Family Matters

Boundary Crossing

Balancing professional decorum with human compassion

Magazine Issue
May/June 2007
Boundary Crossing

I’d been in psychotherapy for more than three years when I was diagnosed with an acoustic neuroma: a benign tumor was growing slowly on my left acoustic nerve, the one that carries information from the ear to the brain. It was the size of a golf ball and took a seven-hour surgery to remove. My recovery was prolonged, requiring 10 days in the hospital and several months of rest at home.

I was 31 years old and living alone. A half-dozen friends gathered around to support and comfort me. My widowed father traveled back and forth from his California home 3,000 miles away. I felt close to my therapist, whom I saw in group and individual therapy. She’d supported me when my mother had died suddenly during our first year of work together.

“My mother died,” I’d uttered simply when she picked up the phone on the evening I got the news. My voice seemed disembodied, but her calmness brought me back.

“Tell me what happened,” she asked, as the sound of running water and clattering dishes faded into the background. It was the first time I’d called her at home. Our brief conversation reassured me that I wouldn’t float away in a bubble of grief.

But my surgery seemed different, and I wondered what to expect from her. I was nearing the completion of my own doctorate and knew that taking a phone call from a grief-stricken client was an acceptable boundary crossing. But what should a therapist do when a patient was seriously ill and couldn’t possibly make it in for sessions?

The night before the surgery, I sat on my hospital bed laughing and talking with my friends and father. I looked and felt well. The only clue to the stealthy tumor growing inside me was a partial hearing loss in my left ear. The cold reality of my impending surgery was still unimaginable.

Into the harsh hospital lights and gay chatter of my hospital room stepped my therapist. She approached hesitantly, probably trying to decide how much to say in front of other people. Her smile was so warm it blocked out whatever words she uttered. She stayed only a moment, just enough time to hand me a container of chocolate Piroulines. “Oh,” I thought, “she doesn’t want to intrude.” But, for me, it was just right—that whisper of her presence, lingering within the tangible sweetness of the cookies.

When I opened my eyes one of the times in the ICU four days later, I felt myself emerging from the drug-induced haze of the post-op period. It was the middle of the night and the nurse on duty gently welcomed me back to the land of the living. She turned on the TV to the comedy Beetlejuice, a bizarrely comforting choice starring Michael Keaton as a crazed, white-faced ghost up to all kinds of funny business. I felt safe in the cocoon of the ICU, but soon my medical condition no longer warranted it.

The room I transferred to on a regular floor was adequate for my medical needs, but the move was psychologically devastating. It had been a mere 12 hours since I’d fully awakened and my emotions didn’t have time to adjust to so many changes in a single day. I was so exhausted and strung out from the drugs that I couldn’t find the words to communicate my distress. My attentive father and the crisp nursing staff assumed that my agitation was the result of a soaring blood pressure and a wildly beating heart, common transient effects of this surgery. How could I tell them about my disorienting and deeply disturbing dreams, filled with bodily fluids and tubes? Surgery is an assault on much more than the site of an incision. My psyche was struggling to integrate so many overwhelming experiences. Despite the crushing fatigue, I managed to call my therapist.

Again, I can’t recall her words. What I clung to was the soothing rhythm of her speech, reminding me that this horror would pass. I wasn’t losing my mind. I’d get well. Her gentle cadences cooled my fevered mind and lulled me back to sleep.

A week later, I went home, with my father beside me. I was shocked anew by the depth of my fatigue; the inability of my brain to attend to something as mindless as a TV sitcom. It was impossible to imagine that I’d ever resume work on my dissertation. I couldn’t even brush my teeth without resting for two hours afterward. How would I ever finish my dissertation? I didn’t have the energy to get to my therapist’s office, but I desperately needed to see her. So she agreed to come to me.

I lived at the top of a four-story brownstone with no elevator. The door to my apartment was on the third floor and led to another flight of stairs that opened into the hallway outside my bedroom. As I lay exhausted in my bed, I heard my therapist’s labored progress up those long stairs, punctuated by gasps for breath. Even through the haze of my own convalescence, I felt alarmed by her physical condition, something that had never been apparent when we walked the short distance from the waiting room to her office.

“Don’t be concerned,” she said after resting a few minutes to catch her breath. “It’s the result of smoking for too many years.” In the three years I’d been seeing her, I’d never had a hint that she was a smoker.

Our meeting definitely wasn’t your typical therapy session. I lay virtually immobile in my queen-size bed. My left eye, which refused to close even when I slept, was covered by a clear, plastic patch. What was left of my hair was cut close to the scalp, courtesy of a home visit from my hair stylist, who insisted on “evening” me out. My two cats surrounded me and purred throughout the visit. I imagined the contrast my therapist must have seen between the alert, active young woman sitting on the pre-op hospital bed and the one now lying before her. But she managed to mask the shock I later learned she felt.

We chatted about cats. I learned that her precious Siamese had died the previous year. “I was inconsolable,” she admitted. She petted Hadrian, my black cat, noting that black cats often have Siamese in them. “I hope this doesn’t make me get another cat,” she laughed. That’s all I remember about the visit: her slow steps, her labored breathing, her affinity for cats.

A few weeks later, I was back in her office, then back at group, then back to work. Over time, I finished my dissertation, got married, and started my own practice. Years after we ended therapy, I ran into my therapist at a convention. We were both in line for a shuttle bus and ended up sitting together. Her smile was as warm and generous as I’d remembered. We chatted about our work and the changes in my life. Her pleasure at seeing me whole and well was evident. As we talked, my mind drifted back to that unimaginable time of my surgery and the way she’d reached across the traditional boundaries of the therapeutic relationship and saved me.

My therapist’s willingness to trade the comfort and security of her office

for the ill-defined crossroads where the role of professional helper meets simple human concern would be considered a boundary crossing by some. Recognizing that the physical and psychic dislocations that followed my surgery had hit me at the most primal level, she went beyond the normal definition of a therapist’s role to soothe my wordless panic and ground me in the warmth of a familiar connection. In doing so, she demonstrated the difference between a boundary crossing and a boundary violation, and, more important, what it means to offer a simple act of grace to another human being.

Dea Silbertrust

Dea Silbertrust, PhD, JD, is a licensed psychologist and associate managing partner of Bala Psychological Resources. She graduated from the law-psychology programs of Drexel and Villanova universities, and works with adults, adolescents, and families on eating disorders, trauma, and women’s issues.