BOUNDARIES AND PSYCHOTHERAPY PART 11:

HEALING DAMAGED BOUNDARIES

Tom Whitehead

A healthy, functioning system of personal boundaries is essential for productive living. People
with poor boundaries often make life decisions damaging to themselves and those around them.
They find themselves trapped in unintended repetitions of destructive patterns, repetitions that
baffle them. In Part One of this article we focused on the nature and functioning of personal
boundaries. In Part Two we will examine the healing of boundary distortions.

Personal boundaries are our psychological and interpersonal" immune system " .Our boundaries
enable us to distinguish between what is good and what is bad for us. They empower us to take
action to eliminate the destructive things from our lives, and to retain the positive. They allow us to
satisfy our needs effectively. So people with healthy boundaries lead satisfying lives, while
those with dysfunctional boundaries are destined for misery. Boundary problems are rightly a
major focus of psychotherapy. When we assist our clients in healing dysfunctional boundaries, we
do a genuine service.

Childhood abuse and neglect are common sources of boundary distortion. In order to cope with
repeated violations, a child dulls her awareness of a basic need. Insensitivity to her need helps her
avoid pain, and so to survive the abuse. But later in life she is unable to detect or respond
adequately to new violations. The result may be involvement in further abuse, either as victim or as
perpetrator.

Our boundaries are regulated by our core beliefs, and are beyond our conscious control. We
acquire core beliefs over time at great personal expense. They may appear nonsensical to the
outsider, but fit the situation in which they were originally engendered. We have no power to
voluntarily give them up, and we will without choice work hard to defend them. Nourishment
barriers playa central role in boundary difficulties. They protect against the experience of a basic
need.

Nourishment barriers are born when a child is continually frustrated in her attempts to satisfy a
need. The child learns that yearning for satisfaction only leads to the pain of frustration. After a
struggle she accepts at a deep level that it doesn't pay to "get her hopes up". She learns to avoid or
derail any promise of satisfaction. After all, such promises lead only to pain. Over time the need
itself is effectively blocked out of her experiential world. Banished from awareness, the need no
longer invites satisfaction. In fact, she arranges her world so that nourishment is never within
reach.

Psychoanalysts long ago noted that, just when a client appears to be making progress, he or she
may act so as to torpedo the therapeutic process. It was as if the patient were actively thwarting the
therapist's attempts to help. So they called the phenomenon "resistance". They recognized that it is
rooted in the avoidance of painful experiences, and believed that it must be battled and overcome if
the client was to improve (Wolman, 1967, p. 9). Hakomi maintains a friendlier stance toward such
blocks to change. Hakomi's originator, Ron Kurtz, called them Nourishment Barriers to
emphasize that a more effective and nourishing way of living lies just beyond (Benz and Weiss,
1989, p. 77).

Nourishment barriers are persistent. They become the most enduring features of personality. The
rest of the personality reshapes itself to accommodate them. The curious result is a " character
process" , a set of beliefs and habits custom-tailored to ensure that certain positive life experiences
never happen. MacKinnon and Michels, in their classic book The Psychiatric Interview in Clinical
Practice, describe the avoidance of affection in obsessive character processes.
The avoidance of such painful affects as fear and rage is easily understood, but the
obsessive is even more anxious to avoid affection, warm th, and love. His sense of strength
and pride is tied to his ever- present, defiant rage, causing him to mistrust any feelings of
warmth or tenderness. In his earlier life, the emotions that normally accompany closeness
have occurred in the context of dependency -, " relations. Therefore, he reacts to his warm
emotions with dependent and helpless feelings that stimulate fears of possible ridicule and
rejection. Pleasurable experiences are postponed, for pleasure is also dangerous. (p. 93)

When we say "boundary problems" we are talking about persistent problems people have
controlling their interactions with others. Examples are inability to separate personal and
professional life, confusion of personal closeness with sexuality, and inability to exit undesirable
relationships. Boundaries are not something different from habits, core beliefs, and interpersonal
skills. Rather, they are systems made up of all these things.

