I'd like to share a story from child psychologist Dr. Bruce Perry's book, The Boy Who Was Raised as a Dog (2006), that questions the artificiality of therapist/client boundaries. The excerpt comes from the chapter called 'Tina's World' where Dr. Perry tells us about how his hesitation to lend a helping hand when seeing his client waiting for a bus on a cold rainy day. The client is a young child who had been sexually abused, and she is not alone waiting for the bus, but in the company of her mother and siblings, all together, a loving family exhausted by poverty and abuse. But they are not in session now, so it is appropriate to offer a ride? This is the doctor's dilemma. It is a sweet story, actually, because the insecurity is shared on both side, the 'therapist' and the 'client', laid bare in mutual humanity.
The scenario I'm sharing is with Dr. Perry and his supervisor, discussing on the case of the child who, he regrets mentioning, had been arriving late to her last few sessions.
"What do you think is going on here?"
"I'm not sure. I think the mom seems pretty overwhelmed."
"You must interpret the resistance."
"Ah. Ok". What the hell is he talking about? Is he suggesting that Tina doesn't to come to therapy and is somehow forcing her mother to be late? "You mean Tina's resistance or the mom's?" I asked.
"The mother left these children in harm's way. She may be resentful that this child is getting your attention. She may her to remain damaged," he said.
"Oh," I responded, not sure what to think. I knew that analysts often interpreted lateness to therapy as a sign of 'resistance' to change, but that was beginning to seem absurd, especially in this case. This idea left no room for genuine happenstance and seemed to go out of its way to blame people like Tina's mom, who, as far as I could tell, did everything possible to her help for Tina. It was clearly difficult for her to get to the clinic. To get to the medical center, she had to take three different buses, which often ran late during the brutal Chicago winter; she had no childcare so she had to bring all her children with her; sometimes she had to borrow money for the bus fare. It seemed to me she was doing the best she could in an extremely difficult situation.
Shortly thereafter, as I left the building one frozen night, I saw Tina and her family waiting for the bus home. They were standing in the dark and snow was slowly falling through the dim light of a nearby streetlight. Sara was holding the baby and Tina was sitting on the bench next to her brother under the heat lamp of the bus stop. The two siblings sat close to each other, holding hands and slowly rocking their legs back and forth. Their feet didn't reach the ground and they kept time with each other, in sync. It was 6:45. Icy cold. They would not be home for another hour at least. I pulled my car over, out of sight, and watched them, hoping the bus would come quickly.
I felt guilty watching them from my war car. I thought I should give them a ride. But the field of psychiatry is very attentive to boundaries. There are supposed to be unbreachable walls between patient and doctor, strict borderlines that clearly define the relationship in lives the often otherwise lack such structure. The rule usually made sense to me, but like many therapeutic notions that had been developed in work with neurotic middle-class adults, it didn't seem to fit here.
Finally, the bus came. I felt relieved.
The next week, I waited a long time after our session before going to my car. I tried to tell myself that I was doing paperwork, but really, I didn't want to see the family standing in the cold again. I couldn't stop wondering about what could be wrong with the simple humane act of giving someone a ride home when it was cold out. Could it really interfere with the therapeutic process? I went back and forth, but my heart kept coming down on the side of kindness. A sincere, kind act, it seems to me, could have more therapeutic impact than any artificial, emotionally regulated stance that so often characterizes 'therapy'.
There. That's the bit I wanted to share. Of course clear boundaries matter, but so does common human decency. And it can get messy when boundaries are blurred, but I doubt any serious damage can happen when the intention is an immediate kind of kindness.