Guarding Your E-Boundaries

Guarding Against Violations of Your E-Boundaries
© Lawrence E. Hedges, Ph.D., Psy.D., ABPP
Clients with borderline and organizing (psychotic) transferences
may request extra telephone contact between sessions which is
usually manageable because it is direct contact. But some clients
may want to e-mail or fax frequent and long messages, letters, pages
from their journal, or notes on their dreams. Since these are not
direct communications, the therapist should be sure that each of
these communications is discussed in session. Have the client read the messages in session so that personal attention and dialogue can
be devoted to the concerns raised.
When e-mail messages become too frequent, too lengthy, or too
personal, so that the client does not want to go over them in session, go
immediately on the alert. Where are these messages coming from? Why
are they not important enough to devote time to? What are you expected
to do with them—especially if they are confused, confusing, or disturbing to
you? Clients often want to gloss over these questions with rationalizations:
“I just need to talk to you at certain moments and voice mail or e-mail lets
me do it when I’m thinking about it.” Or, “If I didn’t call or e-mail, then I
would forget it.”
The many implications of the client’s self-minimization, not caring if
the messages get through, or not being concerned about how they are
impacting the therapist need to be taken up directly and forcefully. Clients
who relate this way usually show little interest or concern in exploring these
or related issues, but the transference elements must be addressed.
The therapist is not being responded to or related to as a real person with
whom to share communication, but more as a mythical fantasized object
who is being attached to meaninglessly. To allow this to continue
without regularly addressing it and pressuring for real communication
in sessions is to collude with the delusion that serves as resistance to
exploring the terror and pain frequently at the heart of the
transference.
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Do not allow clients to put your e-mail address on their buddy list or to
show up on each other’s IM (instant message) screens, as this runs the risk
of colluding with the delusion. You do not need to know when the client is
online, and you do not want to have to read and respond to extraneous
messages from clients when you are on-line. In addition, sending e-mail
messages back and forth maintains the delusion that you are constantly
available in thought and deed. This is especially troublesome when freeassociation
messages arrive, such as “I just feel like killing myself” or “I
could just murder my son.” What are you supposed to do then? Since all
such messages must be noted and/or printed out for the record, you must
also show timely and professional responsiveness. Do you call the client
immediately? Do you do a suicide or abuse danger assessment
immediately? What other cues and comments can an attorney hurl at you
that were sent in an e-mail that you “should have” been immediately
attentive to or careful to systematically follow up?
This technology has crept up on us, and suddenly our personal and
private time and space are being invaded by clients wanting to maintain
fantasized communication with us that is anti-therapeutic and that we
cannot ignore. It is best as a general policy to retain the old posture of
taking up all outside communications directly with the client in session and
actively discouraging voice mail or e-mail communication that cannot be
dealt with directly and that in fact places burdens on you. No long letters
or journal entries should be sent to you unless the client intends to
read them in session. No voice mail or e-mail should be sent that isn’t
urgent, and you should not be on clients’ buddy lists.
You can explain to the client in a straightforward manner, “I
value each and every thing you have to say to me and I want to be in a
frame of mind to take you in seriously and to consider thoughtfully
and deeply what all the messages you give me may mean to you. Offthe-
cuff messages sent and received are fine among friends, but I am
your therapist and I want no thought or word you give me to go
unnoticed, unattended to, or unheeded. I realize that my taking you
so seriously may be a bit burdensome to you at times when you might
simply enjoy sharing your thoughts freely with me, but I value every
minute, every detail, and every thought and image you directly share
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with me, and I do not feel comfortable engaging in casual or careless
conversation or communication with you. Our mission together is too
important.” If there is a need for the client to experience timeless reverie
with you, then let it be in the session, where you are prepared to deal with it
and contextualize it. However, as with all general guidelines about the
psychotherapeutic process, the above comments have to be tailored to
each case. Some of this “reverie” electronic communication may be
important, especially early in therapy during the safety-establishment
phase.
The transference behind lengthy and/or heavy impersonal
messages is almost invariably of an organizing or psychotic type.
The client is terrified of deep and intimate interpersonal engagement
because intimate connection was perceived as the agent of trauma in
infancy. A replication of the trauma, which in the client’s mind is
linked with intimate “I-thou” contact, is dreaded and therefore
avoided. For the therapist to go along with casual communication not
in real time and space is to collude in the resistance memories and to
avoid the painful and often terrifying and disruptive process of
transference remembering in the here-and-now of the therapeutic
relationship.
Some therapists say, “I listen to the voice mails or read the e-mails
because that’s the only time the true feelings come out and I learn what’s
really going on. I hate to stop that flow by restricting it.” Don’t fool yourself.
Almost invariably, these juicy tidbits, as with endless recovered memories
of child abuse, endless reciting of paranoid delusions or hallucinations, or
endless switching of personalities, are not relevant and usable
communications. They are merely the resistance to approaching for,
reaching out for, achieving, and sustaining valuable interpersonal
connections.