by Dr. Danna R. Bodenheimer, LCSW, author of Real World Clinical Social Work: Find Your Voice and Find Your Way
I am often struck by the complex anxiety that we share, as social workers, around creating boundaries. It is, of course, of exquisite importance to maintain solid boundaries in our clinical work. However, it often feels like our wish to remain boundaried becomes conflated with a real and paralyzing fear that somehow we will be transgressive. This fear can keep us from being authentically present in our clinical interactions. In fact, I would argue that this fear is often more driven by the superego, which can act punitively and shamefully, than by our ego, which can act thoughtfully and carefully.
A bit of background
Let me take a second for some background. Our clinical work is basically founded upon Sigmund Freud’s principle of the “talking cure.” Although Freud was not a social worker, his findings and theories loom large in our conceptualization of our own work. He argued that psychological relief comes from the articulation of our thoughts and feelings through language. More specifically, he argued that, through free association, we would be able to access our more inner, unconscious thoughts and bring them to the surface in the presence of an objective and benevolent listener - the clinician.
He was extremely concerned with boundaries and essentially called for the banishment of the clinician’s subjective experience from the clinical encounter - hoping for nearly antiseptic and neutral clinicians. He warned, beginning in 1913, that the more we, as clinicians, become involved in the treatment, the more dangerous the treatment can become.
While we are haunted by Sigmund Freud’s (the father) warnings, we are often less exposed to the very powerful role of his daughter, Anna. Anna was his sixth child. She became a social worker and spent most of her time working closely with children in nurseries, bringing about the movement toward child psychoanalysis. She worked humanely and accessibly with her clients. In other words, she operated from her ego. Not an inflated ego, but a balanced, analytic, and thoughtful one.
Sigmund articulated the very resonate idea of the tripartite mind. He said that we have an id, ego, and superego. He warned, of course, of the dangers of the id - the center for drive and aggression. He also probably did quite a bit, through the creation of his theory, to place us deeply in the realm of our superego as we practice. He believed that therapists might seek gratification from their clients and collapse the boundaries in the service of that. He, in fact, had very little faith in the safety of our egos, as clinicians. Ironically, what is less covered is the fact that he analyzed his own daughter, a certain collapse of boundaries and ego functioning. While he left us to panic as we battle our superegos, his own grandiosity (or id) led him to incredible transgressions.
We cannot remain completely neutral
Because it is essentially impossible to remain completely neutral, sterile, or objective, our attempts to do so fail. When our attempts fail, we fear that we are becoming un-boundaried and, therefore, bad. Really bad, in fact. And our superegos remind us of this over and over again, leaving us in a spiral of shame and loneliness.
I recently had a student discuss a process recording of a final session with a client she deeply cared about. Her client was getting ready to move away for new and promising adventures. My student, the clinician, felt ashamed of how sad she felt about the pending separation between them, but didn’t want to say anything. She wanted to make sure that she didn’t make the session about her. She wanted to make sure that her client didn’t feel guilty or responsible for making her upset. So, they parted ways and her very subjective experience of attachment, sadness, and pride in her client’s accomplishments was never shared dyadically.
Is this a case of good boundaries? I don’t know. I think it is a case of complex super ego functioning. My student became scared that if she were to authentically enter the room, she wouldn’t be able to control herself. She became scared that if she were to authentically enter the room, this would someone eclipse the amount of space that her client could occupy.
In between presence and absence
The fact is that there has to be something in between presence and absence. Further, the shame we feel about how we feel about our clients is not only about boundaries. It is also about the stark vulnerability that comes with attachment. The truth is that we get really attached to our clients, and they can leave us at any time. While they may fear being abandoned by us, the success of our work is actually measured by their eventual abandonment of us. The better we do, the more likely we are to be left.
We need to try and imagine a space between boundary violations and the mythology of neutrality. A space where we take risks. Without this imagination, we start to feel silenced and afraid. With it, we can become creative, balanced, and enlivened. What if my student had said to her client, “I am so sad to see you go, but so amazed by the depths of the work you have done and excited for how prepared you are for the next chapter”? Or, “It is hard to see you go, but I wouldn’t want it any other way, because this is a testament to your growth and your health”?
How do you know if you are operating out of respect for boundaries or out of punitive superego functioning? Or if you are just avoiding your own fear of abandonment? I think that these are central questions that we need to keep asking ourselves. I also think there are some answers. If we can show up in a way that is transparent, premeditated, and careful, I believe we can be with our clients in a brave, important, boundaried and honest way. If we show up in a way that is impulsive, seeking some sort of internal gratification, and feels internally unwise, then I think we are in the realm of transgression.
The clinical frame and our code of ethics
We also have the beautiful support of the clinical frame, whatever that may be. It may be that you meet in a certain office, at a certain time, for a specific duration of time. The frame is designed to contain transgression while allowing for bountiful clinical exploration and possibility. We also have the beautiful support of the code of ethics. We aren’t to barter, create dual relationships, or experience physical intimacy. These ethics exist to contain transgression while allowing for the bountiful possibility of emotional intimacy, the exploration of trauma, and the experience of real attachment.
The fact is that our roots are grounded in complex family dynamics, specifically those between Anna (a social worker and a daughter) and Sigmund Freud (a neurologist and a father), among many others, I am sure. In many ways, this has left us with the intergenerational feeling of shame and residue. It has also provided us with a lot of valuable theory and guiding thought. However, within this we must find our own idiosyncratic mode of truly being with our clients in ways that honor interdependence, vulnerability, and that trust that the mutual articulation of attachment can be survived.
Boundaries don’t have to equal withholding silence, and truly showing up is not a transgression. And our superegos need not be our guide. Our clinical frames and professional ethics more than suffice.
Dr. Danna R. Bodenheimer, LCSW, is in private practice at Walnut Psychotherapy Center in Philadelphia, PA, and teaches at Bryn Mawr College Graduate School of Social Work and Social Research. She is the author of Real World Clinical Social Work: Find Your Voice and Find Your Way available in print and Kindle editions at Amazon.com.