102: Setting Boundaries in Therapy Private Practice
What are Boundaries?
When it comes to interpersonal relationships, boundaries are limits or spaces between people. In other words, a boundary is when one person communicates what they are or not comfortable with. Outside of interpersonal boundaries, we can also set physical boundaries. Physical boundaries include our personal space and touch comfort levels and include physical needs like eating, drinking, and resting.
Setting and adhering to boundaries creates psychological and physical safety. Healthy boundaries help us practice self-care and demonstrate to others what we will and won't tolerate. When we fail to set or uphold boundaries, it can lead to resentment, burnout, irritation, enmeshment, or codependency.
Boundary Setting in Therapy
In a therapist-client relationship, setting boundaries is important for several reasons. Before a client ever makes their way into a therapist's office, a therapist can set boundaries by outlining who they do and don't work with. Yes, creating a niche and adhering to it is a way to operate within a therapist's zone of competence.
Once the therapeutic relationship begins, having boundaries sets the expectations of what your clients can expect in and out of therapy sessions. Second, it models for your client that they can also develop and adhere to boundaries when you set and adhere to your boundaries. Finally, it can build trust between you and your client when you uphold your boundaries. In many unhealthy interpersonal relationships, a lack of boundaries or inconsistency in adhering to them can create uncertainty or discomfort. Showing your clients that you can maintain your boundaries helps them trust you to do what you say you'll do.
Financial Boundaries
Financial boundaries are an important but often overlooked part of therapist-client boundaries. Financial boundaries are when the therapist outlines how much therapy will cost, when payment is due, what happens when a client no-shows or late cancels, and what guidelines are in place for unpaid invoices.
For many therapists, financial boundaries can be uncomfortable. They worry that talking about therapy's financial side or practice will negatively impact their clients. Some therapists say they struggle to bring up payments or fees because they don't want clients to feel like they have to "pay to have someone listen to them." Still, other therapists have their own money stories of working through and struggling to set financial boundaries.
Overcomplicating or overexplaining financial boundaries is a big sticking point with therapists. Instead of a clear and kind policy like, "Same-day cancellations will be charged the full therapy fee," therapists say things like, "I've had a history of people late-canceling. I know you never would, but unfortunately, I've had to take this measure to protect myself and my schedule. And if you did have to cancel, maybe we could work something out so it wouldn't be the full cost of the missed session, but it depends. So again, I wish I could let people cancel right before the appointment, but I've gotten into scheduling and financial trouble in the past."
Setting these types of money-related boundaries with your clients again reinforces trust and consistency and models self-respect. In my work with clients, some of the richest (pun intended) sessions were born out of times when a client was upset with my financial boundaries. Money isn't talked about enough in our society, and as therapists, we can model safety by bringing finances into the therapy room with economic limits.
Therapist Vacation Boundaries
Setting firm limits on your accessibility while out of the office is another boundary in private practice. As a therapist in private practice, taking that first vacation can be nerve-wracking. Having someone to cover is a great option but not available to all therapists in private practice. If having clinical coverage from a trusted clinician isn't an option, you can guide clients to connect with a 24/7 mental health line. When I go on an extended vacation, I review safety planning with my clients. We'd talk about orange flags that would prompt them to phone a trusted friend or loved one or their primary care provider and red flags that warrant seeking emergency mental health care.
Availability of Therapist
The availability of a therapist boundary often bleeds into financial and energetic boundaries. Many therapists think they have to be available at all hours of the day to be "good" therapists. But by setting your working schedule in alignment with your need and energy, you become the best version of yourself. For example, I'm not a morning person, so seeing clients first thing in the day wouldn't be great for me. Other therapists love a weekend warrior schedule, and others like to work evenings. Creating boundaries around your work schedule is the first type of availability boundary. Here's a post for more examples of therapist schedules.
The other type of boundary around availability is when clients can or cannot reach you in between sessions and how. For example, are you available via phone 24/7 for emergencies? What if a client had a stressful–but not emergent–day? Are you available via phone in-between sessions? Do you only communicate with clients via a HIPAA-compliant patient portal? What happens if a client emails you over the weekend? Having these conversations early and in your paperwork helps create and enforce your availability.
