, with that said this is not a form of clinical consultation, training, supervision, or advice. Always adhere to your state policies and professional ethics and training requirements when it comes to your work in being of service to others in these professional roles.
Resources Referenced
Navigating the Challenges Working as a Psychotherapist Pt. II
Healing the Body, Mind, & Spirit from Vicarious Trauma & Burnout (britmarie.com)
A Spiritual & Clinical Take on Vicarious Trauma & Burnout (britmarie.com)
Transform Your Space for Healing: Tips for Creating a Therapeutic Office Environment (britmarie.com)
Table of Contents
Unveiling the Depths
As healers, we experience the highs of discovering our abilities and strengths, the sacredness of holding healing space with others, and supporting other's growth but also the lows of realizing our limitations, misperceptions that can arise within healing relationships, and challenges around healing codependency and navigating boundaries. Mistakes happen, unintentional offenses occur, we are projected on by others or do the projecting, and sometimes, we find ourselves grieving the end of therapeutic relationships. These dynamics along with the weight of responsibility, the development of dependency, and the challenges of maintaining healthy boundaries become learning companions on this journey.
This is a two-part discussion, in this first video and blog, we will go over issues that are related to the interpersonal dynamics of healing relationships. Then in part II we will go over more serious issues like safety concerns and feeling threatened, mandated reporting, being groomed and receiving inappropriate sexual advances from a client, manipulation tactics, and having to request welfare checks for those who may be homicidal or suicidal.
Codependency & Poor Boundaries
One of the initial challenges lies in confronting our own unresolved issues of codependency and poor boundaries.
Codependent behaviors is on a spectrum from mild to severe and can involve characteristics of:
Excessive caretaking and feeling responsible for others' needs, feelings, problems, and happiness.
Difficulty setting boundaries.
Low self-esteem and worth that contributes to seeking validation and approval from others.
Fear of abandonment.
People pleasing.
Difficulty expressing emotions and one's own needs.
Feeling dependent on others for a sense of self that can lead to a loss of identity.
Avoidance of conflict.
Feeling hurt and threatened by others' negative reviews or opinions.
Wanting to control situations or people, driven by the belief it will prevent negative outcomes or ensure the well-being of others.
Codependency is also often linked to difficulty setting healthy boundaries that can cause us to:
Work past our set schedule.
Not end appointments on time.
Give others more time than we have to offer, leading to working through breaks, mealtimes, or at the end of the day.
Feel pressured to respond to clients who do not respect appropriate communication between sessions, resulting in excessive outreach through email, text, or phone calls about counseling needs outside of appointment times.
difficulty reinforcing attendance and billing policies, resulting in openings in our schedules, not billing for missed appointments, and past due invoices.
Feeling responsible for clients' healing outcomes
Tips to Help Heal and Overcome Codependency:
Another healing practice to help heal this is affirming positive affirmations such as:
Lessons in Boundaries
My mentor tells me the moment we become invested in another’s outcome we have become manipulative because we are now focused on our involvement, performance, or efficacy and attempt to control the outcome instead of allowing and trusting the healing and life lessons to unfold as they will within divine timing. This is a helpful reminder to learn to let go of control, surrender, and center myself back into holding healing space for other’s to be themselves exactly where they are in life as we explore some different ideas to support their well-being.
Supporting Others Who Struggle with Codependency & Poor Boundaries
Some clients will push past boundaries and policies we put into place, or they hold expectations that we will fix them, and they will not hold themselves accountable to do the work needed to make lasting changes. I have also had people project blame towards me for them not being healed after a few sessions. We have to remind ourselves and others that therapy and healing work is a walk not a destination or rescue mission. We have to clearly communicate our boundaries, the consequences of what happens if they are crossed, and reinforce those consequences when they have not been respected.
Other’s may not respect our boundaries, but we must, and I know from experience in having to continue to heal around codependency myself that this is really tough and takes years of healing work, self-study, gaining knowledge, & cultivating self-awareness to catch ourselves from repeating these patterns.
Many healers may be recovering from codependency so we may have a higher threshold of tolerance when it comes to people pushing past our boundaries since we learned that was a normal and familiar thing from our childhoods but we need to do our best to make sure we do not ignore red flags and boundary violations and that is where education, frequent self-examination, self-honesty, supervision, and actively engaging in our own healing work is essential to stay balanced as a helping guide when working with others for everyone’s safety and growth.
The Three Rule System to Setting & Reinforcing Boundaries
There is no perfect formula to setting boundaries and circumstances will always vary so using discernment and seeking consultation with mentors is essential in strengthening this skill, but I have a three-rule system that helps me approach how to address boundary issues that you may find helpful in determining how to approach the intricacy of setting and reinforcing boundaries.
