The violation of the boundaries2 in the psychoanalytic process refers to the rupture of the framework that makes the operation of the analysis feasible. The framing provides the conditions for the analyst and the patient to establish a helpful relation for the exploration, understanding and treatment of the conditions for which the patient consults.
But at the same time we must keep in mind what Gabbard wrote:
The psychoanalytic frame is another term that has long bothered me since it conjures up an image of a rigid picture frame. The boundaries of the frame are anything but rigid in an analytic process, where the analyst is repeatedly negotiating and adjusting the frame to the unique needs and characteristics of the patient. (Gabbard, 2016)
The analytical process and the setting in which it develops, mobilizes defences and anxieties in the patient, but also in the analyst. A careful handling of these processes is essential to protect the favourable course of the treatment and to avoid situations that interfere with the analytical process and in some cases make it impossible, provoking its interruption.
In order not to focus on a merely phenomenological description, I consider it necessary to recall some concepts, developed by psychoanalysts from different schools, in order to think through on a metapsychological basis the question of the limits and their violation.
The agreement between the patient and the analyst regarding the setting does not end with the formulation of the rules and their acceptance. This agreement is made not only prior to the beginning of the analysis; it is part of the analysis itself, because the external rules (schedules, frequency, use or not of the couch, fees) influence and are influenced
Training analyst, Spanish Psychoanalytic Society (IPA)
For a detailed revision of both terms (boundaries and violations), see Gabbard (2016)
by unconscious “internal” configurations. So I consider establishing the frame as a continuing process, an essential and ongoing part of the analytic process.
Once the setting is accepted and the analysis begins, some crossings of boundaries are unavoidable for both patient and analyst. But these situations must be understood and, if possible, interpreted and worked through. At this point it is important to differentiate between this kind of crossing and clear transgressions or violations of boundaries, which allow no space for analytic inquiry.
An important part of the relationship between patient and analyst is to find a way to apply the typical model in each case, respecting the fundamental rules; the patient's agreement should not be an act of submission. On the contrary, it requires time and elaboration for the patient to incorporate, through his/her experience, the need to have this framework, both in its role as a facilitator of unconscious communications, and as a protector against ruptures that can lead to breakdown. The agreements reached in the initial interviews must be re-analyzed so that the patient can be an active subject in the constitution and maintenance of the framework.
The classical frame was established over time and by the critical review of complex situations that arose at the beginning of psychoanalytic practice. The analytical technique was developed at the same time as the knowledge of its object of study: the unconscious and its manifestations.
In the early days, the knowledge that was acquired later about the strength of the drives and anxieties that are mobilized in the treatment was not known. The dynamics of transference and countertransference were a relatively late finding, products of the critical analysis of the treatments, their successes, and their failures. The frame is not, therefore, an abstract starting point.
Some examples, because they were published, are well known, such as Breuer with Anna O, or Freud with Dora; but there are many others, unpublished because psychoanalysis developed in fairly narrow social groups, which favoured interference between the analytic relationship and other links, which facilitated confusion or therapeutic failure.
In my opinion, it is not a “dark history of psychoanalysis,” but rather a time of learning, unavoidable and necessary, which provided the empirical basis from which to reflect and theorize about what happened and learn from criticism.
Psychoanalysis is a practice that analyzes its failures and tries to build a way of approach that favours the free association of the patient and the floating attention of the analyst. It is a way to approach Freud's postulate of an “unconscious to unconscious” communication (which constitutes another “ideal model”).
The idea of limit is related to a space, and this concept was coined from Freud's formulations in his letters to Fliess, his essay on dreams, and developed further throughout his work. Some spatial sketches were already drawn in his Project.
These spatial schemes became increasingly complex, when Freud described the incorporation of external objects in mourning processes (Freud, 1917) to configure an “internal world,” occupied by objects and their dynamics, and developed further with the so-called “second topography” (Structural Theory). This conception of the unconscious psyche was expanded in the elaborations of Melanie Klein and other authors.
Internal space results from the more or less distorted introjection of external real objects and their reciprocal relationships. Each individual unconsciously builds up their basic structure of personality. The characteristics of each subject arise both from constitutional influences and from other environmental factors, such as identifications, object relations, and so on.