Positive Boundary Reinforcement
Reinforcing boundaries can be challenging, but it can help you strengthen your relationships with clients when done well. When a client respects your boundaries, thank them for their understanding. For example, "Thanks for paying that late cancelation fee." If they've struggled with your limits, and demonstrate growth in honoring your boundaries, point it out. "It sounds like this week was stressful. I'm proud of how much you leaned on your coping skills instead of emailing me." If there was a tangible boundary that your client respected, acknowledge how them adhering to it helped others. Say you lent them a copy of a book for two weeks. When they return it, you can say, "I'm so glad that book was helpful. I appreciate you returning it on time as I think another client could benefit from it."
Support Setting Your Boundaries as a Therapist
If you need accountability and support setting and adhering to your boundaries as a private practice owner, I can help. In my group coaching program for therapists, we cover financial, energetic, and out-of-office boundaries. Having a small, supportive community of other therapists can be so helpful in adhering to your private practice boundaries. Learn more about the program and what else we cover below.
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Welcome back to Mind Money Balance, where this month we're continuing on the theme of burnout prevention and a big way to prevent burnout is by setting and upholding different boundaries. Just as a reminder, if you're tuning in after my brief podcast hiatus, this month through July, I'm going to be focusing on private practice owners. But it doesn't mean you can't get some good takeaways you just might need to tune out earlier in this episode. I'm going to start this episode by defining boundaries, talking about boundary setting in therapy, financial boundaries for private practice owners, how to set boundaries around your vacation, and availability of your therapist self as boundaries, and then also talking about just like some ways we can reinforce boundaries in our practices. So let's get right to it.
What are boundaries? I think so many of us have heard the term or at least are familiar with it. But I think it's helpful to have like a baseline of what the heck I'm going to be talking about. So boundaries when I'm thinking about interpersonal relationships. So that's a relationship between me and somebody else, whether it's my partner, a friend or a client, boundaries are the limits or spaces between us. In other words, a boundary is when one person communicates what they are or are not comfortable with. And setting and adhering to boundaries creates psychological and physical safety, because boundaries are not just communication boundaries, they can also be physical boundaries, right? Like, please don't come into my space. If I'm the type of person who isn't like into hugs, you know, I can say like, oh, not a hugger, please like take a step back. And it can come to like our tangible belongings, too. I grew up in a large household, and we had a lot of boundaries, around whose clothes were who's--shout out to anybody who grew up in a large family and knows the arguments that can ensue over you know, a change of seasons and a bunch of new clothes. So we can set boundaries in so many other ways. And really, what healthy boundaries do is really protect us; I know it sounds strange to say that telling somebody no protects you. But when we don't set or uphold our boundaries, it can lead to resentment, burnout, which is what we're trying to prevent this month, irritation or in swinging in the opposite direction, it can lead to being a meshed with somebody else or codependency. So healthy boundaries, help us to practice self care, and really reinforces this is how I take care of myself. And the cool thing about boundaries is that they're fluid, they can change over time. And with space, like there may be a day where I'm like, Oh, I just can't even get back to a boundary day is like I'm just putting my phone on silent. And there may be days where I say, You know what, I'm okay, having some inbound calls or whatever. So your boundaries can change over time. And our boundaries can change from person to person, maybe I'm not a hugger, with strangers. But maybe with close family and friends, I welcome hugs, right, they can also change in that context. So when it comes to therapist-client relationships, setting boundaries is important for a few reasons. Before a client even makes their way into a therapist office, a therapist can set boundaries by saying, here's who I work with, here's who I don't. And there it is, again, talking about niching. But creating a niche, and adhering to it is a way to operate within the therapist zone of competence. So you're already setting a boundary before a client even comes in, because they can tell on your website or on your therapist directory profile. Wow, Lindsay works with XYZ people, she doesn't have expertise in ABC people. And that already helps to set the tone for what my expertise is. And my competence is, and that I could go into a whole other tangent on that I have a comprehensive blog post about niching. And it's important that I can link here. And when I say here, I mean the show notes. So if you want to read about that, you can do that later. But I think creating a niche is the first way we set boundaries before somebody even makes their way into our office. Now, once the therapeutic relationship begins, having boundaries sets the expectations of what your clients can expect in and out of therapy sessions. It helps to decrease uncertainty or anxiety, particularly for clients who are new to therapy and don't have an understanding or anything to compare it to in terms of what this type of relationship will look like. And or for clients who are returning to therapy, maybe after a not-so-great experience in a different therapists office. So setting boundaries really helps to model for your clients. Here's how and when I'm available. Here's how I operate my practice. And when you uphold your boundaries, you actually say something like, you know, you can only reach me during, you know, nine to five hours. And after that, you know, here's a safety number that you can call, or I end my sessions on time, when you actually adhere to those, you actually end your session on time, you actually say, Yes, this is the number, you'll have to call after 5pm. It builds trust between you and your client, your client can go, wow, Lindsay actually upholds her boundaries. That's pretty cool. And when we think about a lot of our clients, when we think about maybe unhealthy or non ideal interpersonal relationships, a lack of boundaries, or inconsistency of boundaries can create a lot of uncertainty and discomfort. So showing your clients you have the capacity to set and adhere to boundaries, helps create safety in your therapeutic work, right? It helps them trust you that you're going to do what you say you do. And when we think about how this ties into burnout, prevention, you can actually clock out at the end of the day, you can actually know that when you turn off your work phone, or you Power down your laptop, that you actually will be out of office, so to speak.
