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This book contains a wealth of clinical wisdom for beginning as well as experienced clinicians. The many examples and dilemmas proposed become stimulating opportunities to grapple with the complexity and meanings of the therapeutic frame. The examples serve as reminders of mutual vulnerabilities that emerge in the multilayered therapeutic relationship. The format and discussions provide stimulating teaching opportunities that illuminate supportive protection for both psychoanalytic candidates and patients. Wide-ranging situations involving money, services, gifts, out-of-office contact, self-disclosure, clothing, and physical contact are discussed.
Gutheil and Brodsky have written a comprehensive review of boundary issues in a tone that emphasizes curiosity about dynamic meaning and context. Protecting both patient and therapist by maintaining a clear but not rigid, humane frame is stressed in a variety of real and believable clinical situations. Boundary deviations are presented as full of complex dynamic ramifications that need to be understood in their many layers of multiple meanings in order both to further the treatment and to prevent slipping into boundary violations. Boundary violations and boundary deviations, though connected, are clearly delineated as different. Exploration of dilemmas that involve the dyad in deviations always has as its background aim the understanding of psycho-dynamics, while the wish to facilitate growth and spontaneity, and also to protect both parties in the therapeutic dyad, is kept in mind as well.
The inevitability of boundary deviations occurring in the intimacy and intensity of the therapeutic dyad is acknowledged, and there is a discussion about processing these with the patient so that the available multiple meanings emerge, and then, hopefully, understanding and trust are deepened. Consultation with supervisors and colleagues is also stressed as helpful in guarding against being drawn into harmful boundary violations. The auth