TIFT #68 When Boundaries Become Barriers

“I don’t do that.” Wouldn’t it be nice if setting a boundary were that easy? The client would understand that this is simply part of the method and accept the limitation without complaint with no subsequent fallout. Why not? Adults accept all kinds of arbitrary rules and only complain mildly when the rules don’t make sense.

I recently had the privilege of doing a consultation in which the client showed me a zoom recording of a session with her therapist. They were trying to deal with the consequences of just such an “I don’t do that” in response to a small but highly significant request from the client.

When the client is a child

In this case, the client was dissociative and the part that was dealing with the “no” was a young child, but it works the same even when there is no dissociation. Let’s go back to how maladaptive patterns are created. Typically, the young psyche has been faced with what feels like a life and death problem that can’t be solved. It might simply be unfulfilled emotional needs, which for young people are experienced as existential. Their perception is not wrong because children, at least during their first years, can’t survive, grow, or discover their identity without support from caregivers. In adversity, part of the child’s experience becomes “frozen in time.” The problem remains unresolved because the main coping strategy is to isolate that part of the self and move on.

The goal is re-integration

When a childlike part of the client’s functioning becomes sequestered, the aim of therapy is to help the child part become re-integrated with the adult client. Until re-integration happens, we can’t realistically expect the child part to function as other than a child, and the requirement for re-integration is going through development until childlike patterns are "outgrown." In the case of my consultation, the therapist seemed to be missing the fact that she was not working with an adult. The therapist explained that she didn’t mean to cause any pain but was only following an established rule, as if that would mean something to the child-client. It didn’t. She also appealed to the adult client, who was co-present, to explain this to the child, but the result would still have been ships passing in the night.

How do child parts integrate

How do childlike ego states, or parts, or whatever we might call them, become integrated? The answer is the same as for any traumatized child. First they have to feel safe, then they need to go through a healthy process of growth and development. The developmental work needed is precisely that which was missed out on in the first place. As they grow, they come to an adult level of functioning and that is when they integrate. The take-home is that we simply have no choice but to meet the client where they are, which is often in a childlike position.

In order to know how to handle a client request in therapy, we need to have an idea of exactly what the client wants and why. What is the problem they are trying to solve? There are different possibilities and they depend on the stage of emotional development. So before we talk about how to handle the request, here is a way to categorize developmental stages.

Stage 1: Basic Safety

The first, and most fundamental requirement for children to grow and expand their world is to have a feeling of safety. That means confidence that the caregiver is attached to them. From the first months, babies know just how to motivate the grown-ups to attach and cherish them, and we generally respond. However, as we all know from clinical practice, far too often this need is not reliably fulfilled.

Imagine a client who is stuck at this stage. Their built-in schemas say not to expect the other to be securely attached. They know that they had better be very cautious and try to ingratiate themselves. In therapy, they may catch us at a moment of spontaneity when we show our humanness and attachment. Then they begin to build confidence. Or the child-client may test us by asking for a slight deviation from our usual practice, enough to tell if we are attached and care enough to stretch a little for our client. 

Imagine what happens when the answer is, “I don’t do that.” The child-client will retreat and bury the wish underground. The therapy will come to a halt and the client will experience mysterious shame or depression. The stalemate will continue silently until the therapy is abandoned or the issue is brought to the surface and worked with. This is not theoretical. I have seen it numerous times.

Stage 2: Room to Grow

Having achieved faith that the therapist is securely attached, the child-self will soon graduate to the next level, developing as an individual. That requires stressing the relationship. Very early, toddlers begin to take trips away from the caregiver. They begin to express their individual likes and dislikes. Especially where there have been problems in the bond, this can become a threat to the primary relationship and, if unresolved, to future important relationships.

The instinctive, childlike solution is to try to change the caregiver, and, by extension, the therapist. And of course the stakes get higher when biological factors like sexuality put their weight behind the client’s demands.

If the therapist says, yes, the child expects the problem to be solved. But it won’t be! In actual practice this can never work because every test creates doubts. If the therapist says yes, the client questions whether he or she really cares, or if  the client has pushed too far and the therapist is going to be resentful and retaliate. The only lasting solution is for the child-self to learn that conflict and its associated emotions can be survived.

To put this in different terms, testing the therapist is employed with the aim of avoiding the painful limbic emotions that result from being told no. What we know as adults is that avoiding emotions does not resolve them. The only answer is to go through those emotions in such a way that they are permanently healed. 