Now, financial boundaries are a thing that a lot of private practice owners struggle with. And they're super, super important. But to be honest, often overlooked, otherwise, I wouldn't have a job. Financial boundaries are when a therapist says things like this is how much my services cost. This is when you have to pay your invoices. This is what happens. If you don't show up or you late cancel, here are the guidelines that I have in place when you fail to pay a bill. Right. And those things can be so uncomfortable for us therapists to uphold, they feel so--the word I hear the most is like icky, just feels icky, I can't do it. And they have all these worries about upholding financial boundaries. They worry that talking about money will get in the way of the therapeutic relationship. I've heard therapists say like, Oh, I just I really freak out about bringing up payments or fees, because I don't want my client to have to feel like I'm just there for the money or they're paying someone to listen to them. Right, which is like, that's some stuff, you need to unpack if either of those statements resonated with you no shame or judgment, just know that there's work there to be done. And so many of us as therapists have our own money work, our own money stories that we have to untangle, we have to look at we have to sit with the discomfort of and then we will be able to better set financial boundaries. A common error. I see when new therapists or therapists new adhering to their financial boundaries, is this over-explanation or over-complication of things, instead of a clear and kind policy that is something like, same day cancellations will be charged the full rate, therapists often launch into things like oh my gosh, one time at this agency, I had so many people who are canceling and I know you never would cancel. But unfortunately, because of my bad experience, I've really had to protect myself and my schedule. So if you did, he had to visit cancel, which I know you wouldn't, but like maybe we could work something out. So it won't be the full cost. But it just really depends. And trust me if I could, if I could just let you cancel right before the appointment, I totally would. But like this is something that happened to me in the past. And it really got me into big scheduling and financial trouble. And I just don't want to have to do that again. And again, that's not your problem. But hopefully, you just never have to cancel. And if you do, I might have to charge you but maybe I won't. It's like, Whoa, that's a lot to consume as a potential client, versus just, if you cancel the same day, you'll be charged the full fee. And I again, I'm gonna go back to like modeling and reinforcing trust. When you set these types of financial boundaries in your practice, it reinforces when my therapist says something they uphold it, it helps to model self-respect, the respect that if I say something, I'm going to uphold it, it also helps to model consistency. And what's so interesting about this is in my work with clients, some of the richest pun intended Sorry, not sorry, sessions were born out of times when a client was upset with my financial boundaries. And so for many therapists, if a client was upset with financial boundaries, we might just be like, Alright, whatever I'll like waive the fee or I just won't charge you or whatever the irritation is, but I think as therapists we can really model the importance of sitting with discomfort of talking to our clients about money. It is one of the final taboos in our society and we are trained to talk about things like trauma, abuse, neglect, heartache, and systemic oppression, well, let me take that last piece back. A lot of us are not trained to talk about it, but we do anyway. We're therapists, we can do hard things, we have uncomfortable discussions day in and day out. And so if you can just be there when your client says, I'm pissed that you charge me late cancel fee, or it really upset me that you wouldn't answer my phone call on a Sunday afternoon. Guess what? We can crack into that and figure out what's underneath that. And we have the capacity to tolerate that within a healthy therapeutic relationship. And to me with financial boundaries, I tell my coaching clients inside of Grow a Profitable Practice From the Inside Out, I say, look, by the time the end of the first session is done, I want a potential client or new client to know my fee at least three times. And the reason I say that is because oftentimes will be like, Yeah, my fees like $135, and then I charge in the end of the month. And it's like this throwaway comment. But that's an important thing to know. So for me, the first time they're going to see or hear about my fees on my website, I don't believe in hiding prices, I think that can be really harmful. That's my belief, you're entitled to your own. Two, when I'm on the consultation call, I again, reiterate what my fee is. And then three in that first session, I'm reviewing my practice policies. And that often includes a fee, and I'm making sure again, they understand it. So I want them to hear it three times, I want them to get used to the cost, the investment, the fee, whatever language feels best for you. And knowing that I as their therapist, I'm comfortable enough to talk about money.