1. The first time a boundary is violated we discuss this in detail where the overstep or violation occurred as this may have been an innocent oversight on another’s part and its:
Helpful to gain more information to clarify the reason why this happened.
Provide an explanation as to why it is a violation.
Discuss the expectations for healthy therapeutic interactions & the practice policies.
Lastly, what will occur as a consequence if the boundary is overstepped again going forward, whether this is offering another reminder or letting the client know if this happens again it will result in termination of services, being sent to collections, or being charged for missed appointments.
These first-time boundary violations could just be out of lack of knowledge of how these professional relationships are set up, what the policies are, or due to situational stressors. By communicating and setting healthy boundaries it helps you model healthy relationship skills which can help the client improve areas around this in their personal lives.
2. If the boundary violation happens again then the consequence discussed prior to this will be enforced and it’s shared that this will be the last notice of this and the third time it occurs it will have to be decided whether this results in a termination of services or added charges to cover late fees or late cancellations.
It will then be explored with the client if this is an area where therapeutic work can be addressed to upholding and promoting healthy responses in honoring other's boundaries.
This offers the benefit of the doubt and an opening for some deep and potentially positive healing work around relationships.
3. If the boundary violation occurs a third time, this is a sign to me that the person is fully educated now on the appropriate parameters of a therapeutic relationship and the practice policies, they have been informed of the consequences & had them reinforced, and they are choosing to show disregard or lack of respect to these boundaries whether they mean to or not.
This is a sign that the relationship dynamics are compromised and having to offer harder lessons of terminating services and providing referrals is at times the best way to model consequences of healthy boundaries when they are not upheld.
I am referring to more minor boundary oversteps like chronic tardiness, late cancellations & no shows, not paying invoices on time, or texting, emailing, or calling too frequently in between sessions and trying to discuss therapy matters outside of session. The major boundary violations will be discussed in part II.
Becoming Dependent on Services or the Healer
At times when a client is no longer engaged in participating in their healing work and have created a reliance or dependence on the healer or services this can also be a sign, that termination of services would be most helpful if after addressing this it’s still a reoccurring theme, this can be very difficult to do and create feelings of abandonment for both involved but can be necessary to not foster an unhealthy relationship dynamic that will not serve the client’s true long-term wellbeing.
Setting boundaries and having others set boundaries with us isn’t easy especially when we were not taught healthy boundaries as a child so when someone sets a boundary with us it can feel personal, triggering guilt, shame, embarrassment, and anger which are great leads into potential healing work to address.
How to Respond When Asked for a Hug or When a Client says, "I Love You."
It is my policy that I do not ask others if I can hug them as a healing guide to err on the side of caution, comfort, and each person’s own safety. If I am asked for a hug it is assessed on an individual basis whether it would be appropriate and how the client intended to receive this form of connection. Clients who meet diagnostic criteria for a personality disorder, there is a hard rule of having no physical touch due to issues around healthy boundaries to ensure both of our safety and that clear boundaries are being maintained.
If the request seems like a genuine gesture that does not have any concerning underlying intent or misperception of what that gesture would mean, then a hug or side hug is shared. If a client asks to make this a regular practice each session this may need to be addressed and healthy boundaries communicated based on your own discernment around the appropriateness of it.
Some colleagues especially male colleagues have shared they have a firm policy on no physical contact and share that they appreciate the request and sense of trust and safety the person has with them but to ensure everyone’s ongoing comfort level and safety they will uphold the policy to maintain professional boundaries of no physical contact. If this offends or triggers transference within the client, it can be used as a point to address within their healing work to resolve and accept other’s boundaries without feeling its personal.
The last thing that we will touch on around this is when a client says, “I love you.” If there is boundary, personality, safety, or concerning mental health concerns this is certainly not appropriate and boundaries need to be put into place and education on what healthy therapeutic alliances look like and what is and is not acceptable for the clients to understand. However, when this was said to me it did not have these circumstances involved and these were sincere gestures of gratitude and connection.
For example, when working with children they may be more prone to ask for hugs or say I love you. It pulls on my heart strings not to offer their innocent natures this love in return but it's always essential to follow agency guidelines on this when it comes to physical contact.
Another time I received these statements was at times working with elderly clients with dementia, or non-English speaking clients that I felt were just expressing their gratitude. Instead of saying I love you in return to maintain professional boundaries, I would offer responses like:
"Thank you so much for your heartfelt gratitude; it means a lot to me."
"I appreciate you and am grateful for the work we get to do together."
"Thank you for trusting me and allowing me to hold space with you."
"It is an honor getting to work with you, and your words touch my heart."
"Thank you; you are dear to my heart."
"You are a special person, and I will keep you in my heart."
