Robert M. Gordon,Ph.D., ABPP, LLC

Psychotherapists now know that boundary violations in the therapeutic setting are bad, but most can’t tell you why. Therapists will say it is because of the loss of objectivity and potential for exploitiveness. True, but there is so much more to it. It is critical to understand something about development first to really understand what it means to the patient. Theories of therapy that are not based on the developmental model can’t really explain why boundary violations traumatize.

​

A child needs to be in a protective boundary within the family, within the symbiotic boundary with the mothering object, and feel protected within the self-boundary. If the boundary is violated with too much stimulation, aggression, seduction or exploitation, the child will have traumas and developmental arrests. When a therapist uses his or her patient for personal needs, the patient loses a healing therapist, just as a child loses a parent. The world doesn’t feel safe, and the damage sticks to personality.

Back in the 1970’s when I was studying psychology in graduate school, Encounter groups were very popular. Notions of boundaries were not popular. Lieberman, Yalom and Miles (1973) compared 18 encounter groups led by therapists from most of the leading schools of therapy at that time. They described a group leader who caused more negative consequences than any other therapist. “The leader was a clinical psychologist who had considerable experience leading encounter groups… He was extremely uninhibited. …He also interacted sexually with the women... He revealed his here and now feelings more openly than almost any group member, and participated as a member more frequently than most of the other leaders. He revealed his own personal values and drew attention to himself very frequently...” (p 32-33)

​

I personally experienced an encounter group therapist like this during this period. I was traumatized by the experience. We were all Ph.D. students in an intensive marathon group training program. I saw the therapist using the group members for his own narcissistic needs. I was meanly scapgoated for being too intellectual. I just assumed he was the expert, just as children trust their parents. When we met again for another training session about six months later, we were told that another student in the group had committed suicide, and the group leader was not asked to return to the program. That was almost 30 years ago, and it had a profound influence on me. By contrast, my analysis was characterized by strict ground rules. I knew nothing about my analyst other than his credentials, but I sensed his maturity in his maintaince of the boundaries, and in the proper use of technique. My self-disclosure was not based on his self-disclosing, but the safety I felt in the treatment. My personal experience with these very different therapists made the importance of boundaries very clear to me. After Lieberman, Yalom & Miles’ (1973) book, encounter groups began to disappear, and the American Psychological Association’s Code of Ethics began to catch up with Freud’s ground rules about 80 years later (Gordon, 1993).

​

Freud (1913) early on established the importance of boundaries while he was creating a “talking cure”. Freud understood both the powerful forces unleashed in the intimacy of therapy, and the therapist’s ability to rationalize countertranference. Freud understood that the relationship with the patient was both real and symbolic. The real relationship had to be one of genuine concern for the patient, and one of professional neutrality and anonymity. That meant no extra therapeutic gratifications outside of the standard therapeutic interventions, for either the therapist or the patient. This made it possible for the symbolic relationship to develop. This symbolic relationship allowed the patient to use the therapist to work through past traumatic relationships. If the therapist acted out, the trauma would be reinforced.

​

Freud feared a superficial psychology of only conscious motives. For example, when a patient gives a gift to the therapist, Freud warned to see beyond the gratitude. The gift may represent a sexual wish to corrupt the relationship. The gift may be a reaction formation, trying to undo guilt for hostile feelings. It can mean any number of things in addition to being a simple gift. The acceptance of a gift could communicate to the patient that the therapy is on a superficial level, and the therapist is unempathic. Empathy doesn’t mean being nice. It’s about accurately reading motives that are unconscious. 
Too rigid a boundary would be characterized by refusing something like Christmas cookies, or refusing to acknowledge a patient in an elevator. Either might cause more injury than insight. Too loose a boundary communicates to the patient that acting out is the better way to reduce tension, as compared to insight.

​

Winnicott (1965) extends the term of boundary from protecting the transference to providing a holding-facilitating environment without which the therapeutic process could not occur. Parents need to provide both a physical and emotional holding of the child that provides a sense of limits and safety. For Winnicott, the analyst’s protective environment, conveyed by strict ground rules, allows the patient to test the limits and then feel secure to work on a level of developmental arrests, rather than focus on superficial symptoms. Patients need to have and test limits to grow. Boundaries help to “child proof” the therapeutic milieu, so one is free to explore repressed and disown parts of one’s unconscious self.

​

Bleger (1967) further extends the concept of boundary to the meta-behavior which forms the background for the contents of therapy. It is a frame around the therapy. If the frame varies, the therapy becomes severely compromised. The frame is perceived only when it changes or breaks. Patients will test this frame repeatedly in order to reenact neurotic interactions of childhood. The steadiness and reasonableness of the frame provides an environment for deep ego development.

​

Langs (1973) further elevates the concept of boundary or frame, from a peripheral protecting the transference, or providing a holding environment, to an essential element in psychotherapy. For Langs the therapist’s very maturity is revealed through the maintenance of the therapeutic frame. Just as a parent may say all the right things to a child, but it is more how the parent behaves that will affect the child’s development. If a therapist makes interpretations about setting limits, but doesn’t do so in the therapy, the interpretations will be hypocritical and ineffective.

​

The secure therapeutic frame is expressed by being with the patient only in a professional setting, starting and stopping sessions on time, seeing the patient at regularly scheduled times, maintaining strict confidentiality as legally possible, no extra therapeutic gratifications such as personal story telling, hugging, gift giving, business deals, socializing, or multiple roles. One should never discuss patients with friends or family. Violations of confidentiality, though unlikely to be discovered by the patient, gives psychotherapy a questionable reputation.

​

From the very beginning of creation of psychotherapy, Freud understood the therapeutic need to protect the transference, since the symbolic relationship is necessary for treatment. Winnicott added the understanding that patients need limits and a sense of safety for ego development. Later analysts such as Bleger and Langs elevated the boundary to the therapeutic frame, which defined the therapist’s maturity, and gave meaning to all the therapeutic interventions. Psychoanalysts have been writing about the importance of boundaries for over 100 years. Psychotherapists, regardless of their theoretical orientation, can learn from them that the proper maintaince of boundaries are necessary for personal growth.

 

References

 

Bleger, H. (1967). Psychoanalysis of the Psychoanalytic Frame. International Journal of Psychoanalysis 48, 511-519.

​

Freud, S (1913). On Beginning the Treatment (Further Recommendations on the Technique of Psychoanalysis, I.). Standard

Edition 12; 121-144.

​

Gordon, R.M. (1993). Ethics Based on Protection of the Transference. Issues in Psycholanalytic Psychology, 15, 2, 95-105.

​

Langs, R. J. (1973). The Technique of Psychoanalytic Psychotherapy, Volume I. New York; Jason Aronson.

​

Back to Publications