Suggestions for healing

Part of psychotherapy is development of more functional boundaries. The client needs to be able to
satisfy her needs in non-problematic ways. The client has healed when able to experience real
needs, and able to routinely and effectively meet them. She is doing well when she has learned to
look out for herself. This means she has become re-acquainted with her native intuition, the felt
sense she had before it became distorted by her adjustments. It also means she is ready and able
to act on her own behalf. The therapist can playa special role in healing. He or she can set up
conditions for crossing nourishment barriers experimentally in the therapy room, and can
assist in adopting better ways of living out in the real world. Some general suggestions will speed
this process.

Suggestion 1: Don't re-abuse the client.

Distorted boundaries pull towards recreation of the system that engendered them. This is
significant with all kinds of boundary problems. It is especially important where sexual abuse is an
issue. Then sexual boundaries will likely be confused. There may not be a clear distinction
between emotional and sexual intimacy, or between touch and abuse. At a core level the client may
believe that sexual and emotional intimacy are inseparable. If the therapy is going well, the
clinician can expect from the client, sooner or later, an invitation to cross sexual boundaries. The
invitation is a healing crisis. It can be a positive development, but is one requiring preparation.

Falling into a sexual relationship with the client is NOT helpful. The client's invitation is a bid to
hang onto dysfunctional boundaries. She is saying, "Will you help me continue to experience the
world the way I do now?" A repetition of an abusive pattern will confirm and entrench her sense
that the world is the way she sees it. The clinician must have professional boundaries adequate to
prevent re-abuse.

How does a healing crisis look? The therapist may notice that the client is "coming on" to them, or
just suddenly feel sexually attracted to the client. A sexual element jumps into the therapist's
experience, and it may not be obvious what has happened to cause the change.

An example is Susan, a bright young woman with whom I worked with years ago. Today, the
material with which we were dealing would immediately suggest a sexual abuse history. But in
those days most of us were uninformed about abuse. So things were moving slowly. Susan was
living a dual life, something like what we might today call multiple personality. One part of her
was perfectly conventional, and very feminine. The other part despised her female body, and
wanted a man's body instead. This was her reaction to the contempt with which females were held
in her family of origin. Her having a man's body wasn't possible. So Susan settled for
"owning" the bodies of the men she dated. She dictated all the details of when and how they
might use their penises, for example insisting on holding them while they urinated. For this
purpose she calculatedly picked men she could manipulate.

Though I experienced Susan as attractive, we had been having sessions for several months without
any indication of a sexual element in our relationship. One week that changed. The
moment she entered I strongly felt her sexual presence. Normally a conservative dresser, on this
-occasion she wore snug pink shorts and a loose white blouse. I did a literal" double take" , and
found myself struggling with my own sexual feelings. Though unsure of proper procedures, I did
bring my reaction under control. We continued our work, and the sexual element faded out.

Simply maintaining boundaries was helpful for Susan. Directly acknowledging and dealing with
the issue would have been more helpful.

More recently I worked with Janet, who had been sexually abused by her father over a period of
years. We focused specifically on her abuse issues for about five sessions. Janet was further along
in her personal recovery, and knew what a healing crisis was. So she and I were able to work
cooperatively to make it constructive. It helped that Janet knew what her sexual feelings were
about, and didn't really take them at face value. The dialogue went something like this.
Janet: "Maybe I shouldn't tell you, but I'm attracted to you ...in a physical way.
" Me: "Oh?"
Janet: " I like you, and I get turned on being with you."
Me: "Umm ...Thanks for telling me what's going on. Can I tell you something?"
Janet: "OK"
Me: "Your feeling sexual now fits the work we're doing, and it's perfectly OK. What we do with it is
important, though. "
Janet: "Uh huh. “
Me: "I think you knowwwhat I'm going to say next, but it's a good idea to say it anyway. Can you
pay attention to yourself as you hear this?"
Janet: (Takes a moment to turn her attention to herself) "OK.”
Me: "I want you to know that I think you are an attractive woman. 1 could be attracted to you. But
our relationship is special, like the relationship between a parent and a child is special. To turn it
into a sexual relationship would be deadly wrong. It would be destructive. So sex doesn't fit in it at
all. 1 won't let our relationship turn into a sexual relationship. lf 1 ever started to feel sexual
towards you, I would stop it. We won't ever be sexually involved. "
"What's it like to hear that?"
Janet: "(A little teary) Well... there's a little part of me that's disappointed. But mostly I feel
relieved.”

