Professional Boundaries with Eating Disorder Patients: considering right brain studies and work of Dr. Allan Schore
- Category: Healing Resources
Humanity Appreciation Today, happily, we have evidence based scientific research to back up the use of our humanity in our clinical work with patients. 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: e.g. a patient asks my age, if I'm married or divorced, if I have children, my religion, if I've ever had an eating disorder. 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.) that the patient wants and needs a particular psychological emotional experience she believes will come from sharing such an experience with me.
Sharing Specific Personal Information In other words, its not the information or event that is the issue. The sharing of our humanity is the point. The patient wants to know that she will be understood and appreciated. She wants to know I have a history that will inform me in terms of being present and empathic with her. She wants to know that I can appreciate her pain and personal dilemmas. She also wants to know that I have survived my challenges and her stories will not shock me or cause me to judge her. Perhaps most of all, she hopes that I have healed from what she suffers and that if I have healed then she can heal too.
Person to Person - Right Brain to Right Brain The valuable experience between us is not content, but right brain to right brain communication. We use words because we have to. We communicate far more than words, We need more than words to heal and be healed. Allan Schore, in his fantastic research on affect regulation, impacts many areas of social science and biology by showing that right brain communication is received by the right brain and actually changes brain structure to allow developmental progress. Developmental progress is exactly what is needed for eating disorder recovery. 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 makes for effective connection, growth and increase possibilities for healing.
Answering Personal Questions The key question I ask myself before I reveal personal information to a patient is this: Will my answering this question burden the patient or will my answering support her healing? Often, when I'm asked a personal question I will respond by saying, "I will answer your question. But before I do, can you tell me why you want to know or what meaning this information has for you?" People suffering from eating disorders have rarely experienced a quality relationship where their boundaries were respected. In general, they know little about respecting boundaries. Responding with respect and care to their questions helps begin the process of learning and appreciating what personal boundaries are - mine and theirs. This kind of communcation also shows a woman with bulimia or anorexia that she can meet limits and caring from a person at the same time. Such an experience is often new and always in the service of health and personal development. People recovering from eating disorders need the presence of honest, caring and respectful human beings in their lives. I believe, with the backing of neuroscience, that we psychotherapists can’t keep true to our profession unless we are true to our humanness.