Traditional psychotherapy focuses a lot of attention on creating boundaries in the therapeutic relationship. This concept applies to concrete measures such as a clear beginning and end to the session and rules about contact between appointments. There are also more gray aspects to boundaries such as the therapist sharing personal information or ensuring the limits of the personal connection in therapy so the treatment can focus on the well-being of the patient.
Many books and articles delve into the effects of setting boundaries, and newer therapeutic orientations explore the benefits of looser boundaries. The evolution of the meaning of this term in recent years reflects changing attitudes and expectations for therapy in people's lives.
Certain illnesses such as eating disorders force the therapist to take a closer look at the boundaries in treatment, especially when present attitudes about the therapy relationship do not coincide with the most effective care.
The psychological component of an eating disorder is relentless. The thoughts to restrict food or binge, buoyed by the constant need to lose weight and the feeling of inadequacy, press to the fore of one's mind over and over again.
The only way to placate them appears to be engaging in the eating symptoms. Struggling against those thoughts to try to follow a meal plan and then manage the feelings that surge forward when not numbed by eating disorder symptoms can feel like a never-ending battle.
The most successful treatment for eating disorders involves regular contact between the patient and treatment team. The person needs very regular support in order to successfully confront the eating disorder thoughts throughout the day.
In order to be available enough for recovery, therapists often loosen the boundaries significantly. This change undoubtedly has an effect on the therapy but also gives the person the support necessary to be able to continue effective recovery.
In treatment that works, the therapist-patient relationship strengthens considerably and may even become very personal even though the boundaries of a professional relationship remain clear. This dichotomy can be confusing and is even a point of contention within the community of clinicians treating people with eating disorders.
The next two posts will present the pros and cons, respectively, for loosening the boundaries in therapy for an eating disorder and explain how this component of treatment is critical to meaningful recovery.