When conducting a session with a client in therapy or counseling, what are the limits to where you can meet?
I have heard that some therapists/counselors do house calls (please correct me if I am wrong). Does this mean that the client could come to the counselor's home? What are the rules for this? I've also heard that you can't have a social life outside of the office with clients. Does this mean you can't say hello if you run into each other unplanned. #counselor #therapists
The therapeutic relationship is different by design. It’s an important difference in that professional boundaries are in place and should remain that way.
A boundary in counseling is much like a boundary on a piece of land. It’s a line that both people recognize and honor. It’s a line that says where the relationship begins and ends. It sets the therapist apart from other people in your life.
There is no set standard for the particulars of boundaries. Different models for therapy and different disciplines have different ideas about what the boundary closes in and closes out. Different therapists operate according to their training and their own ideas of what it means to “bind” the relationship. It’s why some therapists offer you tea and others don’t; why some therapists end sessions with a hug and others don’t even shake hands; why some will stop and chat in the aisle of the grocery store and others aren’t approachable; why some therapists will allow going over time during a client’s crisis and others feel it’s important to keep a strict end time.
Your therapist is responsible for making boundaries clear at the outset of your work together. Basics like when and where you will meet, fees, consequences for you not showing up for an appointment, and expectations for in office vs. out of office contact should be spelled out clearly. He or she should carefully explain the rules of confidentiality so there can be no misunderstanding about who has access to information from your sessions and what would trigger notification of authorities.
Hugs and affectionate physical contact are generally not OK. Current research has determined that hugs or other displays of affection between therapist and client cloud the meaning of the relationship. Sometimes, if ritualized, this can be okay. But if the client is uncomfortable or the therapist isn’t professional about it, it can lead to confusion of roles.
The therapist needs to be clear that he or she will never accept gifts or special favors from you. You are paying for his or her time and expertise. There is no need to provide any other compensation.
Yes, sometimes therapists bend their own rules. A therapist may insist that all therapy happen in the office, for example, but decide to take a walk around the block with an antsy teenager who just can’t sit comfortably with an adult. Or he might go outside with an agoraphobic client as part of a desensitization process. Another therapist might make an exception when someone is in a hospital or homebound due to injury. Still another might not generally accept invitations to go to a client’s milestone events (wedding, funeral, graduation) but may make a careful decision to break that rule when it would be helpful to the client.
The important factor in making a decision to cross a boundary is the mutual judgment that it is clearly for the client’s benefit. The meaning of the crossing needs to be carefully discussed in session.
Dating a client, calling and accepting calls that are primarily social in nature, or using the client’s time to vent about the therapist’s issues isn’t OK. Responding to a client’s requests, even insistence, that they meet informally or socially is a more subtle yet important violation. It confuses the relationship and makes it difficult for the client to trust or to do this or her therapeutic work. Crossing is sometimes advisable. Violating is inexcusable.
Daniela has given you a very thorough answer. I'd like to say that for me personally, a boundary was that I would meet clients only in the office. Sometimes I met them at schools or in hospitals, but never in my home. House calls usually refer to going to a client's home. There are some types of counseling where that is appropriate, such as in-home social work visits. Most psychotherapists prefer a more professional, quiet and controlled environment than a person's home for psychotherapy sessions. This helps provide structure and helps maintain professional boundaries, as well.