From its start, psychoanalysis has been enmeshed in the uncertainties and problematics of boundaries, boundary crossings and boundary violations. From a socio-cultural perspective, the very introduction of psychoanalysis as a theory and therapeutic practice, one that attempts to uncover truths that we all try so hard to hide from ourselves and that speaks openly about and calls attention to sexuality, especially infantile sexuality, can be seen as crossing a line of ‘propriety’ marked by denial that had existed in upper middle class, bourgeois society and the Viennese medical establishment of Freud's time. Despite the changes brought about by the sexual revolution in the West, I would insist that we are still a culture prone to the avoidance of truth, deeply and habitually steeped in the practice of denial.1 Add to that the possibilities—often the inevitability—of transference love (Freud 1915) and the impulses to action mobilized by the treatment in both analyst and patient (Freud 1914), coupled with the many instances of analyst-patient romantic involvement that entangled so many of the early pioneers and have continued to confound our profession through the years, and it is difficult not to wonder if psychoanalysis isn't inherently tied to the mobilization of something transgressive that exists within us all.
Unfortunately, the list of prominent analysts, leaders of our field, that have been involved in boundary problems has been far too long and disheartening. There are great opportunities in the potential therapeutic gains of analysis to change lives and alleviate suffering, but also terrible risks. Freud (1915) acknowledged this early on, when he said that there was a
“serious danger of this therapeutic method. The psycho-analyst knows that he is working with highly explosive forces and that he
Page 1needs to proceed with as much caution and conscientiousness as a chemist. But when have chemists ever been forbidden, because of the danger, from handling explosive substances, which are indispensable, on account of their effects?” (pp. 170–171)
As with so many things pertaining to the emotions and psychic life, it is sometimes difficult to find a language that properly takes all cases and nuances into consideration. Writing from the perspective that a sexual relationship between analyst/therapist and patient is an ethical boundary violation, I will use this designation of boundary violation as a shorthand to refer to analyst/therapist pairs who become physically, romantically and/or sexually involved. In doing so, I wish to emphasize that I am fully aware that each participant is driven by their own unconscious wishes and needs; that the circumstances of each couple are unique and different; that there are many different kinds and levels of feelings that can be involved in either member of the pair; and that there are different degrees of ‘abuse’, ‘complicity,’ and ‘damage’ that can be present in the situation for either party.
Through chance and circumstance, over the past years I have had many opportunities to join with colleagues nationally and internationally to study the impact of various types of boundary crossings and boundary violations. Some of the most significant and sometimes violently destructive of these have been sexual boundary violations of patients by analysts and therapists. In the company of such outstanding colleagues such as Marvin Margolis, Glen Gabbard, and Malkah Notman, I have participated in study groups where we not only attempted to understand the psychology of different couples, but also examined the impact of these events on the analytic Society, its candidates and members, and the general public's opinion of and relation to psychoanalysis as a whole. An important component of this work was assessing the possibilities of, and possible mechanisms towards, remediation and repair, not only in regard to the involved patient and analyst, but collaterally throughout the Society and its training components and within the public's attitude to our profession.
Some of my own questions, and the hypotheses and conclusions I have come to, have been expressed elsewhere.2 Three issues that I would like to reiterate are these:
* Looked at from the psychological perspective of the boundary violating analyst/therapist, the physical/sexual contact with the patient is also—sometimes predominantly—a narcissistic appropriation of the object, often in the service of the unconscious need to stabilize a damaged or fragmenting sense of self.
* Although it must remain a speculation, because few boundary violating analysts/therapists labelled as predators have been encountered in my studies, I suspect that what drives their actions is a primitive form of narcissistic object use in the service of unconscious preservation of their psychic sense of self.3 That they, too, are ‘emotionally needy,’ like the ‘love sick’ analyst/therapist, whose unconscious aim is the rescue of a depressive object needed to be shored up for the sake of their own psychic survival. The difference is that the predatory boundary violators are looking more for enlivening sensation sources than psychic objects. They may be more unconsciously interested in the vampire-like self-sustaining appropriation of the object as sensation source for their own survival needs, than in acting out a more unconscious, object relational scenario of self-preservation through object reparation.
* Although it is not clear that there is a causal connection or, if there is one, in which direction the arrow of causality flows, there seems to be an unexpectedly high correlation between sexual boundary violations and pre-existing organizational difficulties within the analytic Society in which they occur. So much so, that I would caution any colleagues, who are investigating or dealing with a sexual boundary violation in a psychoanalytic Society or Institute, to also consider and examine the institutional culture in which it has taken place. I am not suggesting that there is always a clear connection, but narcissistic appropriation, convoying, denial of problematic behavior, nepotism, favoritism, callous power politics, and other irregularities have often been uncovered in the on-going life of the affected Society or Institute.
Levine 2010a, 2010b, Levine and Yanoff 2004.
To consider an analogous metaphor, Winnicott (1954-55) spoke of an early stage of infancy, before the sense of a separate object was available to the infant, as ‘cupboard love’ and ‘ruthless pre-concern.’
