Response from Carolyn Costin

Carolyn Costin, Director of Monte Nido and Affiliates, and author of The Eating Disorder Sourcebook and !00 Questions and Answers About Eating Disorders responded to my last post about Professional Boundaries with these words:

"The topic of our relationship as clinicians to our clients is always a hard one to discuss. There are so many reasons for us all to be concerned about this dynamic. From the very beginning in my work with eating disorder clients I found that they needed to hear from me as a person, not just as a therapist. Although I am careful, I do talk about myself and share from my experiences . . . I do not share the horrors and dirty details of my illness. I discuss strategies for overcoming it that worked for me.

I also maintain contact after clients have left treatment . . . if a client emails or calls I respond; I also occasionally reach out to them to see how they are doing. It is possible to maintain boundaries: it is the nature of the relationship that is important. They always know they are clients or former clients, not friends.. . take the client who called after 7 years of recovery who was in town with her new baby and wanted to see me. Should I say 'Make an appointment"? For me my humanness overrides that silly thought and I agree to a cup of coffee together. . .

The key, for me, is that although there are guidelines, at some point we also have to trust the things that we know. . . . I do my best to keep true to my profession and my humanness at the same time."

Thanks Carolyn, for your wise and thoughtful response. I'm looking forward to hearing from other colleagues. Until next time, blessings! Gail Hall

Comments

[Joanna Poppink, LMFT]

Caroline, you wrote: "The key, for me, is that although there are guidelines, at some point we also have to trust the things that we know. . . . I do my best to keep true to my profession and my humanness at the same time."

I almost agree with you wholeheartedly, and now we have evidence based scientific research to back up the use of our humanity in our practices.

Appropriate boundaries between patient and psychotherapist are essential in any psychotherapy and particularly in the field of eating disorders. However, the topic is often
discussed in terms of content.

I believe that when a patient wants to know about my private life or wants to include me in her private life (weddings, funerals, births, graduations, award events, etc.) the patient wants and needs a particular psychological emotional experience from sharing the experience with me.

In other words, it’s not the information or event that is the issue. The sharing of our humanity is the point.

Again, I agree with you. There's no need to share "dirty details."
The value is in right brain to right brain communication, not content.

Allan Schore, http://www.allanschore.com/ in his fantastic research on affect regulation, is showing affective neuroscience, neuropsychiatry, trauma theory, developmental psychology, attachment theory, pediatrics, infant mental health, psychoanalysis, psychotherapy, and behavioral biology that right brain communication is received by the right brain and actually changes brain structure to allow developmental progress.

The discoveries revealed by the increased sensitivity of neuroimaging validates what many sensitive clinicians have known for a long time. Honesty, caring, empathy, sharing
spontaneous imagery, acknowledging physical responses to clinical material make for effective connection, growth and increase possibilities for healing. http://www.biosynthesis.org/html/allan_schore.html

My pause in wholehearted agreement with you, Caroline, is a slight shift of emphasis. I believe, with the backing of neuroscience, that we can’t keep true to our profession without keeping true to our humanness.

P.S. As part of my practice, I've attended a wedding, but not the reception. I’ve visited a new mother in a maternity ward. I’ve applauded from the audience when a person received a hard won and well-deserved award. I’ve called patients in fire areas during Southern California fires to check on their well being. I ask to be notified regarding outcome of surgery.

Joanna Poppink, LMFT, Los Angeles psychotherapist, specializing in adult eating disorder recovery.

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