Afterwards Janet requested and received a hug, monitored and judged non-sexual by both of us.
Fuzzy sexual boundaries can lead to misinterpretation of therapeutic interactions. This is more
likely when the therapist uses touch. The client may experience clinical touching as inappropriate
intimacy. In that case he may allege improper conduct where none exists. The best
prevention for unfounded allegations is careful pre-therapy groundwork. Thoroughly explain to
the client the use of touch as a therapeutic tool. Obtain written consent for its use. Routinely
assess new clients for sexual abuse issues. When using touch with clients known to be confused
about boundaries, consider having present an assistant of the same sex as the client.

The crisis around sexual abuse issues is certainly dramatic, and so makes a good example. But
boundary difficulties of other kinds also lead to healing crises. For example, consider the client
who is never taken seriously by others. She will unwittingly be acting in such a way as to confirm
her core belief. The therapist may at some point find herself bored, covertly wishing the client
would go away. Casual, unfocused treatment may result. This constitutes a re-abuse too.
Familiarity with the client's history will help the therapist identify boundary problems, and
anticipate what form the crisis will take.

Suggestion 2: Provide exposure to healthy boundaries.

The client needs to be immersed in a healthier system. This means maintaining good boundaries
yourself. It also means encouraging the client to associate with other healthy people, and having
him pay careful attention to their interactions. These will be people who don't match his bad
boundaries, for whom he feels little or no "chemistry". He may initially experience them as
uninteresting, incomprehensible, or even frightening. We have noted that everyone in the social
field helps maintain everyone else's boundaries. Swimming in a healthy system applies a gentle
force that will invite him towards health. Over time, the new ways tend to "rub off" on him.

Attending directly to damage can speed healing. There is a natural process by which we all correct
intrusions in everyday life. Anne Katherine notes that:
Boundary violations can be healed right away if the sufferer tells the intruder that a
boundary has been violated and the intruder immediately apologizes or somehow
expresses concern about the violation. Note the two parts to this. The one whose limits
have been breached must make the offense known and the offender must respect the limit.
(Boundaries, p. 86)
We can minimize damage by taking prompt corrective action. In the best of worlds both victim and
transgressor promptly affirm the reality of the intrusion, and the transgressor voluntarily
makes amends. This clarifies for everyone what the boundary should have been. Erving Goffman,
in Relations in Public, notes that correction can happen even without the cooperation of the
offending party. This is pretty important, since in systematic abuse the offending party is unlikely
to admit anything. The therapist can help. She needs to explicitly confirm the reality of the
violation, and note the damage. And she needs to make it clear by word and by deed what good
boundaries are like.
Suggestion 3: Assist in overcoming nourishment barriers.
Now comes the tricky part. A healthy environment is often not enough. When people are able to
heal on their own, they usually do. What makes them candidates for psychotherapy is their
difficulty with healing. Nourishment barriers distort their perceptions, and pull towards recreation
of unhealthy conditions. This traps the client in repetitions. So nourishment barriers must be
systematically identified and overcome. Working at the barrier is how healing happens. .

The kind of intervention that will be helpful depends on the type of barrier. So we need to get
clearer about the types of barriers, and how to overcome them. To do this we will need to examine
the way boundaries are defended. We get some help here from Hakomi theory. The
phases of boundary defense correspond pretty closely to phases of the Sensitivity Cycle.

