Molnos, A. (1998): A psychotherapist's harvest

Boundaries, therapeutic situation and the four triangles

A further condition for a successful therapy is the establishment and maintenance of firm, yet flexible (5) boundaries. These are limits established and maintained by the therapist. The importance of establishing and handling the therapeutic boundaries properly from the start cannot be overemphasized. No psychotherapy can take place without boundaries. Different types of therapy have different boundaries and some are uniquely psychoanalytic.

The issue of boundaries is often neglected. Such neglect is mainly due to a certain confusion between the frame, the sum total of the boundaries, in which the therapy takes place and the process of therapy itself, confusion between the therapist's role as an administrator and manager of the therapeutic situation and her role as a participant in the process. The topic of boundaries tends to be avoided particularly by those therapists who have a misguided fear of appearing authoritarian or too directive if they set the conditions clearly and firmly.

Therapeutic boundaries can be divided into four categories: the boundaries of place, time, conduct required and therapeutic relationship. Boundaries may be seen to have three functions. The first is to carve out a special, psychological space from everyday life which is the therapeutic situation and in which the therapeutic process takes place; the second is to create a secure base for the patient; and the third is to set a baseline for observation.

The (6) therapeutic situation which is created with the help of the boundaries is separate from everyday reality. In it the therapeutic process takes place which is illustrated graphically by the (7) four triangles.

At this point the reader interested in the therapeutic process should study the diagram of the four triangles and then return to this text.

The diagram of the four triangles represents in an abstract form the content and process of any analytically based or dynamic psychotherapy from the beginning. The process starts in the assessment interview: the patient comes with his problem; no matter how he presents it, while we explore it, we soon find out that the core of the problem is some disturbance in his relationships with others; as we take his history, we look for patterns and we discover similar patterns in his past; finally, sooner or later we see the same pattern appearing in the here-and-now of the relationship with the therapist. In the course of therapy we keep on working on this pattern.

The three corners of the large triangle in the diagram refer to the patient's current (C) problem, to his problems in the past, mostly with his parents (P) and to the same problem as it is bound to arise in the therapeutic situation, here and now with the therapist (T). As all these problems occur in relationships with persons close to the patient, the name given to the large triangle is "triangle of person". Each of the crucial, problematic relationships signify psychic conflict for the patient which is represented by the three smaller triangles inside the triangle of person. Each is a "triangle of conflict" and represents the patient's internal conflict between his true feeling (X), his anxiety (A) about it and his defences (D) towards both. His true feeling (X) is repressed and the anxiety (A) is caused by his repressed true feeling which threatens to surface. The true feeling can be positive (+X) or negative (-X) or ambivalent ( X), that is to say a combination of opposite feelings. Please, note that from now on we will use these symbols in the text.

Knowingly or not, when we take the patient's history we are looking for patterns, and by doing so we are using the four triangles and we keep on using it during the course of the whole therapy: the conflict now, out there; the problem in the past, there and then, and, finally, the problem here-and-now.

 

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