Internal space has its roots in the real, external space that the child experiences with his earliest objects, such as the mother's breast. This real space can be unconsciously recognized or denied, according to the conscious and unconscious features of the mother-baby relationship. From the real and fantasized aspects of this experience, the child will introject an internal space, which favours its development or leads to various forms of disturbances.
The formation of internal space is a challenging evolutionary process that is sometimes successful, but sometimes fails. In a development of
the Kleinian theory, Britton (1998) describes how in “normal development the perception by the child of the parents' coming together independently of him unites his psychic world. It creates one world in which different object relationships can occur, rather than monadic serial worlds each with its own object relationship” (p. 41). In other words, the integration of the internal world depends on the adequate resolution of previous phases, which allow the subject to tolerate the experience of a primal scene in which he/she does not participate; tolerance of this exclusion opens the way to a separate development.
With some modifications, this space parallels that described by Winnicott (1971) who called it a “potential” or “transitional” space in his experiences with children's play. These ideas are related to the potential space recounted by Ogden (1985). Ogden writes: “Perhaps the most important and at the same time most elusive of the ideas introduced by Donald Winnicott is the concept of potential space. Potential space is the general term Winnicott used to refer to an intermediate area of experiencing that lies between fantasy and reality. Specific forms of potential space include the play space, the area of the transitional object and phenomena, the analytic space, the area of cultural experience, and the area of creativity.” Of course, these notions also apply to the analytic relationship.
For Winnicott, “Potential space… is the hypothetical area that exists (but cannot exist) between the baby and the object (mother or part of mother) during the phase of the repudiation of the object as not-me, that is, at the end of being merged in with the object (Winnicott, 1971b, p. 107). This kind of link in the potential space favours the appearance of paradoxes (me-not me, internal reality/external reality) that the analyst tolerates without trying to resolve.
Just as the structure of the internal world is partially conditioned by the links with objects, the real links will also be influenced by unconscious structures and dynamics. Our mode of relationship with others is marked by the unconscious in combination and conflict with rational thinking.
The organization of the analytical setting must offer a framework of the greatest possible neutrality in which the patient can project his internal world, in close but asymmetric relationship with that of the analyst. In
this framework, the patterns of the analysand's internal world are channelled onto the analyst through transference and can be observed and, when possible, interpreted. The analyst's interventions are marked by his countertransference, which makes the analysis exposed to unconscious tensions on both sides.
The relative stability of the frame is a helpful means for observing the oscillations in the transference and countertransference relationship, and provides a means of containment, understanding, and interpretation. Respect for limits does not mean a rigid frame. But it is only from a clear definition of the limits that deviations can be observed and given meaning. It is impossible for an analysis to pass without some alterations of the setting (schedule, payments, etc.). But it is important to differentiate the necessary flexibility from the transgressions that make the analysis impossible.
These limits are intended to protect the analysis. Therefore, the analyst and the patient must strictly limit their relationship to analysis: no ties of any other kind should be allowed. Obviously, these limits rule out any physical contact or sexual relationship. These considerations are not obvious because analysis, by its very nature, mobilizes unconscious libidinal or aggressive impulses that powerfully influence the field of transference and countertransference. These impulses may go unnoticed by the analyst who might, only after they have occurred, become aware of them.
A different situation would be if the patient or analyst indulges in the conscious performance of these impulses due to unmanageable demands for satisfaction or with rational justifications that can be argued. The spontaneous expression of fantasies, their containment, and their working through, is made possible as long as analytical limits are maintained. Within this space, impulses can be represented and achieve symbolization and thought. This process facilitates overcoming pathological defences and creating new and more satisfying ways to manage and contain anxieties.
This potential space is not rigid or constant but is subject to changes that expand or reduce its operation. At this point it may be interesting to recall Britton's contribution of a “post-depressive position.” On the one hand, he no longer considers the classic depressive position as the final
goal of development. On the other, he warns that each new experience may imply a movement from D to Ps, which implies minor disruptions inherent to normal functioning. The move to Ps stimulates a recovery of D, but it is a new D, incorporating the new experience and fuelling mental growth. This movement can facilitate or impede either the capacity for symbolization or the tendency to concretization. An oscillation between these extremes is inevitably present in all analysis and therefore distinguishing necessary oscillations from violation of the limits is not easy.