Boundary Violation

Boundary Violation

Figure 1.

Figure 1 depicts a personal boundary and its violation. The circles represent the boundary
itself. It separates what belongs from what does not belong. The area inside the circle represents
the things that belong. The things that don't belong lie outside the circle. A combination of our
native intuition and our life experience determines whether something belongs.

The second diagram in Figure 1, the one with the arrow, depicts a violation. Something that doesn't
fit is intruding. We will use the example of sexual boundaries between a father and his teenage
daughter. Suppose that father and daughter are playing together, and that a sexual element begins
to creep into their play. In this case the circle represents the father's relationship with his daughter.
The arrow represents the intrusion, the appearance of a sexual aspect in their generally non-sexual
relationship. The father suddenly notices his daughter's breasts and thighs in a new way. A basic
and automatic part of him heads towards arousal. The daughter might be aroused in a less clearly
focused way. As we noted in Part One of this article, all persons present in the social field take part
in maintaining boundaries. So both father and daughter participate in defense of the sexual
boundary between them.

Phases of Boundary Defense

1. Detection 2. Action 3. Control 4. Equilibrium

Detection Action Control Equilibrium Figure 2.

Figure 2 represents the sequence of phases the boundary system goes through to deal with
intrusions. Of course, in the real world things aren't as clear cut as these little pictures would
suggest. One phase kind of blends into another. Even so, the diagram will help clarify the process.

In the first defensive phase, internal resources lead to DETECTION of the intrusion. Father notices
what is happening. The information comes to him as a felt sense that something is wrong. He feels
uncomfortable. His daughter also feels that something is amiss. Were they not able to detect the
intrusion, no action would be possible. Detection contains the seed of effective action. It
corresponds to the clarity stage of the sensitivity cycle, the emergence of awareness of a need.

In the second phase, internal resources initiate effective ACTION against the intruder. Father puts
on the brakes. He distances himself emotionally, tightens his muscles, does some self-talk,
rationalizes. Daughter also takes action. She distances herself momentarily, and watches for
cues from father. Were they not able to initiate a counteraction, father might well continue to
respond sexually to his daughter, despite his discomfort. Action corresponds to the effectiveness
stage of the sensitivity cycle.

In the third defensive phase, the action taken leads to the experience of CONTROL. The boundary
is complete. The sexual connotations of their play are under control and both know it. It's possible
to have accurate detection and effective action, but no experience of control. Without that
experience, the pieces have not congealed into a whole. Control is the intuitive glue that binds the
elements into a functioning boundary. The control phase corresponds to the satisfaction stage of
the sensitivity cycle.

The fourth phase is EQUILIBRIUM. The focus can shift to something else. The sexual aspect has
disappeared, and father and daughter resume their play. All of this may have taken place in a
couple of seconds, without a word spoken between the two. Equilibrium corresponds to the
relaxation stage of the sensitivity cycle. It means letting go of the process, and moving on.1

Table 1 - Difficulties and Options. 2

PHASE WHAT DIFFICULTY LOOKS LIKE OPTIONS TO TRY

detection Fails to experience needs enhance capacity for mindfulness
oblivious to situations develop sensitivity to native need
numb explore ways need is covered up
masks true feelings identify bodily signals
lacks "common sense" integrative work
- OR -
experiences substituted needs
action unable to act explore and elaborate impulses
fearful of acting identify barriers to action
freezes improve self-esteem
stuck practice crossing barriers
- OR - bite size
acts impulsively teach specific skills
assertiveness training
role playing
group methods
self help books
classes
group therapy
control ineffectual increase options
weak practice and rehearse
unsure of self systematize responses
inconsistent build sense of mastery
disorganized, confused call attention to successes,
- OR - acknowledge
avoids situations practice "taking in" success
substitutes "wall" for boundary mentors, role models
support groups
homework
equilibrium doesn't recognize success take in nourishment
repeats defensive maneuvers practice letting go
can't let go of concerns redirection
preoccupied with boundary interrupt self-focus
- OR - role reversal
aborts boundary defense
Table 1 lists difficulties at each phase, along with options for therapeutic work. We will consider
the options at each phase.

