The Myth of Immediate Therapeutic Response
Setting limits for early career psychotherapists
If you’re reading this and you’re a psychotherapist or counsellor, it’s likely that you feel a natural pull to supporting others. Perhaps it’s what brought you to the profession and what drives your desire to help people.
One of the most important lessons I've learned over the years, (and wish I'd had a better handle on earlier in my career) is that maintaining appropriate boundaries from the very first contact is of central importance.
Many new psychotherapists feel pressure to be ‘therapeutic’ from the moment someone reaches out. Often, we’re expected to be endlessly accommodating, accepting and welcoming, which can leave some therapists questioning where to draw the line when receiving an enquiry that doesn’t sit right, or where something feels ‘off’.
If you’re an early career therapist reading this, perhaps you’ve wondered if setting limits or declining to work with someone might seem uncaring or unhelpful, even if your gut instinct is telling you that you’re not the right therapist to work with a particular individual.
If we were to act on this concern (working with anyone who asks for fear of not being a ‘good enough’ therapist if we don’t) it could lead us into uncomfortable situations that ultimately serve neither ourselves nor potential clients.
The reality is this: pre-psychotherapy contact is assessment, not psychotherapy.
Your role during initial enquiries is to determine whether you're the right professional for that person's needs, and the therapeutic relationship doesn’t begin until you’ve settled on an agreement to work together. Anything before that point is preliminary conversation.
When Professional Boundaries Matter Most
Let me share a scenario that might feel familiar. Imagine receiving an enquiry from someone who initially describes struggling with a particular issue, for example - addiction to gambling. You know this is outside your scope of practice and respond professionally, explaining that gambling addiction isn’t something you have experience in, and so you refer them to a colleague who specialises in the issue they’ve described.
The person then emails back, reframing their concern entirely:
“Actually, it's not really gambling addiction, it's trauma from childhood that's affecting my work. I saw that trauma is listed on your website as something you work with, so how can I book with you?”
When you maintain your professional position and suggest they speak directly with the specialist you've recommended, they might respond with something like:
“I've already tried a gambling specialist, and they weren't helpful at all. I'm really struggling to find anyone who will meet me. This is my first time reaching out and I wish I hadn’t bothered. I'm finding the whole process very invalidating. I don’t think you really care about people at all!”
This type of response is, consciously or unconsciously, designed to make you feel guilty for maintaining your boundaries. You might find yourself thinking, ‘Perhaps I should just offer them a session’ or ‘Maybe I'm being too rigid.’
Here’s my advice:
Trust your instincts when something feels ‘off’ about an initial enquiry.
Some things to look out for include:
Obscuring Identity: e.g. Not including a full name or sufficient identifying details in the first message. Or using a random-word email address.
Shifting presentations: The person describes entirely different issues when your initial response doesn't meet their expectations.
Boundary testing: Questioning your professional judgement or pushing back when you explain your scope of practice.
Demands rather than requests: Expecting you to justify your decisions or accommodate their specific requirements.
Emotional manipulation: Attempting to make you feel guilty, unethical or incompetent for maintaining professional boundaries.
You Are Allowed to Say No
This might be the most important message for early career psychotherapists: you are not obligated to work with everyone who contacts you. Even if someone's presenting issue falls within your listed specialities, you have the right and professional responsibility to assess whether you're genuinely the best fit for their particular needs.
Sometimes saying no is the most ethical thing to do. Taking on clients when you're not confident you can help them effectively, or if their presentation falls outside of what you’re comfortable with, serves no one well:
Don’t be afraid to say no if something doesn’t feel right.
Being Professional vs. Being Therapeutic
There's an important distinction between being warm and professional versus taking on a therapeutic role prematurely. You can be kind and respectful in your communication. You can be clear about your availability and expertise, helpful by providing appropriate referrals, and professional in maintaining boundaries. However, this doesn't mean you need to be therapeutically responsive to their concerns or obligated to explain your clinical reasoning in detail. You're not required to accommodate every request or responsible for managing emotional reactions to your boundaries before any therapeutic relationship has been established:
You are not in a therapeutic relationship until you’ve made an agreement to start working together.
How you handle initial contact sets expectations for the entire potential therapeutic relationship. If someone struggles to respect your professional boundaries before you've even met, this often indicates how they might engage going forwards in the therapeutic relationship.
Remember, healthy therapeutic relationships are built on mutual respect and established limits / boundaries.
Practical Guidelines
When responding to initial enquiries:
Be clear about your working methods (online/in-person, session length, fees)
Be honest about your expertise and refer appropriately when someone's needs fall outside your scope.
Trust your professional instincts if something feels uncomfortable.
Don't over-explain your clinical reasoning for referrals.
Maintain consistency in your responses, even if someone pushes back.
Research consistently supports the importance of clear professional boundaries from the outset of any therapeutic contact. Studies emphasise that ‘asserting and maintaining clear professional boundaries is essential clinically, ethically, and personally’ and that boundary-setting helps both client and psychotherapist develop appropriately (Psychotherapy.net, 2024).
Research has found that inappropriate boundary management by psychotherapists is one of the most common violations in professional client-therapist relationships. This means that early establishment of limits are vital for ethical practice (Careers in Psychology, 2021). The literature consistently shows that clear boundaries from initial contact protect both parties and establish the foundation for effective therapeutic work.
Utilising Supervision
If you find yourself frequently second-guessing your initial responses to enquiries, consider discussing these interactions in supervision. Your supervisor can help you recognise when your limits are appropriate and support you in trusting your professional judgement.
Remember, developing confidence in setting boundaries is part of your professional growth. Each time you maintain appropriate limits, you're not only protecting your own wellbeing but also modelling healthy professional relationships.
Final Thoughts
Being a psychotherapist doesn't mean being available to everyone who contacts you, nor does it mean you must justify every professional decision you make. Your expertise, time, and energy are valuable resources that should be directed where they can be most effective.
Trust your instincts, maintain your boundaries. And remember that saying no to those whose needs fall outside of your scope, leaves you available for those you can support; those who will benefit from what you have to offer and who approach the therapeutic relationship with mutual respect.
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References:
Black, S. C. (2017). To Cross or Not To Cross: Ethical Boundaries in Psychological Practice. JANZSSA - Journal of the Australian and New Zealand Student Services Association, 25(1).
Careers in Psychology. (2021, September 4). How to Set Professional Boundaries as a Psychologist. Retrieved from https://careersinpsychology.org/how-to-set-professional-boundaries-as-a-psychologist/
Psychotherapy.net. (2024). An Early Career Lesson in Boundary Setting Helps the Client and Therapist Grow. Retrieved from https://www.psychotherapy.net/blog/title/an-early-career-lesson-in-boundary-setting-helps-the-client-and-therapist-grow
Society for the Advancement of Psychotherapy. (2024, September 25). Boundaries and Multiple Relationships in Psychotherapy - Recommendations for Ethical Practice. Retrieved from https://societyforpsychotherapy.org/boundaries-and-multiple-relationships-in-psychotherapy-recommendations-for-ethical-practice/
As ever, I really appreciate the practical wisdom of your articles Amanda. I can just imagine this piece being useful to early career practitioners and so have shared it. When you offered the distinction between pre-therapy and therapy, I thought about the phenomenon of pre-transference - that the client is starting to have ideas about us, and we are starting to have ideas about our clients, even before we’ve met and started work together. Perhaps some of the dynamics you’ve described here in those initial exchanges might be considered examples of pre-transference.
This is fantastic advice Amanda! I wish I’d had it at the beginning rather than
learning the hard way….