Alright, let's move on to therapist vacation boundaries. I'm recording this at the start of summer. So a lot of us might be going out of office for long weekends or maybe long weeks. And it's the time of year where it's really important to make sure that your clients know when and how will they be able to access you when you're gone. That's another boundary. And as a therapist in private practice, the very first vacation that you take can be so nerve-racking. So of course do what is the most clinically appropriate for you. If you have the option to have another clinician cover for you, that's a great option. But it's also not available to all therapists in private practice. So making sure that you have some sort of clinical coverage when you are gone, even if that clinical coverage is called this 24/7 Mental Health Line. The county that I'm located in has a crisis line that is a step down from calling 911. So it's a dedicated 24/7 Mental Health line that they can call and say I'm feeling really stressed and feeling really anxious. Maybe you're not or they're not concerned about their safety, but they need somebody to talk to that is an option, you'll have to look into your county, your area, what types of resources are available. But of course, hospital 911 is always an option. And when you're thinking about upholding these vacation boundaries to me, when I'm out of office, I am out of office, when I am on vacation, I am on vacation. So if I know I'm going to be gone for several weeks or even a long weekend, I'd let my clients know that I'll be gone, I'd let them know who to reach out to. But we also do a bit of kind of safety planning and pre-emptive triage. We talk about orange flags, those would be things that might prompt them to double down on a coping skill or call a loved one or a friend or maybe reach out to their primary care provider for some additional support. And then we talk about red flags that warrant seeking crisis or emergency health care, right. So making sure you have your client's best interest at heart and making sure they have access to appropriate resources when you're gone. And you have your appropriate out-of-office available. Now, your therapist vacation boundaries might be different than mine, you might say, it's actually far more stressful for me to go on vacation and to not have some of my clients be able to access me, that's fine too. But tell them say FYI, I'm going to be on vacation, I might be in an area where I don't have cell service. Or you know, I'm just not near my phone. It'll probably take me 24 hours to get back to but if you have something you need to talk through, that isn't an emergency, I can call you back within 24 hours. Again, I'm making up that vacation boundary when I'm out. I'm out but everybody is different. So figure out what type of boundary you want to need and make sure you clearly communicate it to your clients.
