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As co-chair of the 2023 IAPSP conference, where Geist and Nocek’s paper was first presented as a plenary, I have been grappling with the clinical, scientific, and ethical complexities their paper presents. In homage to Donna Orange, who followed Levinas’ privileging of ethics, I will start with that.
The major ethical concern is the dual relationship Dick entered into with Meredith once they decided to co-author the paper. In the lead-up to the conference last year, I checked with the Board of Registration of Psychologists in Massachusetts to see what their take would be on this. They did not see the paper but knew it was co-authored by a senior psychologist/analyst and his patient. Their general position was that if the patient/co-author gave her informed consent it would not be considered automatically unethical. However, the caveat was that if the paper or presentation caused harm to anyone (the patient, other patients, or members of the community), then it would cross the line into unethical behavior. Thus, the major ethical concern raised by their paper is its potential harm to Meredith, Dick’s other patients, and/or the various communities to which they belong. This has been a concern shared by many of us. What is unclear are the criteria for determining whether there has been harm to any of these parties. If our organization is concerned about that, then it needs to generate a process for determining whether harm has occurred.
From a “scientific” standpoint, I agree with Dan Perlitz that the paper is problematic if its purpose is to demonstrate the clinical efficacy of permeable boundaries. The paper lacks essential elements for demonstrating efficacy, such as compelling evidence that permeable boundaries have been helpful with the problems Meredith came into analysis to address. All we have is Meredith’s personal testimony that permeable boundaries have been transformative for her. This may be the case, but we don’t “see” the struggles that permeable boundarie