In assembling this issue, I attempted to go beyond the more obvious and immediate problem of sexual boundary violations and to include a wide international cast of authors. I gave each author contacted carte blanche to write about boundaries, boundary crossings, boundary violations and their vicissitudes in the clinical or educational situation, in our institutions and organizations and in the culture at large. I thought that the latter might especially strike European and Latin American colleagues as relevant, given the recent problems of mass migration and cultural immigration/diversity. Not surprisingly, however, most chose to focus on topics closely related to the analytic consulting room.
We begin with an historical review of sexual boundary violations written by Jeffrey Berman and the late Paul Mosher. It covers a good deal of ground and offers readers access to many of the key references on the subject of sexual boundary violations. Next is an essay by Andrea Celenza, who is one of the more knowledgeable contributors to the subject of sexual boundary violations in the North American context. She examines the problem in the light of the #MeToo movement in Western culture, offering an historical perspective on North American psycho-analysis' coming to terms with the reality of sexual boundary violations. Among her conclusions is the view that “most male therapist/transgressors are one-time offenders who exploit one patient, usually over a period of time, where the … conscious experience is one of a mutual rescue fantasy and an idealized romantic love.” She adds, “the tragic truth is that these victim/patients usually do represent an unconscious meaningful other to the therapist/analyst in very particular ways… These women are not objectified and interchangeable (as they are with psychopathic predation) but are very specific transference objects to the therapist, harkening back to unresolved childhood internalized imagoes.”
Celenza also notes that “Institutional group-related contributions from various areas of institutional life and its culture can unwittingly encourage enactments of sexual boundary violations… [G]roup effects and political dynamics (corruption, systemic abuses of power, cover-ups, harsh training experiences, etc.) … can affect individuals and play a part in the motivational configuration eventuating in sexual boundary violations.”
Guillermo Bodner examines transgressions from the perspective of the metapsychology of the frame, noting that although “it is impossible for
an analysis to pass without some alterations of the setting (schedule, payments, etc.)… it is important to differentiate the necessary flexibility from the transgressions that make analysis impossible.” It is a matter of how we build contact with the patient and develop intersubjective, unconscious to unconscious, capacities for the creation of “thirdness,” a point of reference outside of the dyad that allows us to view psychic reality and internal mental space and functioning. “The paradox of psychoanalysis is that it mobilizes real forces, impulses, desires, inhibitions, to be treated as fantasies, as psychic productions… this paradox always exists and, furthermore, without it there would be no analysis. But … the fact that real impulses or feelings are treated as psychic products implies a permanent risk of confusion or frustration for both the patient and the analyst.” In the face of this, “it is necessary to underline [to ourselves and sometimes to our patients] that the only help we can offer to our patients is through the analysis of the conflicts and not through the gratification of the impulses, much less in collusion with ours…[S]ome analysts distort the notion of aid, when they do not clearly limit it to the rigorous application of analytic resources.”
Readers who are not familiar with Viviane Chetrit-Vatine's (2014) writing about ethical seduction and matricial space are in for a special treat when they encounter her essay. Drawing on the writings of Laplanche and the philosopher Levinas, she proposes that analysis is built on the foundation of the analyst's ethics, “an ethics of emotionally loaded asymmetric responsibility towards the other … an ethics of truth.” This emerges in her formulation of the matricial space transference, which is a core element in what makes us human and is the source of the caretaking impulses evoked in each of us at the sight of the newborn baby. This transference is an expected pre-conception of every patient and should be met with a sublimated response of “ethical passion [as the analyst] is the one able to be responsible for the other, the one who is or has in themself a matricial space for the other.” How to do this in a way that maintains a symbolic, analytic position rather than becoming caught up in concrete attempts of provision at the level of the actual or the Real is the challenge and often the problem.
Heribert Blass, current President of the European Psychoanalytic Federation, closely focuses on the confusion and disorders of thinking that may accompany and lead to boundary crossings and boundary
violations, suggesting that when seen from this perspective, individual and institutional boundary problems may manifest themselves differently but arise from a common core of disturbance. Referencing Ogden and Bion, he reminds us of the “careful handling of psychoanalytic thinking [needed] to preserve the ‘waking dream thought’ and dreaming dimension of experience … [as a guide to] the clinical situation.” He cautions that “Abandonment and negation of the fantasy character of the analytic relationship” can lead to “a serious, usually destructive, misconception of the psychoanalytic process with considerably damaging effects for the [patient].” Blass applies this caution to claims of needing to go outside of the analytic process in the name of introducing the analyst's ‘authenticity,’ noting that this may lead to actions that are apt to be confusing or misguided for both analyst and patient.
As an editorial aside, I always wonder what can be more ‘authentic’ than an analyst trying to make analytic sense of what is happening in a session? To my mind, any feeling of inauthenticity should be examined from the perspectives of possible communication via unconscious projective communication from the patient, the analyst's own unconscious countertransference propensities and dynamics, and a limitation of the analyst's preferred conscious and unconscious theories to be broad enough to make analytic sense and meaning of whatever is going on in the process and within the unconscious minds of each participant.
