Types of Boundaries in Home-Based Therapy
Many of you might be familiar with this boundaries worksheet from Therapist Aid, but how does one apply theory to practice in a client’s home? This week on My Car is My Office and on the blog’s Instagram and Facebook page, I explore what boundaries can look like in a home setting and how to adapt what we learned about boundaries in graduate school to fit our needs in the field. There is ample research to suggest that counselors in these settings also perceive lower levels of comfort than their peers in office settings which can make it difficult for home-based therapists to address boundary crossings.
It is also important to recognize how boundaries can differ across setting, populations, families, and cultures. For example, a client with an intellectual disability might not understand how physical boundaries work or a client who grew up in a family with poor material boundaries might think it’s perfectly ok to ask their therapist for money. What an opportunity for you to use your psychoeducation skills to model appropriate boundaries!
Please note that these boundary crossings are written in terms of a client crossing the therapist’s boundary although an unethical or untrained therapist can certainly cross these boundaries. Zur points out that the power differential between therapist and client in the client’s favor is especially evident in home-based services which is why this article focuses on that type of power dynamic.
Keep reading to explore what boundary crossings can look like when working in a client’s home and some ideas of how to set a boundary in this environment.
Types of Boundaries
Physical boundaries
Refers to how the therapist and client use the space and physical touch. Space and how we use the space is so important in home-based counseling because we are literally stepping into the client’s environment. A client entering your physical space can be an issue of safety. This might not age well, but you can also enforce 6ft for social distancing.
Crossing:
Client enters your space or blocks your way to the exit in the home, client attempts or succeeds in touching you (again, this can differ across cultures and contexts), client looks through your binder, phone, car, bag, or other private space.
Setting a boundary:
“Please do not touch me again”
“I am allergic to cats, I’m going to ask that you pick Fluffy up until after our session so I can focus completely on you”
Intellectual Boundaries
Refers to thoughts and ideas. In home-based therapy, we might see signs of our client’s beliefs and ideologies in their homes, whether it’s religious symbols on the wall or a confederate flag in the front lawn (Hello, rural Louisiana). As a counselor who practices from a feminist theoretical perspective, I recognize that the personal is political and invite these conversations. However, I also recognize that my privilege allows me to move safely, although uncomfortably, in homes with more extreme decor based around ideologies.
Crossing:
Crossing this type of boundary can be more passive than active in home-based counseling; sometimes a client can “cross” these boundaries when we bring these feelings home with us or when they ask you to reveal your own beliefs. Try some creative counseling techniques to redirect these more personal questions.
Setting the boundary:
“I’m not here to discuss my own political beliefs, but it sounds like you are very passionate about this candidate. What do you think it is about her message that resonates with you?”
“I’m hearing that your faith is very important to you. Although I don’t offer christian counseling specifically, I do practice from a holistic framework meaning we can definitely work to improve your spiritual health together if that’s something you want to discuss”
Emotional Boundaries
Refers pretty obviously to feelings or emotions. Emotional boundaries might also refer to how much you allow a client's words to affect your own emotional state. A therapist with strong emotional boundaries understands when it’s appropriate to share personal information and when not to share personal information. On the other hand, a client who has poor emotional boundaries might share “huge” amounts of personal information within the first few minutes of meeting the therapist (what constitutes personal information in a session can be subjective).
Crossing:
Again, this crossing is more passive because it involves us, as the professional, allowing the client’s behaviors and words to “cross” our own emotional boundaries.
Setting the boundary:
Schedule your most emotionally draining clients at times where you have the most energy to uphold your own emotional boundaries
“Wow, thank you so much for sharing your life story with me! I am going to ask that you keep that next thought in mind so we can discuss that after we complete this intake”
Sexual Boundaries
Refers to consent, agreement, respect, and privacy around sex. For your safety and to protect your job and license, it is important to make your supervisor aware of such types of crossings. Sometimes when you try to set a hard boundary around discussing sexual topics, a client might attempt to gaslight you and suggest you are “blowing things out of proportion” or they “meant it as a joke”. Here are some common responses to gaslighting to help you reset that boundary.
Crossing
Can be extreme such as crossing a physical boundary in a sexual manner. It can also be more subtle such as a client commenting on your body, taking a picture/video of you, or telling you personal, sexual information.
Setting the boundary:
“Thank you for the compliment about my hair, but I’m going to ask that we focus on you for the remainder of the session”
“Although I want you to know that this is a safe space, I’m afraid it’s out of my scope to answer questions on sexual functioning. Would you like assistance in making an appointment with your doctor? If not, I will not continue this discussion, but I am here if you change your mind about making that appointment.”
Depending on the situation, it might warrant not seeing the client in their home or referring out to another service. If you feel unsafe, leave as quickly as possible! Discuss options with your supervisor AFTER you leave the home!
Material Boundaries
Refers to boundaries around your items and material goods. A client going through your possessions can be not only unnerving on a personal level but can also be a violation of HIPAA laws if they see identifying information about other clients in your possession such as notes or names on calendars.
Crossing:
Client looking through your phone, computer, purse, backpack, vehicle, or any other personal space. Can also look like a client asking for material goods such as cash to pay bills or your cell phone to make a personal call.
Setting the boundary:
“I can understand how hard it is to be curious about your therapist, but it is not appropriate to go through my bag”
“I do not allow my clients to make personal calls on my cell phone, however, I can offer you some resources about applying for a free phone using information from your SNAP benefits”
“My agency does not allow me to give money to clients. What are some other resources we can think of together for financial assistance?”
Time Boundaries
This is a big one for home-based therapists because it can sometimes feel like we’re always “on call” since we work off of our cell phones. Setting boundaries around your time off and time at work is vital to preventing burnout. If you haven’t already, check out the article “4 Options for Call Return Policies” to explore some options for setting boundaries around communication with clients. Decide on a policy, and try your best to consistently set this boundary.
Crossing:
Clients calling outside working hours, clients asking you to stay later than normal session time
Setting the boundary:
“I’m so glad you look forward to our sessions, but I’m going to ask that you write down what you want to tell me over the phone and save it for our next appointment as this number is for scheduling purposes only”
“I am afraid we are running out of time for our meeting as I have another client after this meeting. I am really looking forward to continuing this discussion next week”
What are your go-to ways to set boundaries when working in clients’ homes? Please share your thoughts in the comments and be sure to check out the rest of this series on boundaries.