When these types of interactions occur, they will need to be assessed on an individual basis the appropriateness along with the safety and comfort involved.
Transference Challenges
Transference is a concept in psychology that refers to the unconscious transfer of feelings, attitudes, and patterns of behavior from past significant relationships onto a present relationship with another person. This can arise more often within the therapeutic relationship than in other healthcare roles due to the intimate nature of the work.
For example, a person who had a difficult relationship with their mother may unconsciously transfer their feelings of anger or frustration onto their therapist. Alternatively, a person who had a positive relationship with their father may unconsciously transfer feelings of trust or admiration onto their therapist, which can affect the therapeutic relationship.
Transference is a normal and natural part of the therapeutic process, and therapists are trained to recognize and work with transference in order to help their clients better understand and resolve unconscious conflicts and emotions. Identifying and addressing this as the therapist helps cultivate understanding that the client responses towards them are not personal and can be a form of projection and an important area of focus for treatment.
Receiving another person’s transference can be difficult, we can be idolized, other’s may have high expectations of us to meet their needs and see us as an authority, we can become relied upon more than what is helpful, clients may want to be our friend or develop a romantic interest in us, or we are blamed and receive negative feelings of others towards us from their former experiences.
Releasing the Ideals of Who You Think the Healer Is
Other's may also create ideals of who they think the healer is, how they live their life, or imagine they have an ideal life, have figured the answers out to complete healing, do not suffer or endure challenges like they do, or expect them to be a certain way. Appropriate self-disclosure can be helpful for others to see that we are all human and together doing this life thing which is sometimes beautiful and abundant and other times painful and sorrowful, and no one is excused from these realities.
When we use disclosures in these ways it can help the client release these ideals of there being a power differential and that healers or helping professionals are not above the human condition and do not have all the answers and are going through this healing and learning journey no different. This can help redirect these expectations in healthier ways for the client to see that they do not need to measure their progress to anyone else’s and all the healing that is done is truly within one's self, the therapist is only a guide for them to discover this truth along with one’s own power, potential, & inner direction.
Countertransference Challenges
Countertransference which refers to the therapist's emotional or psychological response to a client, which may be unconscious. It's essential for therapists to understand their own emotional responses and how they might impact their ability to provide objective and helpful guidance to their clients.
There may be a time that a client triggers feelings of being unsafe or threatened and we may be aware it may just be countertransference and hypervigilance but I think it's still our job to ensure our sense of emotional and mental safety at all times and if this cannot be resolved in a safe way in your own healing work and supervision than a helpful approach would be to honor your experience and seek to serve the client in the best way through terminating services and providing a referral.
I was once screamed at by a client who was very distressed and hurting within their own rights and lost control of their emotions and projected the pain of their trauma onto me and this was very startling and frightening. My inner child no longer felt safe as this triggered childhood trauma of mine, and it was communicated with them that if this type of response occurred again that services would be ended. We took a treatment approach together to strengthen stress tolerance and emotion regulation and were able to continue our work finding ways to honor both of our needs and safety.
However, a colleague shared that they were deeply triggered by a client, and they had to make the difficult decision to inform them that they could not be of service to them. They knew they needed space to process for themselves before overextending themselves and their emotional limits to working with someone where unresolved trauma triggers and countertransference was occurring.
Sometimes we overextend our support to another even though this is with good intent it can be an unconscious drive of people pleasing, projecting our past with a former caregiver onto them of wanting to caretake to receive validation, or we can project blame onto clients and direct negative feelings and responses to them.
Inappropriate Relationships
Other challenging issues around countertransference is if a therapist begins to develop romantic feelings towards their clients. If this occurs, seek immediate supervision, and terminate and refer the client due to the objectivity of a therapeutic relationship being compromised by these feelings. It is not encouraged to share these feelings with the client when referring as we must ensure their sense of safety and uphold appropriate boundaries. Terminating services and referring when this happens also can help ensure that this does not lead into compromising your own ethics, values, and integrity from exploiting the client in this way and coming on to them or pursuing a relationship with them. Then within your own therapy work and in supervision, work to address these feelings and issues and explore and process any reoccurring themes of countertransference.
Another area like this is if we begin to have fondness of clients and desires of wanting to be their friend or go into business with them or vice versa. We must always uphold healthy boundaries within these relationships and remind others and ourselves that this is a healing relationship, and I am a friendly professional, but I am not a friend or potential business associate. We must not exploit the relationship in this way, cross this boundary, or open ourselves up to significant liability issues. We are humans and its normal to want to connect with others, but professional judgment and ethics must be always front and center around this.