Detection. Clients with problems at the detection phase often appear oblivious. Where others are
painfully aware that something is wrong, they may show no reaction. Or they misinterpret
situations. They may have learned to "tune out" or distort their intuitive responses to situations.
A good example is Mark, a young man who attended our abuse issues workshop. Mark had
frequently gotten into physical fights with other men. In the workshop we use a "slow approach"
exercise to explore boundaries around personal space. A stimulus person very slowly walks
towards another who is observing his own response in mindfulness.

Mark noticed that he became increasingly frightened and tense as he was approached by a
stimulus man. But when the other was about arms length away his fear vanished, and Mark
became emotionally numb. The exercise provoked his painful recall of beatings by his
stepfather. Young Mark was always terrified when his stepfather came after him. He would
try to escape, and sometimes he was successful. But when the stepfather got within arms
 length he "numbed out" to cope with the beating that was sure to follow. As an adult,
Mark's alternating fright and numbness led him into frequent misinterpretation and
aggressive behavior around other men.

Mark would benefit from more ability to mindfully attend to his automatic responses. This could
take the form of more exercises like this, mindful experience with males. The therapist might help
Mark uncover needs masked by his fright and numbness. These would likely include needs for
positive relationships with males, something his life sorely lacked. The methods of
Hakomi can be great with barriers at the detection phase.

A client may experience a substitute need rather than the authentic one beneath it. Alice Miller in
The Untouched Key examines the close connection between childhood abuse, distortion of needs,
and repetition of abusive patterns. She notes that as a culture we engage in widespread repression
of our genuine needs, so avoiding the pain they would engender. Rather than respond to our real
needs we engage in destructive substitute gratification (pp. 167-170). She argues that our inner
numbness blinds us to the obvious connection between the abuse of children and the destructive
behavior of adults. It is only when the facts of suffering are sufficiently disguised and indirect that
we can bring ourselves to contemplate them at all.

The simple, commonplace facts of child abuse are not given a hearing; if they were, the
human race would have greater understanding and wars could be prevented. Only if they
are presented in a disguised, symbolic form can they arouse great interest and an emotional
response. For the disguised story is, after all, familiar to most of us, but its symbolic
language must guarantee that what has been repressed will not be brought to light and
cause pain. (Miller, 1990, pp. 75-76)

Child molesters provide a classic example of substituted needs. There is reason to believe that
most molesters were themselves abused as children (Walker et al, 1988, p.113). When the child
was abused, he was overwhelmed with anxiety, anger, shame, and confusion. Over time, as the
child identified with his adult abuser, his original distress was buried. By the time the victim had
become an abuser, it was out of his reach. The yearning for safety and protection, the fire fueling
the pattern, is masked by a substitute. In all of us the sight of the vulnerable child evokes echoes of
our own childhood vulnerability. But this experience is rejected by the abuser. Instead, he
experiences a desire to assume a power role with the child. The abuser hides from his own
vulnerability through continued abuse of others.

The general therapeutic approach at the detection phase is to enhance awareness of real needs.
Teaching mindfulness is a move in the right direction. Where an inauthentic need is hiding the real
one, the client needs to uncover it. It may be helpful to explore the mechanisms the client uses to
cover it up. As an intermediate step the client can learn to recognize bodily sensations that signal
the need. In cases of severe abuse sets of needs may be dissociated from one another. These "little
personalities” need to become better acquainted with each other.