Bion paid special attention to the processes that underlie thought formation. He started from clinical experience with patients unable to think; personalities whose psychic structure leads them to use other means of communication, which go with or replace verbalization and symbolization. The analyst would have to grasp the meanings of this ‘other’ communication in the session if he or she has the appropriate sensitivity, experience, theoretical and countertransference knowledge, and containment capacity. However, there are frequent situations in which only after the session or during supervision can one become aware of these processes.
In short, there are patients who cannot use their minds to think, but evacuate their impulses onto the object, that is, onto the analyst in the session. Bion observed seriously ill patients, who may feel that the analyst's interpretation stands for a rejection of their projections, leading to a vicious cycle of malignant misunderstandings. These observations are important because they mark moments in all analyses during which the difference between fantasy and reality is reduced or collapsed. They may imply a permanent or transitory inability of the analyst to recognize the only forms of communication available to a patient at a critical moment during the analysis. This inability can lead the analyst to confuse the meaning of the patient's projections, which transfers to the analyst his inability to discern reality from fantasy. In those moments, the analyst can take these projections as concrete elements that drive “action.”
Bion described a function of primary objects, by which the infant's projections are transformed into alpha elements, suitable for storing, dreaming, and symbolizing. But he also described that, under the effect of some drives such as envy, an anti-alpha function is set in motion, which
produces beta elements not suitable for symbolization and thought, but rather promotes their expulsion, by mechanisms such as projective identification.
Ogden (1985) describes how the discourse of some patients may reflect “imitative deeds, words, behaviours and actions tainted with ego and superego traces with the interference of secondary process, especially rational thinking that may be regarded as originating from anti alpha-function…” (p. 49). “Clinically, a lack of resonance, depth, associations, being stuck with manifest content, are good pointers to a move from the symbolic to concretization (beta activity).” (Abel-Hirsch, N. 2016)
The boundaries of the psychoanalytic framework represent distinct zones of the unconscious that protect us from psychotic intrusion or other serious disturbances. Therefore, the notion of limit in the analytic frame implies the border that prevents the uncontrolled irruption of primitive anxieties in the form of psychotic manifestations. The notion of “uncontrolled” must be underscored because the irruption of the psychotic functioning can be unavoidable at certain moments of an analysis. But it is crucial to differentiate the primitive or psychotic manifestations, which occur under the protective restrictions of the frame, from those that are triggered by the systematic violation of the frame.
These lengthy considerations are intended to suggest that the setting is not a protective shield against possible violations. But a careful scrutiny of the frame and its oscillations during the session offers us important signals that must be examined in order not to act instead of analyse.
It is important to bear in mind that the responsibilities of the patient and the analyst are not the same. It is part of the asymmetric relationship. We can understand the unconscious dynamics that underlie these violations, but the analyst must manage his conflicts in such a way that they do not affect the analysand or the transference field. While the patient can freely express his/her impulses and fantasies, the analyst is obliged to protect the frame through interpretations and a careful inquiry of his countertransference.
The violation of the frame tolerated or encouraged by the analyst (giving in to the patient's fantasies and projections or to his own impulses) is
traumatic for the patient (and often also for the psychoanalyst) despite the immediate gratifications obtained. The breakdown of the protective framework and its outcome in harmful actions has the meaning of incest when a parental figure from whom protection and help is expected becomes the agent of abuse. The transgressions trigger a disturbance in which the patient, like the child, must bear the burden of “containing” the analyst/parent, inverting the normal organization, or colluding with the inevitable catastrophic consequences.
In the models that have been developed from better attention to the role of the analyst, his countertransference and the effects of his interpretations, the concept of ‘the third’ stands out among others. It is a common point to many theoretical and technical developments.
J. Benjamin states: “The concept of the third means a wide variety of things to different thinkers, and has been used to refer to the profession, the community, the theory one works with—anything one holds in mind that creates another point of reference outside the dyad (Aron 1999; ; Crastnopol 1999). My interest is not in which “thing” we use, but in the process of creating thirdness—that is, in how we build relational systems and how we develop the intersubjective capacities for such co-creation. I think in terms of thirdness as a quality or experience of intersubjective relatedness that has as its correlate a certain kind of internal mental space; it is closely related to Winnicott's idea of potential or transitional space. (Benjamin, 2004).
