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Creating A Safe Space: Setting Boundaries With Patients

January 26, 2024


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Establishing a strong, therapeutic relationship with patients can be a cornerstone of effective treatment. This unique bond, characterized by mutual respect, understanding, and empathy, can significantly enhance the patient’s engagement in treatment, thereby maximizing positive outcomes. Striking the right balance in this intricate relationship can be crucial, requiring healthcare providers to carefully establish boundaries without compromising the trust and compassion needed within the therapeutic alliance. 

This delicate balance not only protects the integrity of the professional relationship but also fosters a safe, therapeutic environment in which patients feel valued, heard, and motivated to take an active role in their own mental healthcare journey. Understanding and implementing these principles can be a positive step toward cultivating successful patient relationships and delivering high-quality, patient-centered care. Here, we’ll explore the importance of healthy boundaries in therapy and how to set them as a provider.

The Role Of Mutuality And Respect

In recent years, therapy has begun to undergo a shift toward collaboration and mutual effort, meaning that therapists have started to ensure that treatment strategies involve the client as an active and equal participant. This type of conscious participation has been found to contribute to more positive outcomes and lasting improvements. 

In one recent study, researchers found that when therapists ethically and mindfully utilized self-disclosure and immediacy techniques, the level of insight and positive progress in treatment for clients improved. Their team also discovered that immediacy—which is the act of using the immediate moment to inspire the client to look at the interpersonal process occurring in therapy—was associated with clients’ improved ability to open up and confront potentially harmful perspectives. This study demonstrates how therapists can utilize self-disclosure and immediacy to motivate their clients to be more open about their experiences in therapy.

For example, immediacy may be used in instances where it could be helpful for the therapist to point out the way in which clients are responding to specific questions or events that have occurred. Pointing out the manner in which clients are responding within the therapeutic relationship may help open them up to new perspectives.

Researchers also note the importance of therapists maintaining an awareness of the considerations for properly sharing personal information, being considerate of the amount of sharing, and ensuring that disclosure is only used when it facilitates independence and the well-being of the client. 

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How To Set Healthy Therapeutic Boundaries

Boundaries set a clear delineation between professional responsibilities and personal involvement, preventing any confusion or misunderstanding that may negatively impact the treatment process. Establishing and respecting these boundaries can help promote a healthy, productive conversation that encourages patients to openly discuss their thoughts and concerns.

Some helpful considerations for therapists include the following:

Use Client Agreements 

Utilizing client agreements or contracts can be a pivotal step in establishing boundaries in patient relationships. Therapists may use these documents as a formal introduction to what can be expected from both the therapeutic process as well as the relationship between the two parties. These agreements help by explaining the importance of boundaries and their role in fostering a healthy therapeutic alliance. 

The contract between the therapist and client may include details such as:

  • The therapist’s roles and responsibilities
  • Appointment timings, duration, and cancellation policies
  • The importance of open communication
  • The therapist’s commitment to refrain from personal involvement or relationships outside of the therapeutic context 
  • The types of interactions and feelings that may impede treatment

When drafting a contract to explain boundaries to patients, it can be important to strike a balance between being direct and empathetic. While it can be crucial to maintain professionalism and delineate the scope of the therapeutic relationship, avoid using language that is not overly stern or harsh. The goal is to create a safe, empathetic environment where patients feel understood and respected. 

A contract that is too rigid or severe could potentially make patients hesitant or uncomfortable, which may impede the therapeutic process. At the heart of patient relationships is a thread of compassion and understanding, which can be reflected in all communications. Studies have shown that strict treatment may lead to decreased patient commitment and treatment efficiency. 

Strive For Balance

While setting boundaries with patients is vital, therapists may struggle to maintain a balance between compassion and straightforwardness. Boundaries that are too rigid can potentially harm the collaborative relationship, leading to a loss of trust from the patient or causing them to become closed off. Conversely, boundaries that are too loose may blur the professional relationship and cause complications. By maintaining a balanced approach, therapists can create a safe space for their patients that enables healthy active participation in therapy. 

In order for therapists to achieve this balance, it may be helpful to consider new perspectives on the therapeutic process. For example, clinicians may approach client relationships with the idea that they’re collaborative rather than a simple “intervention” that only considers clinical knowledge and perspectives. Recent research points to the fact that shifting the goal of therapy from an intervention to a process of “making” may help therapists strike this balance more effectively. 

In a recent study, researchers found that many common mental health strategies involve using pre-existing sets of ideas and procedures to address complex and unique life situations. They explain how while common treatment interventions such as cognitive-behavioral therapy are often effective and may be adapted to different cases, the therapeutic relationship may be enhanced by adopting the viewpoint that both parties have the knowledge, experience, and ideas needed for a successful improvement in mental health. 

Based on the findings of this study, therapists may consider the human commonalities that are present and how these can be essential in co-creating a new set of habits and perspectives for their clients. Through the process of discovery and the creation of new habits, individuals can gain the clarity and insight needed to instill real positive change. Therapists may consider how they can actively engage clients in a process of creation, either through new ideas, new habits, or creative and/or exposure endeavors that lead to personal discovery. 

