As licensed professionals, we must be concerned with boundary violations. But, are enforcement agencies going too far? In this guest article, Bryant Welch, JD, PhD, explores conflicting trends in ethical enforcement and contemporary psychoanalytic treatment.

ETHICAL AND LICENSURE PITFALLS FOR THE RELATIONAL PSYCHOANALYST

Over the last fifteen years, I have consulted with many mental health professionals struggling with professional issues before state licensing boards and/or the APA Ethics committee. Enough of these cases have involved relational psychoanalysts accused of boundary violations that I think the issue of boundary problems in the contemporary practice of psychoanalysis merits a word of caution.

The word "boundary" in psychoanalysis contains so many elements that one's head spins when trying to define it. At a minimum, it refers to the appropriate distance between therapist and patient, the appropriate division of labor within the relationship, and the nature of the setting in which the treatment takes place. In psychology and other professions, the term boundary also borrows heavily from the legal concept of fiduciary duty. It is a term we use to convey the absolute priority that we must give to patients' interests over our own interests. For example, one use of the term "boundary violation" refers to the therapist's usurping the treatment relationship for the therapist's gratification rather than for the patient's growth, be it sexually, financially, or in some other way.

More recently, however, perhaps beginning with the work of Winnicott, the term "boundary" is also relevant to the early intersubjective relationship between mother and child, or in the treatment, between the therapist and the patient. Paradoxically, it can be construed as a somewhat boundary-less state or, more precisely, one in which the boundary between therapist and patient is suspended. The therapist and patient may, as the mother and child do in early infancy, enter into a state of such attunement that it is as if the same boundary incorporates both of them. At the same time, the lines of separation are muted, thereby creating a feeling of safety in the infant or the patient by the holding mother or therapist. Read on ...

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