Boundaries, boundaries, boundaries—we cannot live without them, but can we live with the ones we create? We create boundaries, whether we are aware of them or not, whenever we begin a new group or meet with an already existing one. The most elementary boundaries relate to time, space, task, and role. How we understand these boundaries may inform us about more complicated ones, such as how we deal with contact among members, or between members and us, outside of the group.
I will outline my understanding of in-group boundaries in this column, and devote the next column to the thorny issues that arise over contact outside of the group.
Time boundaries include how often the group meets, on what day(s) of the week, at what time, how long it meets each session, and for how many sessions it is scheduled to meet (time-limited versus ongoing). While we may take time boundaries for granted, they have a powerful organizing influence on the life of the group.
I was trained in an ideology of precise time boundaries, so I started and ended my groups on time. When I was leading my first groups on an inpatient substance abuse unit, I continued this pattern. I was unprepared for the fallout from this simple procedure. The patients began to complain to their other therapists when their other groups (which had never operated on any consistent schedule) were not similarly consistent. After a couple of decades of conducting outpatient group therapy, I have become a little more flexible about time boundaries, but still I am rarely more than five minutes late starting or ending a group.
Jeffrey D. Roth, MD
Space boundaries involve both the group's institutional setting (residential treatment, agency, or private practice) and actual physical setting. The institutional setting has a prominent effect on the primacy of the group's attachment to the therapist. In residential treatment, the group member has an initial attachment to the treatment institution that employs the therapist, who is generally unknown before the group members arrive in the first group. In contrast, in a private practice setting the patient usually comes to the therapist by individual reputation or referral.
Similarly, the actual physical setting is determined by the institutional setting. In residential treatment or an agency, the group therapist might have little or no authority to determine the size of the group room, the comfort of the chairs, the presence of a door that can be locked, or the quality of the room's soundproofing. The therapist in private practice has more influence over all of these aspects of the physical setting, and each of these aspects has its own impact on the experience of the group's boundaries.
To cite one egregious example regarding a group setting, one therapist whom I supervise told me of a medical director who routinely would barge into group sessions—as if the group did not have or deserve boundaries.
Focused to the proper task
The primary task of a therapy group is to provide help to its members. While therapists might have many different theoretical orientations that lead to different ways of formulating exactly how this help is delivered, the direction of authority is unambiguous. Therapists may derive substantial support for their own recovery in the process of leading therapy groups; their capacity to receive this help may be necessary for them to accomplish the primary task, but the therapist's recovery is not the primary task.
Likewise, other benefits that we may derive as therapists are ordinarily well spelled out: We are paid for our services and we obtain professional satisfaction. These tasks are also incidental to the primary task of helping the patient, even if they may be necessary for the group's optimal functioning.
Other tasks may be incompatible with the primary task of helping the patient. Some common boundary violations involve enlisting the group member as a sexual partner, a business partner, or a drug dealer. These boundary violations are of course incompatible with the therapeutic task, as they tend to take precedence over a concern for the group member's well-being. I offer these flagrant examples to build a foundation for a later examination of less obvious boundary crossings.
Role boundaries arise in a straight line from task boundaries. We generally see two differentiated roles in a therapy group: the therapist role and the member role (some groups have cotherapists and some groups might have observers). Consonant with the group's primary task being to deliver help to its members, the role of the therapist is to provide this help, and the role of the group member is to receive this help. Of course, if life in our therapy groups were this simple, I would not be writing this column. The fun really begins when we witness our group members struggling mightily to avoid receiving help from us or from the group. We then have the opportunity to earn our keep by confronting dysfunctional roles as various group members enact their unmanageability in front of the group's eyes.
Many of these roles emerge in the group itself, but sometimes (particularly in ongoing groups, but also in residential treatment where the opportunities exist) group members will engage in dysfunctional roles in their contact outside of the group. This topic will form the basis for my next column.
Any readers who have experience with group members being in contact with each other or with the therapist outside of the group are welcome to share their experience, strength, and hope with the readers of this column by sending the stories to me at firstname.lastname@example.org.