This approach may help clinicians make decisions based on the patient’s well-being and unique situation and allow them to engage in more personal, honest discussions without sacrificing necessary boundaries. 

Practice Self-Awareness

In clinical practice, professional self-awareness can be a critical skill that may help therapists improve their ability to achieve real and substantial positive results with their clients. Many studies point to the fact that most boundary violations are not committed by predators or ill-intentioned practitioners, but rather by naive and young therapists who may be new to therapy. These practitioners often have a strong personal stake in the well-being of their clients or may be stuck within a rigid framework. 

According to a recent study, one of the main ways that therapists may violate boundaries is by becoming overly engrossed in their clients’ issues while feeling responsible for the problems they are experiencing. Researchers note that it is essential for practitioners to understand how to be caring, understanding, and empathetic in professional ways without overly immersing themselves in their clients’ lives and concerns. They state that “…the clinical encounter is a potential minefield for complex relationship issues to develop and for students to be both dazzled and confused by the tumultuous feelings developing in them.”

Researchers point out that professional self-awareness requires therapists to develop the capacity to understand the feelings that may stir inside of them when confronted with the real-life emotions and vulnerability that often present in therapy sessions. Therapists must learn how to keep healthy boundaries with clients without pushing them too far away. This requires them to be able to sit with the natural emotions and feelings that come up during sessions without being reactive. Instead, therapists can learn how to observe their clients and apply decision-making in a non-emotional context.

Clinicians may also benefit from understanding the concept of intersubjectivity, which involves being aware of the feelings that are exchanged in the therapeutic relationship and using mindfulness as a guide to pick up on important cues. 

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Create A Safe Space For Healing

In the therapeutic journey, incorporating client feedback can be a crucial aspect of fostering a safe, healing environment. Actively seeking and valuing the client’s input can encourage an atmosphere of mutual respect and collaboration while also enabling independence and growth. This practice helps ensure that therapy is person-centered, with the individual’s unique experiences, perspectives, and goals at its heart. It also allows the therapist to adjust their approach in line with the client’s needs and create a tailored, responsive therapeutic strategy that enhances the likelihood of positive outcomes.

Ensuring clients feel safe is a fundamental requirement of the therapeutic relationship. This safety extends beyond the physical environment, encompassing emotional and psychological safety as well. It can be crucial for therapists to cultivate a space where clients feel free to express their thoughts, feelings, and fears without the risk of judgment or reprisal. This can be achieved through consistent demonstration of empathy, acceptance, and unconditional positive regard.

Addressing therapeutic ruptures can also be a vital aspect of creating a safe space for healing. Therapeutic ruptures, or breaks or strains in the therapeutic relationship, can be an inevitable part of the therapeutic process. These ruptures can manifest in various forms such as feelings of dissatisfaction, unmet expectations, or an overall sense of disconnect between the therapist and the patient. In many cases, these events may help therapists to develop a deeper understanding of a client’s mental state and patterns.

Addressing these ruptures effectively can help therapists build and maintain healthy relationships with their clients. It typically involves a three-step process: identifying the rupture, exploring it, and repairing it. Initiating a conversation about the perceived strain can be the first step toward identification and guidance. Therapists may choose to gently bring up the topic, inviting the patient to share their feelings and experiences first.

Exploring the rupture involves understanding the context, emotions, and triggers associated with it. This stage requires the therapist to display empathy and active listening without alarming the client or making them feel like it is their fault. The final stage involves jointly finding solutions or coping strategies and might include adjustments to treatment plans or communication styles. Therapists who navigate these stages with compassion, patience, and openness often find that the process of addressing and repairing ruptures can lead to even stronger therapeutic alliances. 

Support Options

For therapists, attending therapy can be an enriching experience, offering a space to develop self-awareness and improve or maintain their own mental health. It may be especially valuable for improving one’s ability to create a safe space for clients that minimizes reactivity and creates mindfulness of personal emotional leanings and tendencies. Fellow therapists may offer insightful feedback on communication patterns, relational dynamics, and emotional responses. If you are a therapist aiming to improve your practice and emotional awareness, signing up with a platform like BetterHelp may be beneficial.

Through an online platform, you can choose between phone, video, or live chat sessions with a licensed therapist and select a session time that works within your schedule. Since some online therapists offer appointments outside of standard business hours, therapists can access sessions in between their busy schedules, making this option convenient for those who need flexibility. 

Studies have shown that therapists who engage in online therapy techniques or training such as acceptance and commitment therapy and mindfulness training may experience improved self-awareness, and as a result, improve their ability to maintain healthy boundaries with clients. 


Setting boundaries with patients can be a vital aspect of fostering healthy and effective therapeutic relationships. This often requires ongoing conversation, understanding, and mutual respect. Guided by values of compassion and empathy, ensuring a safe space for patients is not just about protecting the therapists’ well-being but also about enhancing the quality of care for the patient. As professionals, we must continually challenge ourselves to navigate this delicate balance with grace and commitment, fostering a therapeutic environment where both parties feel heard, valued, and respected. If you’re struggling to strike the right balance as you set boundaries with your clients, consider enlisting the help of a licensed therapist locally or through an online platform like BetterHelp.