Action. Clients with problems at the action phase act either too fast or too slow. Sometimes they
seem frozen or stuck. Sometimes they are too fearful to act. Others act impulsively. They
experience a need, but have trouble initiating appropriate action.
Examples lie in the stories of battered women. Many such women have endured years of severe
physical and emotional abuse without initiating any action. Most recognized that something had
to be done, but were unable to do it. It is common for the woman to be paralyzed by fear that things
will get worse if she does act. There is often a realistic possibility that the man will seriously harm
her or her children if she tries to leave. It is also common for her to believe that she deserves bad
treatment, or that she will be unable to make a life for herself without her battering mate. All these
beliefs inhibit her capacity to act in her own behalf, and are elements in her damaged boundaries.

The general therapeutic approach at the action phase is to explore impulses triggered by needs,
elaborate them, and develop them into effective responses. The need itself, when fully
experienced, points the way to appropriate action. Barriers to action should be explored.
Systematically improving self-esteem may make action easier. Assist in crossing the barrier in an
experimental way. Bite-sizing may help to reduce the level of threat associated with responding.
Assertiveness training is useful for many clients. The client can be assigned to a mentor, someone
with more ability to act. Teach the client specific skills needed for effective action. Use
role-playing to illustrate effective responses, and get the client familiar with the response pattern.
Therapy groups can provide insights, exposure to healthy boundaries, and specific skills. Self-help
books are a useful adjunct.

Control. Clients with problems at the control phase may look weak, ineffectual, or inconsistent.
They may seem disorganized or confused. Or they may cope with situations by building "walls"
rather than boundaries. They appear to have no effective sense of control over the situation, and
their boundaries are unreliable and wavery.

Good examples are provided by women at the women's shelter. Each of them has taken an
important step in coming to the shelter. Yet on average a woman will leave her battering mate
five times before ending the relationship for good. What happens the first four times? She decides
to go back to him. Maybe she feels she can't make it on her own. Maybe she's afraid she's done the
wrong thing by leaving. There may be pressure from the batterer or from families to reunite. Some
women don't have adequate support for their decisions. Whatever the reason, she is left with an
experience of failure. Her boundaries aren't solid yet, and she can't consistently protect herself. Her
boundaries held this time, but may not the next.

Here's another example:

Kate, a member of a therapy group, often interrupted others and brought attention to
herself. Group members were a little put off by her disruptions. The therapist asked her to
notice what it was like to hear him say, "You deserve attention. " Kate experienced in
response a painful constriction in her upper chest. The therapist helped her explore this
sensation. It was linked to her belief that she was outside the group, rejected by the other
members. Kate tearfully revealed she had been struggling all her life for acceptance. At
this point Beth remarked that she liked Kate. Beth said she felt Kate was the kindest person
there. Kate ig1lored Beth's comment, and continued to talk about her struggle for
acceptance. The therapist asked her to listen to Beth again. She did listen, and seemed to
hear her for the first time. Then Kate said, "[can't let myself believe that. You could take
that back any time. "
What's going on? It's clear that Kate has gained a degree of acceptance by group members. The
problem is that she can't let herself experience control. Her struggle has paid off, but she can't take
in her own success. Her conscious goal of acceptance is driving her to hog the spotlight.
Instead this behavior is moving her aw-ay from her goal, inviting the group to reject her. Her
nourishment barrier is continually recreating her experienced world of rejection. Exercises with
mindfulness and bite sizing might help Kate take in the experience of mastery.

The therapeutic focus at the control stage needs to be on building and taking in the experience of
mastery. Many specific techniques can be used. Homework between therapy sessions can put
skills to the test in real-life situations. It's good to monitor progress frequently. Call attention to and
label successes, and have the client spend time savoring them. A support group can assist in
acknowledging successes.

Equilibrium. Problems at this stage involve failure to let go, or premature letting go. The person is
preoccupied with some boundary defense.