In the present discussion, the use of the third object is to be distinguished rigorously from the intersubjective third or symbolic third for there is no recognition of a separate subjectivity in the mind of the transgressor. Rather, the third is used, as in Benjamin's (2004) “negative third,” in complementarity or doer-done to relations, as Ogden's (1994) subjugating third, or the way Aron (1999), and Greenberg (1999) use the concept, as representative of the analytic community.
Considering the causes and remedies for the breakdown of recognition , and the way in which breakdown and renewal alternate in the psychoanalytic process , led me to formulate the contrast between the twoness of complementarity and the potential space of thirdness. In the complementary structure, dependency
becomes coercive; and indeed, coercive dependence that draws each into the orbit of the other's scaling reactivity is a salient characteristic of the impasse. Conflict cannot be processed, observed, held, mediated, or played with. Instead, it emerges at the procedural level as an unresolved opposition between us, even tit for tat, based on each partner's use of splitting (Benjamin, 2004).
The paradoxical aspect of the frame is well expressed by Celenza : “In these ways, the treatment setting is a complex structure that uniquely instantiates several contradictions. Especially interesting is the way the treatment setting combines these two contradictory axes: the axis of equality and mutuality (a “we're in this together” type of experience) along with the contradictory and imbalanced focus on the analysand (a “you are in this alone” type of experience).” This is reminiscent of Winnicott's idea of the transitional space paradoxes, mentioned above.
With what has been said so far, it seems clear that neither personal analysis, nor theoretical and clinical training, offer a guarantee of safety against possible violations of the limits. As Gabbard points out, “Anyone who has studied this phenomenon in any detail soon learns the disconcerting truth: We are all potentially vulnerable to various kinds of boundary transgressions, including sexual ones, with our patients” (Celenza, 2007; Gabbard, 1994).
It is frequent and understandable that the desire to “help the patient” is at the basis of our choice of psychoanalysis as a profession. But it is necessary to underline 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. In my opinion, some analysts distort the notion of aid, when they do not clearly limit it to the rigorous application of analytic resources.
Containment of the patient's demands is a difficult aspect to handle. There are regressive demands that reject interpretations or analytical intervention and demand satisfaction from the real. This can lead the analyst to “act in aid of the patient” by colluding with such demands, which may be sexual or have strong erotic components.
It would be a mistake to think that the analyst acquires the analytic function in his training and retains it forever. Analytical work with many patients, while reinforcing our experience and knowledge, also produces “wear and tear.” This fact affects our willingness to start each session as a new experience, open to recognize what we are living, in this singular moment, without just applying what we know that may not even be relevant to this specific moment.
The confidence in the psychoanalytic method is necessary to handle the vicissitudes of the transference relationship. It is not an uncritical submission to classical technique, but a deep-seated introjection of theory and technique, which allows us to adapt to each singular case that we take in treatment. The alternative would be to condemn our professional practice to a sterilizing dogmatism.
At the same time, this framing strives to protect the analyst and the patient from dangerous acts that seriously interfere with the analysis, causing situations in which action replaces analytical reflection or thwarts its continuation. The transgression of the psychoanalytic framework during a treatment can be a serious situation, leading to severe consequences for the patient, for his family and also for the psychoanalyst; it also affects the institution and the profession in general.
The transgression of limits is something that occurs in social life, usually associated with power relations, work hierarchy, physical, or “spiritual” power, as in the religious sphere, and other environments of dependency. The paradox of psychoanalysis is that it mobilizes real forces, impulses, desires, inhibitions, to be treated as fantasies, as psychic productions and to hypothesize their meaning as psychic, their unconscious motivations and aims. This paradox always exists and, furthermore, without it there would be no analysis. But at the same time, 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.
The analyst's role implies not ignoring the patient's objective and subjective realities, but at the same time not staying trapped in them. It is a permanent movement in every analysis. On the patient's side, it means accepting the frustration that their realities are transferred to another
stage (their internal world, the transference relationship) instead of being satisfied, as they demand, in the real world. On the side of the analyst, it means assuming this role of analyzing without satisfying the instinctual demands, as already suggested by Freud: psychoanalysis can only be carried out in a climate of deprivation.
