SUMMARYHarm in talking therapies, and in healthcare professionals’ relationships with patients generally, has received little attention in comparison with harm by medication and other treatments. There has been little research into causes, types and effects. Professionals behave as if it does not happen and tend to react defensively to complaints. We believe that it is essential for professionals to understand the potential for harm and evaluate their actions in order to make them safer. This article defines harm in the therapeutic context, discusses its prevalence and then focuses on adverse idealising transference: the adverse effects that may arise when a patient transfers idealising feelings onto the professional.LEARNING OBJECTIVES•Develop a greater understanding of the problem of harm in psychotherapy•Be aware of adverse idealising transference and its possible harmful implications•Be aware of therapist actions that may encourage the development of an adverse idealising transferenceDECLARATION OF INTERESTNone.

SUMMARYSexual boundary violations by healthcare professionals is a subject that has largely been ignored in the UK. There has been little research into the field. It is rarely taught on professional training courses and practitioners appear to know very little about it. The history of sexual boundary violations is littered with failures to notice, failures to report and inadequate justice for victims and perpetrators alike. Perpetrators are commonly assumed to be predators. Given the many widely reported recent events in our media of both predatory and other sexual offenders, we believe it is timely for all healthcare and other professions working with vulnerable people to take the problem seriously, to provide appropriate services for victims, evaluation and assessment of perpetrators, and sanctions that fit the crime in order to regain public trust.LEARNING OBJECTIVES•Develop greater understanding of the problem of sexual boundary violations by professionals•Be able to manage the care of a patient who has been the victim of a sexual boundary violation•Understand factors in professionals that may lead to a sexual boundary violationDECLARATION OF INTERESTNone.

This paper examines three instances of enactment, which occurred in the early stages of a thrice‐weekly therapy. The emphasis is on both the origins and consequences of the therapist's contribution. Particular attention is paid to the unconscious nature of enactment, as a phenomenon that can precipitate both a refusal and an actualization of the patient's transference; the former, in this case, leading to further acting out and the latter to malignant regression.