Therapy News

This article is a guest post from Nicole Perry, M.A.

As helping professionals, we pride ourselves on empathy and compassion. We see the person in front of us in pain, and we can attune to it. Connecting with people is kind of our superpower (one that we work very hard at getting right). 

And yet, we also need to learn how to manage this strength. One of the biggest struggles I see for therapists is how hard it is for us to say no to clients. We’re so attuned to the pain our clients are in, that we want to do anything we can to relieve it. We definitely don’t want to disappoint people or add to their struggles. But we’re not actually superheroes. We all have our own, very human, limits. And if we try to take it all on, sooner or later, it’s going to catch up with us.  

If You Don’t Set Boundaries, Your Body Will Do It For You

When I ask more seasoned therapists what helped them start setting boundaries, many of them tell me it’s because they experienced firsthand the consequences of what it’s like to do this work without them.

“My body started shutting down and I basically had no other options,” one therapist admitted. For her, it got to a point where she was hospitalized for Crohn's disease. Putting her health on the backburner was no longer a risk that she was willing to take. For me, it was chronic migraines that stopped me. At first I tried to push through and not let anyone see the pain I was in. I spent hours lying in the tub in the dark just trying to recover from the day. At some point I stopped caring about making it look like I was okay. I wasn’t. The pain was intense enough that I would have done anything to make it stop. Working less and under less stressful conditions was the least I could do. 

Other therapists started taking boundaries more seriously when they saw the impact it was having on their clients. One therapist shared that she found she had less patience with her clients. “I started becoming just one more person in my client’s life who was getting frustrated with them for their lack of progress. I found myself grumbling about them whenever I saw them booked for the day. I know I wasn’t as present or empathetic with them as they deserved, and I know that it was because I was exhausted. I have no doubt that they picked up on this, and that it seriously impacted their trust in me.” 

Another therapist admitted she made ethical mistakes that she wouldn’t have if she’d taken the time to consult. “I was so pressed for time that I didn’t slow down and take the steps I should have taken to make sure the work I was doing with this client was really in my scope. We realized too late that it wasn’t. That client never came back, and I’m still carrying it with me.”

Usually by the time people draw a line, it’s because they’re feeling burnt out, resentful, or overwhelmed, and they have no other option. I know many of us have been taught to give everything we have, even at great detriment to ourselves. The good news is we don’t have to wait until it gets this bad. Amazingly, when we listen to our limits and set boundaries, it gives way to a more compassionate, ethical approach.

Aiming For A Compassionate Connection Over the Long Haul

For those of us who feel bad when we have to say no to clients, I think it’s important to keep in mind our greater goal. What we’re really trying to do when we say no to things that aren’t a fit for us is protect our emotional energy and honor our internal limits. We do this so that when we do show up to work with clients, we’re doing it from a grounded place. We want to show up with aliveness and without resentment or bitterness so that we can be the warm presence our clients really need. We’re setting these boundaries because it helps sustain and nourish us over long careers connecting with people. Personally, I want to be doing helping work for a few more decades, and so I need to think about what’s good for my body over the long haul. 

I also think that when we are clear on our own limits and can trust in ourselves to voice them and trust our clients to handle it, we’re modeling something pretty amazing. We are teaching our clients that it’s OK to say no. We’re teaching them that you can be a caring person and say no. We’re teaching them that you can stay in connection with someone while you’re saying no to their request. When we say no in a way that’s kind and clear, it makes room for clients to say no too. As a feminist therapist, I want to do all I can to help clients know and truly feel that they’re allowed to say no, both within the therapy room and outside it. 

It’s Not Going To Go As Badly As You Think It Is

The last thing I think we need to remind ourselves of is that most people are actually really good about hearing our “no’s”. For example, when I first started out, I agreed to work some evenings as a favor to clients who worked during my usual office hours. When my health got worse and I had to draw a line, I simply told people that I don’t work in the evening. And their reply? “Oh, OK“. And then they picked another time. I was completely surprised to discover that most people were just asking about evening hours because it was most convenient and they hadn’t memorized my working hours - but that didn’t mean they couldn’t come during the day. The same was true when I dropped one of my weekend days. Turns out most people could come during the week if that was the time that was available.

In my early days as a therapist, I also felt like I had to try to work with almost any issue that came through my door. This was true especially if I’d already had a first session with someone. I would usually try to help them as best as I could, use up a lot of supervision hours, and struggle through until it got to a point where I was most definitely stuck and had to refer them out. Looking back, there was a much earlier point, with almost all of these clients, that I knew it wasn’t in my wheelhouse and they would be better served elsewhere. But I felt bad telling them so. I felt like it would be taken as a rejection or that I’d be giving up to soon. I thought that if I just challenged myself and worked through it, I’d be able to figure it out. Of course what ended up happening is that by the time I was really stuck, they were more attached to me, and it was a harder conversation to end the therapeutic relationship. Now I’m better at redirecting people early on, even from their initial emails. If I have a feeling that the issue they want to work on is beyond my scope, I’ll just say that right away. I’ll give them a few names of other therapists who might be a better fit and basically wish them the best. Almost every time, that’s been met with appreciation for helping point them in the right direction. 

The thing that makes the biggest difference here is when we can be open, direct, and communicate our limits clearly. What I’ve learned is that most of the time, people don’t know that we’re bending over backwards when we’re bending over backwards. When we understand and name our boundaries, most people are quite happy to respect them. And when they aren’t? Well, better to know that early on and make decisions accordingly.