An example lies in the following incident. Tony was a graduate student on internship at a place I
worked. His graduate program had put him on probation because he had washed out of a couple of
previous internships. Tony and I were in the sandwich line of a delicatessen.
Tony: "I'd like a roast beef sandwich. "
Counter Man: "Sorry. We don't have any roast beef. Can I get you something else? "
Tony: "I had roast beef the last time I was here. "
Counter Man: "We usually do have it, but today we're out. Would you like something else ? "
Tony: " I want roast beef. "
Counter Man: "We don't have any roast beef today, sir. "
Tony: "You always have roast beef here."
Counter Man: "No sir. Not today. We're out."
Customers to the right and left are beginning to stare. Tony doesn't notice. He is examining each
item in the deli carefully, taking his time. Triumphantly he points to a large slab of meat on a rear
counter.
Tony: "There! That's the roast beef!"
Counter Man: "No sir. That's Iamb. Would you like a Iamb sandwich ? "
Tony: "That's roast beef!"
The counter man looks at me. But I am pretending to be an innocent bystander. Like the other
bystanders, I am edging away.
Counter Man: "No sir, that's Iamb. "
Tony: "That's the roast beef. Bring it over here! "
The counter man takes another look at me, and at Tony. Then he dutifully hauls the slab of meat,
which weighs about forty pounds, to the front counter.
Counter Man: "See? The label says 'Lamb.'
Tony inspects the label carefully. It clearly says 'Lamb. ' Tony seems perplexed. He reads the label
again, then examines the meat. There is a moment of hopeful anticipation. But Tony's eyes return
to the back counter. He points to another of the several slabs of meat there.
Tony: "There! That's the roast beef!"

On that occasion Tony had three slabs brought to the front counter, none of them roast beef. It isn't
hard to see how he gets into trouble. When he feels unfairly treated, he defends himself
aggressively. His defense is effective. But once he starts he can't let go. The longer he persists, the
more obnoxious and crazy he seems.

Problems at the equilibrium phase can be unreasoning and inappropriate persistence of some
strategy that might be effective in smaller doses. They can look like over defensiveness,
paranoia, obsessiveness, hysteria, chronic irritability or anger. Such things are difficult to tolerate
interpersonally, and hard to deal with therapeutically.

It helps if the client knows that his persistence is undesirable. If he doesn't know that, you're both
in for a rough ride. Then an invaluable first step is increasing awareness of the problem. Feedback
from others can be helpful. Role reversal too. Have the client experience what it's like when you do
what he does, and he is stuck with the role others must play. If the client has trouble experiencing
the mastery he does have (a hangover from the previous stage), it can help to have him slow down
and savor it.

Exercises in mindfulness may help clarify why he can't stop. Recently I was working with Sam, a
client at a public mental health clinic.

As a teen Sam had been dominated and terrorized by an older man. The older man was
diabolically manipulative and cruel. He tricked many boys into virtual slavery. He
convinced Sam that if he tried to get way his parents would be killed. As a result of years of
this abuse, Sam harbored intense anger towards all authority figures. He had fought with
the police many times. He quickly became violent when threatened. Sam had kept the
memory of those years repressed (with drugs and alcohol. He (vas not aware of the source
of his irrational and persistent anger. After a cocaine overdose he made the decision to
enter a drug rehab program. Counselors helped him grasp the emotional link between his
anger and his domination by that evil man. Sam came out of the program with a new
understanding of the pattern of his life, and a conviction to change his violence.

Sam has made rapid progress since the emotional source was identified. He finds it easier to resist
violence. For example, he resisted jumping on a mentally ill man who threatened him with a knife.
He also resisted antagonizing the police who questioned him about the incident. Sort of like
winning a double header. Not bad!

Once the client is aware that changes are needed, you can go right for it. A few years back there
was a popular technique for helping obsessive people control persistent thoughts. When the
thought would not go away, the client was trained to yell "Stop!" and clap his hands loudly. This
was a stupid technique, but it worked for a lot of people. It shows that problems of persistence can
sometimes be addressed by pushing directly on the system. Practice letting go. Get the client
familiar with ways of interrupting and redirecting his focus, and have him rehearse a lot. Give him
homework assignments too.

