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Yesterday I had a call from “Ann”, a woman I have known for over fifteen years. I first met Ann when she came to me for psychotherapy in her mid-twenties. After about three years of therapy we agreed that she was on emotionally solid ground. She was better able to manage and grow her relationships, she was happy with her professional choices, and she was ready to start a family. In other words, Ann was “launched” from the uncertainties of youth into adulthood.

Since then I have had periodic contact with Ann. She returns for short-term help with various events and changes in her life. The most recent call, for example, came in response to conflicts in her extended family that were beginning to impinge on her immediate family.

I mention Ann because she demonstrates the importance of continuity in relationships. Ann could just as easily have called a therapist in her new community, which certainly would have been more convenient. But she wanted to talk with someone who knew her—someone for whom she did not have to provide history or create context. Perhaps of most importance, each time Ann called it was with confidence that I would make time for her. She did not feel the need to ask permission to return, she rightly assumed that she was entitled to reach out to me and that I would respond.

phones Photo credit: Kevo89 / Foter / CC BY-NC-SA

Contrast Ann’s experience with that of a young man in foster care, “Don”, who was seen in a community clinic. A few weeks after completing therapy he left a message for his therapist asking if he could talk to her by phone for a few minutes. In response to this “boundary violation”, the therapist was required to file an “incident report” with her supervisor, who, in turn, had to report the call to her supervisor. The therapist was not allowed to return the call without written permission. Permission was granted, but only for her to tell Don that she could not talk with him because therapy had ended and a continuation of their relationship would be inappropriate.

The therapist documented the “incident”, noting that Don was extremely distressed when she told him that she couldn’t set up a time to talk with him, commenting, “Oh, so I guess you stopped caring about me when therapy ended.” Her explanation that she was bound by clinic policy did little to comfort him, nor did telling him that he could ask his caseworker for a referral and go through another screening if he wanted to try therapy again.

Policies that treat any attempt to extend therapeutic contact as a boundary violation demonstrate a fundamental lack of understanding of human relationships and our need for continuity in our connections to those we care about. Maybe Don’s call did stem from a wish to establish a personal relationship with his former therapist. Maybe he had something important to share. Maybe he just wanted to know if she did still care. She will never know, because she was not allowed to ask. And maybe Don was left to conclude that therapy, like psychoactive medications comes only in carefully measured doses—in some cases, with no chance for a refill.

By Toni Heineman