Sexual relationships between patient and therapist: Boundary violation or collapse of the therapeutic space?

Abstract

The thesis is that sexual relations between patient and therapist are not best described by the concept of boundary violations. In fact, boundary violations typically do not result in the pain and trauma that is so characteristic of sexual relationships between patient and therapist. It is argued that sexual relationships are fundamentally a different kind of transgression from those that can be captured solely by "boundary violation." It is in the very nature of analytic therapy that the therapist makes a commitment to treat all of the patient's communications as expressions containing meanings that were intended. When a sexual relationship takes place between the analytic pair, that promise is broken, and the analytic space collapses, leading to pain and often trauma. The argument is made that this collapse of the analytic space is the essential quality of the trauma in sexual relations between patient and therapist, not boundary violations. This thesis is illustrated with a case treated in analytic therapy.

Treating clients who have been sexually abused by a therapist.

“…For clients, this fundamental betrayal of the therapeutic process calls into question the safety and validity of all of the relational aspects of therapy, which constitute such a large percentage of what makes therapy work, especially with this population. Unless the subsequent therapist is prepared to openly discuss the matter of trust, and more specifically, that there is no reason why the client should have it or for the new therapist to expect it and why the new therapist is willing to patiently earn it, then the subsequent therapy is unlikely to go well, or last long (Luepker, 1990a;Pope, 1994;Summers, 2017). Luepker (1990a) suggested discussing the adaptive nature of distrust after being harmed and how it makes sense that this experience would be present in follow-up treatment, which is consistent with how the issue of trust is addressed in trauma treatment more broadly, especially with survivors of complex trauma (e.g., Courtois & Ford, 2013).…”

Verliebtheitsgefühle und damit assoziierte Phänomene gegenüber PatientInnen in der Psychotherapie

“…Barnett, 2014) oder es handelt sich um Falldarstellungen und Reflexionen (z. B. Breger, 2014;Celenza, 2010Celenza, , 2017Färber, 2013;Gelso et al, 2014;Hayes, 2014;Kuchuck, 2013;Pizer, 2017;Summers, 2017 Erklärungsmuster: Bezüglich der Ermittlung von Erklärungsmustern wurden die Therapierenden gebeten, eine konkrete Situation zu Verliebtheitsgefühlen gegenüber der Klientel zu schildern sowie anhand einer Mehrfachantwortauswahl Gründe für das Aufkommen solcher Empfindungen zu selektieren und/oder eigene zu nennen. Gemäss den qualitativen Analysen der Antworten äusserten sich die Therapierenden dazu, was sie unter Verliebtheitsgefühlen im therapeutischen Setting verstehen (Konzeption), wie sich ihnen Verliebtheitsgefühle gegenüber der Klientel gezeigt haben (Manifestation) und weshalb diese Empfindungen entstehen können (Ursachenfaktoren) oder verhindert werden (Schutzfaktoren).…”

When the frame breaks: Ripple effects of sexual boundary violations.

“…The analytic relationship is inherently asymmetrical, and the analyst holds the main responsibility for adhering to ethical guidelines (Gabbard, 2016; Summers, in press). The analyst is responsible for restoring a broken frame as best as he or she can.…”