Stage 3: Ready for Emotional Healing

This is the level of development that good candidates for classical psychoanalysis have already achieved. They have experienced emotional healing and are already prepared to process strong feelings in relation to the “frame.” Arbitrary rules actually create a backdrop for working through issues around power and control. In the example under discussion this kind of healing had not yet been experienced, and testing was the only solution with which the child-client had any experience.

How do children learn to have feelings of positive anticipation about emotional healing, as opposed to avoidance of emotions? The answer is by experiencing the classic healing moment. As I have described before (TIFT #64), the first requirement for this to occur is activation of painful emotions from the limbic system which are sent up the channel to consciousness and to the therapist. The second requirement is illumination, during which the therapist brings a new, larger perspective. “It’s ok for you to be upset and I understand how angry you feel. I may not change my mind, but I won’t punish you for having feelings, even rage at me.” When that new information filters down to the limbic system, healing takes place via memory reconsolidation, where the memory of disagreement as a life-and-death threat is traded for something perceived as benign and expectable in caring and close relationships.

How does this play out in actual therapy?

In the consultation, the child-client had asked to touch the therapist’s hand. Was the client at Stage 1? Was she testing whether the therapist was firmly attached? Or  was she in Stage 2, where the child-client was instinctively hoping the therapist would say yes and collude with her in avoiding painful emotions? 

What is a therapist to do? The therapist’s answer was to assume the client was in Stage 3, as prescribed by traditional psychoanalysis. By not yielding, she would force a stormy tantrum through which the client would discover that her anger could not destroy the therapist and that the therapist cared enough to be willing to stay with the client. The result would be a healing moment in which rage, left over from an abusive past, would finally be processed and healed as described in Level 3.

How to handle the client's request seemed to hinge on the level of development, which was uncertain. Holding out might possibly have worked in this therapy, but, based on two years of relatively slow progress and the client’s having struggled with the issue for weeks without resolution, it appeared that the answer was no. If the client was still in Stage 1, then allowing limited touch would largely solve the problem and give new trust and energy to the therapy. If the client was in Stage 2, they would be embarking on an unending, unwinnable battle.

The therapeutic trade-off

The solution I find myself using most often is to give some, but to do so in exchange for insight. I expect the client to become more open to acknowledging the emotions behind the request. I might say, “I’m ready to try this but I want us to explore what you are looking for and what your wish might mean.” My giving may lead to the client wanting more and more. Sooner or later I’ll have to say no,” but by making a trade, I will have gained the advantage of insight. How the strategy plays out helps to clarify which of two questions the client is trying to answer and which stage the client is in.

If the client is at Stage 1, then giving a little will show that the therapist, in contrast to early figures, is firmly attached. The question will be answered and the need to test will decrease. On the other hand, if we are at stage 2, then the client will briefly feel glad that the therapist has said yes, but will soon want more. The desire will come back with more insistence. However, having gained some awareness in the discussion, the client will be more ready to experience the inevitable "no" as a necessary and caring response. The emotions will still have power but the dyad will be ready to move into Stage 3 and a healing moment that will resolve emotions that, long ago, were too big and too dangerous to face.

Conclusion

I have tried to highlight qualitative differences in the levels of development, but in practice, they are less sharp and more fluid. Being ready to process emotions might be seen as our primary job. On the other hand, being ready for these healing moments requires first establishing the safety of knowing the therapist is attached, plus some anticipation that strong emotions won’t destroy client or therapist. With those prerequisites met, dealing with issues around the “frame” can be an opportunity to work successfully through issues from early life.

This is where I think Harry Stack Sullivan’s concept of the “participant observer” is particularly helpful. When we are struggling with real issues around the “frame,” we are inevitably entering into the participant role. What’s special about being a therapist is that we have a mandate to move freely from participant to observer and back. Our willingness to be a participant allows us to meet the child-client on their level and helps the client feel safe enough to expose strong emotions and wishes. Then we can gently pull back to build a joint understanding to provide the illumination equally necessary for healing. 

Our field has evolved, through intuition and experience, to bring together the two requirements for emotional healing, activation and illumination. Only recently has the science of memory reconsolidation given us a neuro-physiological explanation for why this is. Now, at last, we know that activation and illumination, when they meet in the limbic area, are the keys to our client’s growth and healing. With this knowledge, we can continue to refine existing techniques to achieve those two requirements. Not only that, but with closer awareness of the process, we will more often be able to promote healing moments instead of having to wait for them.

Jeffery Smith MD''

Photo Credit:  Nick Fewings, Unsplash