And outside of vacation. I think just general availability of yourself is really important in this kind of bleeds into financial boundaries and just energetic interpersonal boundaries as well. A lot of us think we have to be available 24/7, and you know, there are a lot of reasons for that. But when we're in private practice, we're not really hopefully working with people who are high risk, right, that would not be appropriate for private practice outpatient care, which is why I say hopefully, we're not in that situation. Now, that does not mean that we don't have crises situations arise in private practice. But we are not the 24/7 ER, so we really need to think about that as well. So that caveat aside, I believe therapists do best when they work, a schedule, in alignment with their needs and their energy. Like for me, I am not a morning person. Ask, literally anyone in my life, I wake up, and I like drink coffee for 30 to 60 minutes, and I just like stare. That's just the way that I am. I don't want to do any chit-chat. I don't want to go for a run, I definitely like just, I definitely would be a shitty therapist if I was seeing somebody bright and early. So seeing clients first thing in the morning is just not a good thing for me. Now, other people love morning appointments, and they're like, Oh, I would love to see my clients at 7am or 8am. Good for you. There are people out there who are also early birds and would love to get therapy done bright and early. Other therapists love just doing like the weekend warrior schedule where they clock in on Saturdays and clock out on Sundays. And then they have the rest of their week to attend to other things. Other people are night owls, and they love working from like, 4pm to 9pm. I have a post that again, I'll link if you click on the show notes, there will be a blog post linked where I have different therapist schedules. So you can kind of take a look and peruse about what schedule feels good for you. But it gives these examples to say look, the boundary around when and how you work is the first type of availability. That's when you say I'm available, generally Monday through Thursday from 10am to 5pm, or, or whatever your boundary is. And that boundary is also when you see clients, a lot of therapists, especially when they're starting out, or they're trying to build their practices, they do things like they say, oh, yeah, I work Monday through Friday, nine to five, and then a client goes, Oh, well, I work during that time. So can you see me at seven? And the therapist because they're anxious about kind of having a client and building their caseload? They're like, Yeah, of course, I can see you at 7pm. And before we know, we've already broken a boundary right out the gate, instead of saying something like, you know, I don't work evenings, a lot of my clients who have work, traditional work schedules, they'd like to see me at the start of the day or during their lunch hour, do you think that would be a possibility? Right, helping them to kind of explore other things. And of course, just being really clear, if that's not a fit for them or not a fit for you, that's fine. So outside of the schedule boundary. The other type of boundary around availability is when clients can or cannot reach you in between sessions and how. I kind of talked about that in the vacation boundary piece. For example, are you available through phone, if a client has a stressful but not urgent or emergent day? Can clients you know, send you messages as much as possible through the HIPAA compliant patient portal, even if that takes, you know, hours and hours out of your week to kind of read and review them? What happens if somebody emails you over the weekend, having these types of conversations early and in your practice policy paperwork helps to really create and enforce your availability. And to me all of these things lead themselves to burnout prevention. Because when we feel like we are on at all hours of the day, we can't clock out of our private practices we feel like we're on call. That's really hard for our nervous systems. To every time we hear a phone ping think it's a client in a crisis, or to be out at like a family picnic and hear an email ding and feel like you have to respond right away. It's really hard to be fully present as a therapist when you are acting as a therapist all hours of the day.
So let's start also making sure that we're reinforcing when our clients adhere to our boundaries, with some positive reinforcement things that we're also pretty good at doing as therapists. And it can be kind of tricky to do, I think setting boundaries and communicating them as hard. But what's even harder is actually following through on it. But I really think when you reinforce your boundary, when you uphold your boundary, it helps again, strengthen your relationship with clients, are you sick of hearing it yet? Am I a broken record? Don't answer that. When a client respects your boundaries, thank them that's like baseline. So it could be thanks so much for paying that late cancellation fee. Period. You don't have to like go on and on about why it's good and this and that. If they have historically struggled with your boundaries, and then they demonstrate growth pointed out to them, right, that's therapeutic growth. It could you could say something like, Hey, it sounds like this week was really stressful, when you're in a session with them, I'm so proud of how much you've leaned on your coping skills instead of emailing me. And then even talking through like, what was that like for you? How did you deal with it? How did you know it was something that you could tolerate and it wasn't an emergency, right? Let's say there was a like tangible or physical boundary that your client respected. Let's say you lent them a copy of a book that you're obsessed with, and you lend out to clients all the time. For any therapist who's ever lent out a book, it can feel like well, I just gifted somebody a book. But if you're really in the habit of like lending books make sure it is a loan, meaning when they return said book, you could say, I'm so glad that book was helpful. I really appreciate you returning it on time. And I know another client could benefit from it. Because you're getting that positive boundary reinforcement, but you're also kind of touching on something else that can be really beneficial for our clients, which is knowing that they're having done a good thing can help other people. And so by saying, Hey, thanks for returning that book, somebody else now gets a chance. That's pretty cool, right?
So those are some boundary-setting tips and why they are so important. If you are struggling as a private practice owner to uphold your financial boundaries, your energetic boundaries, your scheduling boundaries, we spend an entire session on it in Grow a Profitable Practice from the Inside Out. That's my group coaching program for social justice-minded or marginalized therapists. I'll be reopening things not just yet but if you want to get your name on the waitlist, go to MindMoneyBalance.com/ProfitablePractice to kind of learn a little bit more about what that group entails and to get your name on the waitlist. More to come but just thought I would sprinkle that out there for now and I'll see you guys in a couple of weeks.