Impact of Boundary Violations

Analysts from the U.S. and abroad have given the COPE Study Group on Boundary Violations detailed accounts of the impact of boundary violations on institutes. All spoke of the negative consequences for psychoanalysis as well as for the larger mental health community. Candidates and analysts, alike, lose faith in what they are doing and referrals for analytic treatment decrease. The destructiveness magnifies when the violating analyst has been in a position of power, as in the case of a training analyst or a public spokesperson for our profession. The study group has learned how widespread these occurrences have been, and how challenging it has been for an institute to deal effectively when a boundary violation comes to light. The initial reaction is almost always disbelief and denial. We have also learned how difficult and lengthy the healing process has been in the aftermath of a boundary violation for the affected institute. We hope this column will be a resource for analysts and institutes.

Whether the institute is small or large, rumors (true or false) about alleged boundary violations, especially sexual ones, proliferate. Once these speculations abound, they contaminate all of us. The alleged abuses are often discussed by both the aggrieved patient and by friends of the patient. If a friend is in treatment with another analyst, that analyst is hamstrung, feeling caught between a duty to keep confidentiality and a duty to report, especially if reporting is mandated by the state. One complication is that state laws concerning reporting or responding differ depending on discipline. (For example, M.D.s have mandated reporting in some circumstances while Ph.D.s and M.S.W.s may not.) Furthermore, when an analyst hears her analysand speak about a putative violator, especially if the violator is someone known to her—perhaps even her training analyst or an important source of referrals—the complications increase. Often, there is a conspiracy of silence, not unlike the conspiracy of silence we find in families struggling with incest or other well guarded family secrets. Everyone involved feels besmirched. In all the incidents we have heard about, there was considerable lag time before the institutes were able to organize a serious response to the problem.

Analysts typically pathologize the violator, trying to disidentify and deny in themselves similar vulnerabilities. This tendency effectively replicates the kind of vertical splitting or compartmentalization that makes one vulnerable to sexual misconduct in the first place. Power and/or grandiosity in some analysts, notably training analysts, can exacerbate this splitting and can lead to a narcissistic entitlement to go beyond the rules. Furthermore, we found that there is often a transgenerational impact when analysands identify with these splits in their training analysts. If these situations are not adequately handled, violations continue to occur for decades. Long-lasting aftershocks may be felt even after effective action has been taken.

Our COPE study group learned that “a sense of paralysis and helplessness can sweep over education committees and ethics committees alike,” according to Glenn O. Gabbard, Morris L. Peltz, and the COPE Study Group on Boundary Violations in their article, “Speaking the Unspeakable: Institutional Response to Boundary Violations by Training Analysts.” There are many complicated transferences to the training analyst who has committed a sexual boundary violation, which makes processing and investigating complaints extremely difficult. In many cases, outside consultation was useful. Bringing in colleagues who are knowledgeable about boundary violations, but not embroiled in the group dynamics of the institute, may provide a reasonably objective and fairer determination of the best way to proceed. Some institutes have completely reorganized their bylaws in order to facilitate the process of healing and to decentralize power.

Frequently, the victim-patient is overlooked in the aftermath of sexual violations. Marvin Margolis states, “The analytic society or institute must be prepared to offer help to the abused patient, especially in regard to referral to a new therapist. Consultation and/or mediation may be indicated on a continuing basis.” It can often be helpful for the analyst and patient to sit down together with a knowledgeable third party. The whistle-blowers may also be neglected, shunned, or accused of unscrupulous motives. Involved institutes should make efforts to provide an analyst-advocate to prevent such marginalization.

Experienced consultants recognize that we are all subject to confounding transference-countertransference situations. The notorious violators who are predators and who are often responsible for multiple violations are the minority. When conceptualizing the common characteristics of single victim cases, it is useful to consider a spectrum, with “lovesickness” at one end and “masochistic surrender” at the other, with many points in between, as Gabbard and Eva Lester suggest. When colleagues recognize that an analyst is enmeshed in boundary crossings, they should use the institute's psychoanalytic assistance committee, which is able to intercede. Local rules differ on how complaints are handled, but it is important that an institute has a clear path for an individual to follow when he/she suspects a boundary crossing or violation is occurring and that he/she is never left alone with the responsibility of what to do. We also encourage all members, no matter how senior, to make use of consultation on selected patients as a way of monitoring difficulties in early transference enactments.