Proximity – Space Between Therapists and Clients in Psychotherapy

By Ofer Zur, Ph.D.
 

 

The seating, or other spatial arrangement, represents a boundary between therapists and clients. Some therapists establish a clear physical boundary between themselves and their clients by sitting behind a desk while interviewing or consulting with clients. Others may establish the boundary between themselves and their clients by the placement of a low coffee table. Many other therapists leave the space open and do not partition themselves from their clients with furniture.

In contrast, traditional psychoanalysts sit out of sight behind the client who is lying on the analytic couch, establishing a visual boundary rather than a physical one. In special circumstances, such as prison settings, a therapist and a client may have a glass wall between them. Group therapists are likely to sit in a circle side by side with or opposite their clients, and psychoeducational-focused therapists may sit side by side with their client watching a video. Adventure or outdoor therapies, which involve backpacking, rope courses, or flying trapezes, have a very different spatial arrangement compared to the traditional therapy office. As with any boundary in therapy, the physical setting and any spatial arrangements between therapists and clients are always organized with the clients’ well-being in mind and can be understood within the context of therapy (i.e., the clients, setting, therapy, and therapist factors).

Space Between Therapists and Clients in Psychotherapy

Actual distance between therapists and clients is another obvious expression of the extent of the boundary between therapists and clients. Like any boundary in therapy, it must be understood within the context of therapy. The therapist-client distance may change from client to client; for example, child clients may require or seek less distance than adult clients. Winnicott was reported by his client, Margaret Little, to hold her hands clasped between his through many hours as she lay on the couch, apparently in a near psychotic state (Little, 1990). Clients’ gender and sexual orientation may also influence the distance that therapists or clients choose to sit from each other. Therapists may establish more distance when working with clients with borderline personality disorder or who are paranoid, volatile, or hostile. When it comes to seating arrangements and space between therapists and clients, therapists are not always in full control of the situation. As with touch and language, clients may or may not comply with therapists’ established parameters and they may cross or violate the therapists’ set boundaries. A client with borderline personality disorder may violate the therapist’s boundaries by inappropriate attempts to touch or kiss him or her. A paranoid client may choose to sit farther than the standard distance. Aggressive, hostile, or violent clients may attempt to intimidate therapists by “getting in their face” or being physically aggressive.

. . . The setting of therapy determines what is an appropriate distance or spatial boundary between therapists and clients. Psychiatric medication evaluations and some forensic evaluations may be conducted in a more formal setting with more distance than other forms of therapy. Therapeutic orientation is another factor that determines the distance between therapists and clients. Humanistic or feminist-oriented therapists are likely to sit closer to their clients to reflect their focus on authentic and intimate therapist-client relationships. The traditional analytic setting in which therapists sit behind and out of clients’ sight is significantly different, from a boundary and proximity point of view, than that of body psychotherapists who may use actual therapeutic touch with clients. Adventure or outdoor therapies also create different distances between therapists and clients who may be supporting each other on a rope course or otherwise interacting closely in a variety of activities. Distance can also vary within a session or from session to session with the same client. Within sessions, therapists and clients may start and end the session with a handshake and then settle for more distance during the session. The therapist may choose to go over and hold the hands or shoulders of a sobbing, grieving client or perhaps approach a client who has just announced a special accomplishment, such as receiving a diploma, and give the client a congratulatory pat on the back or high five. . . The nature and quality of the therapeutic relationship is another factor that is likely to affect therapist-client distance. A closer and more intimate relationship is likely to naturally encourage closer proximity. Some therapists sit farther from their clients than others, reflecting not only their personal therapeutic orientation but also their own cultural and personal sense of comfort with space and proximity.

The above text is an excerpt from: Zur, O. (2007) Boundaries in Psychotherapy: Ethical and Clinical Explorations. Washington, DC: APA Books, pp. 203-205. Copyright, American Psychological Association, 2007.

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