Grief that Arises when Therapy Relationships End
The last thing we will touch on is when therapy ends with a client we enjoyed working with. Whether they stopped attending, became upset with us and terminated services, it was a mutually agreed upon end to services because they met their healing outcomes, or they passed away. As humans we create bonds and attachments, this doesn’t mean we don’t have good boundaries it just means we have a heart that doesn’t differentiate business matters from human connection.
It is normal for us to grieve these changes and the end of these healing relationships as long as we do so appropriately and process through these feelings in our own healing work and within supervision.
Offending Clients
There are going to be times we misread what the moment asks for and we unintentionally offend clients by something we said or did not say. Maybe we said the wrong thing, offered our own bias or opinion, did not validate their feelings, said something in ill timing, in family therapy made another feel ganged up on or triangulated against, gave advice that was not applicable or helpful, tried to jump too far ahead in the healing work instead of being present with where they were in their stage of change or lastly upset a client by terminating services for any number of reasons. When we are confronted by these mistakes, it can negatively impact our sense of competency and effectiveness and cause shame or guilt for not getting it right and hurting or upsetting a client we are trying to support.
We never know exactly how we are impacting another person’s experience or how they interpret what it is we are saying. We are human and make mistakes and can’t always get it right. The only way to cultivate this balanced judgment is through making these mistakes and learning from them along with time, maturity, professional development, continued education, and the ultimate teacher being experience itself. Even being a seasoned therapist, we will inevitability get it wrong sometimes or we just will not be someone’s cup of tea. This too is valuable learning experience that allows us to forgive and accept ourselves as we are as well as others.
Sometimes the therapist truly makes a mistake or says something that was offensive or inappropriate and during these times we must acknowledge these oversights, biases, and limitations and apologize and resolve the conflict with humility, sincere apology, and reflection on how to learn from this and improve one’s interaction within the therapy context. Other times, there will be a misperception on the client’s part, and they may interpret what was said much differently than we meant which can feel shocking, unexpected, and confusing when we are confronted with it.
We cannot assume what we say and do has the same meaning for us as it does the client or that they will perceive this in the way we intended for it to be received. Regardless, we can still acknowledge that we have caused offended feelings, apologize for the misunderstanding, offer an explanation without defensiveness or blaming, and discuss what healthy resolution of this matter looks like for all involved. We can also thank the client for their assertiveness and courage to share when they feel offended and for the opportunity to resolve this in a healthy and helpful manner. If the client feels regularly offended, there may be underlying factors around relational and attachment trauma, personality disorder factors, the therapeutic relationship may have come to its end, or we may simply not be the right provider for the client.
Navigating Confrontation & Accepting Our Humanness
Another issue that can arise is loved one’s of clients can become upset with changes or boundaries the client is creating in their personal lives and relationships or questioning the treatment received, leading them to reach out with upset or accusatory calls, emails, and threats. Other times we may be in the good grace of a client and feel there is a positive rapport built and then they are disgruntled, triggered, or feeling abandoned which can lead to confrontation, verbal and physical attacks, threats, disparaging remarks and reviews made online, license complaints, or lawsuits.
These confrontations can be shocking, painful, and disorienting. We can address these issues when they arise with the client and work to resolve them in a healthy therapeutic manner and other times when the therapeutic relationship has been ended, we must turn inward to resolve these challenges within ourselves. We must do our best to stay grounded, recognize that often this is not personal, and we cannot be responsible for other's misperceptions, actions, choices, and thought process. However, we can own our mistakes and learn from them going forward.
Take time to reflect on mistakes, failures, and oversights. Grieve and release attachments to other’s perceptions of us or our reputation and work to address and resolve our own wounds and issues from our past that this may be triggering. When unexpected or confrontational interactions occur, it's important for us to be kind to ourselves, identify self-deprecating talk, or negative thought patterns around fear, shame, or guilt and work to reframe this along with forgiving and accepting ourselves or the client if needed.
We must work to accept our humanness, the human condition of making mistakes and having failures, accept our responsibility in matters, and allow others to be responsible for themselves, their feelings, and actions. Lastly, we should turn towards our mentors, supervisors, and peer groups to help us process this and gain greater knowledge around our professional development moving forward. And if need be, involve legal counsel if the circumstances lead to defamation, licensure complaints, or litigation.
Closing Thoughts
Thank you so much for joining me in this conversation and if there is anything you would like to add to this, please do share in the comments on the YouTube Video so we can support our growth and gain greater knowledge from one another.
Be sure to check out part II to this that addresses Navigating Major Boundary Violations and Complexities of Working with Others. Also be sure to check out the post on addressing the Clinical and Spiritual Causes of Vicarious Trauma and Burnout that can impact our work with others. After you have finished that tune into part II to that which is a Comprehensive Holistic Guide to Healing and Reclaiming Your Peace from Vicarious Trauma & Burnout.
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