It’s hard to provide a list of “rights and wrongs” that will fit every situation, and Langs’ ideas may be a bit extreme, but they certainly make people think about boundaries and their importance in the therapeutic relationship and that’s a good thing.

Psychotherapeutic Orientation: I think you ought to explicitly acknowledge that these are basically psychodynamic rules. DBT would give different answers about what constitutes appropriate boundaries.

On touch: I was in a therapy group led by two residents. It was primarily behavioral, being focused on midfulness and *some* of the principles of DBT. (It ended abruptly, because the residency program decided to drop all group therapy at its 2 private sites. Since both of our leaders were leaving the clinic that year, we only had a week’s notice. A rising resident had already been chosen, but she wasn’t going to start by terminating over 2 months, but that’s another story.) As the female resident got ready to go, our all female, all straight group gave her a hug goodbye. In context, I don’t think that was inappropriate. When one of the other leaders left to go to a child fellowship, one of the group members bought her some flowers. Again, not inappropriate in my book. Of course, this was in a clinic setting, so some of the baseline rules had been established from above.

As far as whether therapists are trained to not their opinions interfere with their advice: yes, I’d say that most therapeutic training programs do emphasize this. However it is one thing to try to train people to do it, and another (hard) thing for therapists to be constantly aware of what they are doing and to be able to separate themselves and their needs from their patients. The hope is that most all of them can do this.

Thanks.

I’m glad to see your comment on this episode. This is one of my earliest episodes before there were a lot of listeners to the podcast, and as a result the episode I think gets lost among all the others. Langs’ ideas regarding the “frame” are a bit stringent and perhaps old fashioned, so it’s good to see someone take issue with a few of them.

Regarding self-disclosure: this is one I feel pretty strong about in terms of agreeing with Langs. However, you say that “It is important to ask oneself what purpose is being served by such a revelation before putting it out there.” I’ll agree with that.

As for a “hand on the shoulder” – okay. I’m with you on that. I can see that this could have a powerfully positive effect when honest and at the right time.

Also agreed that sessions that start late could be very well justified if the therapist has an emergency that must be taken care of. Again, the critical factor here is why these “breaks in the frame” occur. When they occur because of counter-transference issues – then you have a problem.

As for bartering – very good point there. I don’t have any experience with this so I’ll defer to you on that one. As for the point about guilt: I don’t think I disagree with you. I was thinking of a situation where the therapist might be trying to make a client feel badly if he/she ends therapy early, or when a therapist is reacting (again) out of his/her own unacknowledged and unresolved issues by getting mad at a client. This is a bigger issue than can be easily discussed here in a comment.

I appreciate your thoughts and as you see I agree with many of them. Many people want to know whether or not their therapist is “good”. This is a very, very hard question to answer, but I hope that Robert Langs’ ideas provide some broad guidelines.

Michael

Self revelation can be indicated in the therapeutic process. If a therapist has been through a similar situation to the client, it can help the client to feel better understood to reveal this. There are limits, of course, to how much personal information is revealed, but it should not automatically be seen as an indicator of bad therapy should it occur. However, I do believe that the concern that such a revelation may be the result of countertransference is a valid one. It is important to ask oneself what purpose is being served by such a revelation before putting it out there.

The use of touch is another tricky one. To say that handshakes are the only touch that should ever occur in a therapeutic setting seems extreme. Touch can be extremely powerful. Excessive touching is certainly a warning sign, but a hand on the shoulder at the end of the session can be powerful and beneficial.

As for previous sessions running over, this cannot always be prevented. There may be extenuating circumstances (suicidal threats at the end of the session, etc.). This should only really be a concern should it occur frequently.

In addition, when practicing in rural areas, bartering is sometimes the only option for many clients. It is not ideal, but it is accepted by the APA. However, it should only occur with items that have a known value (services should not be accepted). Many therapists are split on this issue, but it tends to be that those practicing in urban areas are the ones to voice concerns. Funny, that.

As for a therapist creating a feelings of guilt in a client, it is important to note that no one can “make” anyone feel anything. A feeling is a response based on the perception of something. If a client feels guilty, it is not because the therapist made them feel this way. Sometimes past mistakes will come up in the therapeutic process. The goal is to look at these dispassionately and learn from them. A therapist should do his or her best to show unconditional positive regard, but the client may not have the same regard for his or herself. Guilt can and will happen.

Overall, I agree with many of your points. However, I fear a client may ditch their therapist prematurely on the basis of some of your more unyielding statements.