Hakomi and boundary repair

The Hakomi method of therapy has not traditionally framed its work in terms of boundary repair.
Even so, Hakomi offers some important advantages.
A key advantage is that Hakomi's theory and practice recognize nourishment barriers. Hakomi
views them as a significant source of life problems, and an appropriate focus for therapy.
Importantly, Hakomi teaches that personal transformation happens at the barrier". Only there is
the client's need likely to emerge into awareness. Hakomi recognizes the role of mindfulness in
psychotherapy, holding that the automatic defensive behavior characteristic of nourishment
barriers may be reshaped only in non-ordinary consciousness. Hakomi teaches specific,
systematic, and effective techniques for promoting their resolution.

In some psychotherapies touch is prohibited. This prohibition stands in the way of violation,
making squeaky clean professional boundaries less critical. But where there are issues concerning
touch, to refuse to touch clients is probably to refuse to help them. Hakomi therapists are trained to
use carefully framed clinical touch as part of their therapeutic work. A client with dysfunctional
touch boundaries cannot be expected to shoulder any part of the burden of boundary maintenance.
Having discarded the protection of the no-touch rule, it falls upon the therapist to keep sexual
elements of the relationship from blossoming into a re-abuse from the therapist, or an allegation of
abuse from the client.

Practitioners of some therapies err on the side of declining to cross boundaries with clients. This
provides the advantage of minimizing risk. But it also reduces the opportunity for active boundary
repair. Practitioners of Hakomi, by contrast, are generally willing to cross boundaries in an
experimental way, in an effort to increase awareness and promote healing. Though
maintaining sharp professional boundaries is critical for them, Hakomi practitioners can be highly
effective with boundary problems.

Tom Whitehead, M.A. is a Certified Hakomi Therapist with a continuing interest in issues of abuse
and recovery. Currently, he is the Clinical Supervisor of Riceland Matagorda Community Mental
Health Center in Bay City Texas. He can be contacted at 502 Depot, El Campo, Texas 77437,
(409) 543-8154.

References
Benz, Dyrian and Halko Weiss. To the Core of Your Experience, Charlottesville, Virginia,
Luminas Press, 1989.
Goffman, Erving. Relations in Public, New York. Harper and Row, 1971.
Katherine, Anne. Boundaries: Where You End and I Begin, New York. Parkside Publishing
Corporation, 1991.
Kurtz, Ron. Body-Centered Psychotherapy: The Hakomi Method, Mendocino, CA, LifeRhythm
Press, 1990.
MacKinnon, Roger A. MD, and Robert Michels, MD. The Psychiatric Interview in Clinical
Practice, Philadelphia, W. B. Saunders Company,1971.
Miller, Alice. The Untouched Key: Tracing Childhood Trauma in Creativity and Destructiveness,
New York, Doubleday,1990.
Walker, C. Eugene, Barbara L. Bonner, and Keith L.
Kaufman. The Physically and Sexually Abused Child: Evaluation and Treatment, New York,
Pergamon Press, 1988.
Wolman, Benjamin B. The Common Rationale of the Diverse Psychoanalytic Techniques. Chapter
in Psychoanalytic Techniques: A Handbook for the Practicing Psychoanalyst, Benjamin B.
Wolman, ed. New York. Basic Books, 1967.

Footnotes
1. This kind of interaction is normal. Interactions like these are important for the daughter's
development. They are one way that sexual boundaries are progressively clarified. The
converse is also true. If the sexual aspect of the relationship had persisted unchecked, it would
have caused damage. With or without an overt sexual act, the daughter would have left the
interchange with less functional sexual and emotional boundaries.
2. The table is incomplete. Difficulties at each stage can take forms other than those represented
here. The options for treatment are more numerous than are listed here, and in fact are limited only
by the combined creativity of therapist and client.