Charles Levin examines the potential contribution to boundary problems that may stem from the social organization of our profession, suggesting that “we fail to recognize that transgressors continue to be psychological members of our community, even in their ghostly absence, after we have ostracized them; [and] we resist creating a justice process that includes the whole community; one that establishes a space for the analytic group to assume more direct responsibility and accountability.”
Readers will no doubt debate whether Levin's plea is too idealistic, but his call to reconsider the social structures of our organizations and the nature and direction of their responses should be of great interest: “Psychoanalysis needs to develop a process in which transgressors have a realistic opportunity to account for themselves, not only to the affected patient and family, but also to colleagues.”
One of the most important boundaries in psychoanalysis, although not often thought of in those terms, are the boundaries that surround and help define the analytic setting. It has often been remarked that, if it goes well, psychoanalysis, with its processes of free association, use of the couch, focus on the unconscious, psychic reality and the internal world, etc., is unlike anything else that a patient is likely to encounter or experience in their life. The discourse and dialogue that takes place within the analytic space is truly unique. How might it be affected by modifications in the traditional setting? While the latter has evolved and undergone changes in recent years—shuttle analysis, concentrated sessions, tele-analysis—none were as unexpected, precipitous, and potentially tumultuous as the move to a virtual setting imposed upon us by the Covid pandemic.
Anna Migliozzi reflects upon the impact of this change in her child analytic practice from a perspective drawn from the work of Ferrari (2004) and Lombardi (2015, 2017), asking us to consider: Where is psychoanalysis at home? She writes that “the body exists in space, as Freud pointed out, and as a result its spatiality can function as a sort of house where the subject lives, which can help in learning to bear the loss of the customary context of the analyst's office and the physical presence of the analyst, when the pandemic has swept away these familiar qualities.”
Migliozzi's in-presence clinical work with Sara, a young child with significant difficulties in separation (inability to sleep alone) and bodily control (bed-wetting, anal masturbation), was interrupted by the pandemic. She describes how she was able, despite the change in setting, to focus on the patient's internal mind-body relationship and her own.4 “[T]he physical distance imposed by tele-analysis can stimulate the patient to recognize and develop the internal link with their own bodily reality, enhancing the working through of realistic space-time parameters and of the separation from the analyst.”
Migliozzi offers us the further thought that perhaps “the current emphasis on object-relationship theories and intersubjectivity has contributed
For further discussions and descriptions of the impact of the change in setting necessitated by the Covid pandemic crisis, see de Staal A., and Levine, H.B., eds. 2021.
to a disproportionate shift in the axis of reference of the analytic working through onto the plane of external relationships, thus causing the loss of the original emphasis of psychoanalysis on the internal working through and the relationship of the patient with herself.” And adds, “It might be worth asking if we aren't in danger of throwing out the baby with the bathwater by disparaging a priori the internal relationship as old-fashioned one-person psychology.”
Marina Altmann shifts our focus to the boundaries between intrapsychic and relational conflicts, employing the concept of vinculo (link). In doing so, she brings forward and enlivens metapsychological differences such as presentation vs. representation, subjectivity vs. intersubjectivity and argues that “the internal world, the world of others, and the social world are three distinct entities that are alien to each other.” Each makes its own contribution to what we call ‘subjectivity.’ In her clinical illustration and discussion of infant development and research, she carefully elucidates the difference between internal conflicts and attachment/bonding conflicts and the contributions made to these by intrapsychic, intrasubjective, and intersubjective areas.
Our final contributor, Jorge Ahumda, examines boundaries, truth and the problems that arise living in these post-modern, ‘post-truth times’ of relativism and social constructionism taken to their extremes. His essay begins with the world views of the ancient Greeks, touches upon evolution and ethology, the age of Media in western civilization and the impact of Romanticism, the stated goal of which, Ahumada argues, is “an overall dismissal of all boundaries and all continuities, a spiteful rejection of the received and the given.” He connects this with our own Culture of Narcissism, and the fetish capitalism that encourages the search for—and the ‘realistic’ (sic!) possibility of—the recovery of a lost Eden. This insistence on Utopia “fosters blind protagonisms, be they domestic, intellectual or political, readily exploitable by populisms of all brands. Utopia abolishes the ties to everyday common sense, and then boundaries are up for grabs, in a pervasive feeling that … anarchism will be an 'eternal springtime.”
As a final thought, I would like to close with an observation by Bion (1970), who wrote extensively of the inherent human tendency, common to analysts as well as analysands, to turn away from and subvert, even
hate, the truths that may emerge to challenge and confront us in the course of a psychoanalysis. Although Bion was not talking specifically about boundary crossings and boundary violations here, what he has to say should serve as a caution to all of us and give us pause:
“I have rarely failed to experience hatred of psycho-analysis and its reciprocal sexualization of psycho-analysis. These are part of a constant conjunction… [T]he human animal has not ceased to be persecuted by his mind and the thoughts usually associated with it—whatever their origin may be. Therefore I do not expect any psycho-analysis properly done to escape the odium inseparable from the mind. Refuge is sure to be sought in mindlessness, sexualization, acting-out, and degrees of stupor.” (p. 126)
Caveat emptor!