Living with mental illness: Are the boundaries surrounding therapy really the best fit for everyone?

Mental health blogger Fiona Kennedy discussed the pros and cons of the boundaries surrounding therapy

I’ve tried quite a few ways of gaining control of the mental health difficulties I’ve been experiencing most of my life. I’ve gone the medication route. I’ve gone the therapy route. I’ve gone the medication and therapy route. It has all helped, up to a point, but there was always something missing. It’s only very recently that I’ve figured out what that something was.

One of the aspects of traditional therapy that caused serious problems for me was the very strict boundaries that therapists are required to enforce. A session is 50 minutes, and typically there’s one session per week. There must be no contact between sessions. Social interaction is absolutely forbidden. These rules are all in place for a reason – they protect the therapist, they protect the client, they encourage clients to build on the work that was done during the session in the intervening week, and they (ideally) prevent clients from becoming over reliant on therapists.

I expect for the majority of people, regardless of which side of the therapeutic relationship they’re on, these boundaries really work. They worked very well for me, for a long time. But then they didn’t, and it became a huge problem.

I find it really difficult to talk about personal issues and I assume I’m far from alone in this. I can talk with someone else about their problems until the cows come home, but not my own. Because of this, it takes time to get going, and time is of the essence in a 50-minute session. Very often, it would happen that my brain would really only kick into gear after half an hour or 40 minutes, so just as I was ready to really start looking at whatever the issue was, I’d have to pack it up and put it away for another week. But then when the following week rolled around I’d have to go through the same process all over again.

When I was dealing with external crises, this wasn’t such an important factor. I could talk about the crisis, because it wasn’t specifically about me. But once the crises passed, some serious behavioural issues still remained. It was around this time that the Borderline Personality Disorder (BPD) diagnosis came about, and I’m now wondering how much these things were linked together.

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I was insistent that I needed to see my therapist more often, and for longer periods of time, but that wasn’t possible. Even more, that insistence, that need, and the desperation it brought up in me, ticked quite a few boxes on the BPD criterion list.

The last few weeks I’m working with someone who has a very different approach. This approach understands the limitations of the standard 50-minute, once a week session, and so all of my sessions have been two hours long, a couple of times a week. It’s incredibly intense, but an entirely different experience. The first half hour or so is quite similar to a typical session. But after that? It’s as if my brain steps up three gears. I start remembering things that I had long since forgotten. Apparently unrelated thoughts and images come to mind, and once I pause to take a step back and look at them, I can see how much they actually link up and make sense.

This approach also allows for contact between sessions, which has proved hugely helpful. In order to get the most out of the work, I’m required to spend a considerable amount of time reflecting on my thoughts, without any distraction (I wrote about this process a few weeks ago).

This reflection builds on what has come up during sessions, and allows for further progress. Having the capacity to contact my therapist between sessions about any extra detail that has occurred to me means that the next time we actually speak, we can hit the ground running. The change that I can both see and feel coming about as a result of working like this is quite remarkable.

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I realise that this way of working could be overwhelming for some people, and emotionally draining for therapists themselves. It’s time consuming, requires me to put in a huge amount of effort, and occasionally brings up memories that are quite distressing. I’m not in any way saying that more traditional forms of therapy don’t work. Clearly they do, for lots of people. What I am saying though, is that maybe we need to be more open to alternative methods.

Over the last 8 months or so, I’ve gone from believing that I had a chronic mental illness that I was powerless to control, to the realisation that in fact what I believed to be my illness was simply the manifestation of some extremely faulty beliefs and ways of thinking. The ways in which those beliefs affected my behaviour were truly horrific, and without doubt, symptomatic of a problem that needed fixing, but I’m no longer sure they can be classed as an illness.

Having gained some knowledge of how our brains actually work, having had the opportunity to explore the concept of self-compassion, and having been given the time to really engage with my thoughts in a way I didn’t even know was possible, has brought about this change. All I needed was someone to point me in the right direction.


Fiona Kennedy writes regularly about mental health issues on her blog You can also find her on Facebook and Twitter

If you are affected by any of the issues raised in this article you can contact Samaritans free any time from any phone on 116 123 or visit to find details of your nearest branch. You can also find online information at