Transgression within the frame of a psychoanalytic treatment has special connotations because the setting and the dynamics of the treatment stimulate deep and real impulses, both in the patient and in the analyst, of such intensity that they lead to actions instead of analysis and mental growth. What is specific about transgressions in psychoanalysis is that not only both subjectivities are mobilized, but that these movements involve the deepest layers of the unconscious that are repressed or split off.
For many years, analysts of different tendencies have questioned the value of concepts such as neutrality, objectivity, the attitude of the analyst with his countertransference, self-disclosure, and so on. These theoretical questions have been widely debated. Some formulations from the theory of technique have been seen differently in the light of more than a century of clinical experience. These debates arose as more attention was paid to the role of the analyst in the treatment, his subjective involvement, his psychic organization, or the unresolved points of his personality.
But they also have a practical or clinical aspect, to the extent that their modifications may imply changes in the setting that facilitate, beyond the analyst's intentions, actions that distort the analytic process and transform the transference link into a painful repetition of pathological relationships in the patient's history. And the analyst could be encouraged to play a role in the scenario of the countertransference transference, in which the patient and the analyst put into action primitive objects of their respective internal worlds.
Besides major boundary violations we can also consider it a rupture if analyst and analysand only think in terms of the real world, letting aside the apprehension of unconscious phantasies, defences and other mechanisms.
The role of the third object, already pointed out above, is also a dynamic process, exposed to the vicissitudes of unconscious dynamics. J.
Benjamin (2004) points out: “Thus, I consider it crucial not to reify the third, but to consider it primarily as a principle, function, or relationship, rather than as a “thing” in the way that theory or rules of technique are things. My aim is to distinguish it from superego maxims or ideals that the analyst holds onto with her ego, often clutching them as a drowning person clutches a straw. For in the space of thirdness, we are not holding onto a third; we are, in Ghent's (1990) felicitous usage, surrendering to it.” The question remains from my point of view, that both the transgressions and the submission can be the object of analysis and not of actions that distort the work. At this point is important to recall what we wrote before about concretization processes.
A particularly serious transgression is the involvement of the analysand and the analyst in a sexual relationship. These events occur in clinical practice and we have elements to reflect on, among other things, because these actions and their consequences alter the lives of both. On the one hand, it stops the analytical process, but on the other it can produce serious disturbances in the mental state of both. In the case of the patient, it may be that they resume the treatment with another analyst and that they can examine what happened. In the case of analysts, there are many who after these episodes have been analysed again, which provides a deeper understanding of the dynamics that are put into play in such actions. Great suffering appears when analysing these violations is possible. But there are other cases in which the analytic method is devalued and the traumatized individual no longer seeks for this kind of psychological help.
In principle, a training analysis has no difference from any other analysis. However, it is possible that taking a patient for analysis who intends to train as an analyst awakens in us quite different reactions: from sympathy and the desire to help a possible future colleague, to rejection or rivalry against traits that we consider inappropriate to carry out their wishes. Even though we know that our analytic function is disconnected from the admission committee or other organizational structures of each training institute, a confusion of roles is possible. Confusing our roles in such cases results in another variant of violation of the limits, perhaps less serious in appearance, but equally damaging to the analytical process.
Sometimes the idea that ‘helping’ can only be managed through analysis is not stressed enough. Interpretation, working together on occasions to make sense of obscure or inaccessible manifestations of interpretation, containment, also understood psychoanalytically, which means avoiding any act of collusion and even in extreme cases in which a certain collusion is unavoidable, attempting to analyse it as deeply as possible.
On many occasions, the patient's communications invite us to play the role of “good object”; without censuring this possibility at all, we must examine the unconscious motivations that may lead the patient to claim real or fantasized gratifications and the analyst to play that gratifying role. It is possible to discover that, in some cases, these roles do not depend only on the current situation of the session, but also express the actualization of primary conflicts of the patient, and also of the analyst.
The analytical setting is an essential resource for the development of the therapeutic process. This frame must not be rigid but can be traversed during treatment. This happens because these movements are influenced by the unconscious structures that are mobilized in the analysis; a brief revision of these structures and movements are described. It is also necessary to differentiate between unavoidable border crossings and violations that prevent further treatment.