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A Basic Theory of NeuropsychoanalysisA Cursing Brain?A Dream of Undying FameA Map of the MindAfter LacanAgainst AdaptationAgainst FreudAn Anatomy of AddictionAnalytic FreudAndré Green at the Squiggle FoundationAnger, Madness, and the DaimonicAnna FreudAnna Freud: A BiographyApproaching PsychoanalysisAttachment and PsychoanalysisBadiouBecoming a SubjectBefore ForgivingBerlin PsychoanalyticBetween Emotion and CognitionBeyond GenderBeyond SexualityBeyond the Pleasure PrincipleBiology of FreedomBoundaries and Boundary Violations in PsychoanalysisBuilding on BionCare of the PsycheCarl JungCassandra's DaughterCherishmentConfusion of TonguesContemporary Psychoanalysis and the Legacy of the Third ReichCrucial Choices, Crucial ChangesCulture and Conflict in Child and Adolescent Mental HealthDarwin's WormsDesert Islands and Other Texts (1953-1974)Dispatches from the Freud WarsDoes the Woman Exist?Doing Psychoanalysis in TehranDreaming and Other Involuntary MentationDreaming by the BookEnergy Psychology InteractiveEqualsErrant SelvesEthics and the Discovery of the UnconsciousEthics Case Book of the American Psychoanalytic AssociationFairbairn's Object Relations Theory in the Clinical SettingFed with Tears -- Poisoned with MilkFeminism and Its DiscontentsForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFour Lessons of PsychoanalysisFratricide in the Holy LandFreudFreudFreudFreudFreudFreudFreud and the Question of PseudoscienceFreud As PhilosopherFreud at 150Freud's AnswerFreud's WizardFreud, the Reluctant PhilosopherFrom Classical to Contemporary PsychoanalysisFundamentals of Psychoanalytic TechniqueGenes on the CouchGoing SaneHans BellmerHappiness, Death, and the Remainder of LifeHate and Love in Psychoanalytical InstitutionsHatred and ForgivenessHealing the Soul in the Age of the BrainHeinz KohutHeinz KohutHidden MindsHistory of ShitHope and Dread in PsychoanalysisImagination and Its PathologiesImagine There's No WomanIn Freud's TracksIn SessionIn the Floyd ArchivesIntimaciesIntimate RevoltIrrationalityIs Oedipus Online?Jacques LacanJacques Lacan and the Freudian Practice of PsychoanalysisJung and the Making of Modern PsychologyJung Stripped BareKilling FreudLacanLacanLacanLacan and Contemporary FilmLacan at the SceneLacan For BeginnersLacan in AmericaLacan TodayLacan's Seminar on AnxietyLawLearning from Our MistakesLove's ExecutionerMad Men and MedusasMale Female EmailMelanie KleinMemoirs of My Nervous IllnessMental SlaveryMind to MindMixing MindsMoral StealthMourning and ModernityMovies and the MindMurder in ByzantiumNew Studies of Old VillainsNocturnesNoir AnxietyOn Being Normal and Other DisordersOn BeliefOn IncestOn Not Being Able to SleepOn the Freud WatchOn the Way HomeOpen MindedOpera's Second DeathOvercoming Destructive Beliefs, Feelings, and BehaviorsPhenomology & Lacan on Schizophrenia, After the Decade of the BrainPhilosophical Counselling and the UnconsciousPractical Psychoanalysis for Therapists and PatientsPsychiatry, 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WorldThe Brain, the Mind and the SelfThe Cambridge Companion to LacanThe Challenge for Psychoanalysis and PsychotherapyThe Clinical LacanThe Colonization Of Psychic SpaceThe Condition of MadnessThe Couch and the TreeThe Cruelty of DepressionThe Dissociative Mind in PsychoanalysisThe Dreams of InterpretationThe Examined LifeThe Fall Of An IconThe Freud EncyclopediaThe Freud FilesThe Freud WarsThe Fright of Real TearsThe Future of PsychoanalysisThe Gift of TherapyThe Heart & Soul of ChangeThe Knotted SubjectThe Last Good FreudianThe Late Sigmund FreudThe Letters of Sigmund Freud and Otto RankThe Mind According to ShakespeareThe Mystery of PersonalityThe Mythological UnconsciousThe Neuropsychology of the UnconsciousThe New PsychoanalysisThe Power of FeelingsThe Psychoanalytic MovementThe Psychoanalytic MysticThe Psychoanalytic Study of the ChildThe Psychoanalytic Study of the ChildThe Psychodynamics of Gender and Gender RoleThe Puppet and the DwarfThe Real World Guide to Psychotherapy PracticeThe Revolt of the PrimitiveThe Seminar of Moustafa SafouanThe Sense and Non-Sense of RevoltThe Shortest ShadowThe Social History of the UnconsciousThe Surface EffectThe Symmetry of GodThe Tragedy of the SelfThe Trainings of the PsychoanalystThe UnsayableThe World of PerversionTherapeutic ActionTherapy's DelusionsThis Incredible Need to BelieveThoughts Without A ThinkerTo Redeem One Person Is to Redeem the WorldTrauma and Human ExistenceTraumatizing TheoryUmbr(a)Unconscious knowing and other essays in psycho-philosophical analysisUnderstanding Dissidence and Controversy in the History of PsychoanalysisUnderstanding PsychoanalysisUnfree AssociationsWalking HeadsWay Beyond FreudWhat Does a Woman Want?What Freud Really MeantWhen the Body SpeaksWhere Do We Fall When We Fall in Love?Whose Freud?Why Psychoanalysis?Wilhelm ReichWinnicottWinnicott On the ChildWisdom Won from IllnessWittgenstein on Freud and FrazerWittgenstein Reads FreudWorld, Affectivity, TraumaZizek
This is a book that would primarily
be read by mental health professionals. It has been used as a text in
classes and it is a clearly written, excellent resource. The authors are
well known in their field and have extensive experience in dealing with
and Lester are talking about boundary violations in therapy from a dynamic and
treatment oriented perspective. Thus, the focus is on internal representations,
transference and countertransference rather than
specifics of ethical codes or laws. They
look at both nonsexual and sexual boundary violations.
The authors begin with an
explanation of how mental representations of self and others are
developed and how people experience psychological boundaries. When a
patient begins psychoanalytic therapy, a set of parameters of treatment are
instituted: the analytic frame. The authors say, "The analytic
frame is an envelope within which the treatment itself takes place." (p.
39) and "the analytic frame creates an atmosphere if safety."
(p. 41). Within this frame patients are then safe to explore thoughts
and feelings from the past. They establish a
transference to the therapist. The authors talk about the responsibility the
analyst has in the professional role: that it is not to gratify libidinal
needs but to help the patient make sense of the past and to preserve the
analytic space so that the treatment can continue.
This book contains an extensive
chapter on the history or the analytic movement and how an understanding of
transference and countertransference developed over
time. It also contains some unfortunate examples of boundary violations on
the part of some early and well known analysts. The authors appear to feel
the need to provide historical context as "blind spots in one analytic
generation may well become blind spots in the next." (p.
In the chapter on sexual boundary
violations Gabbard and Lester say "although
discussions of sexual boundary transgressions generally imply that
interpersonal boundaries are being crossed, earlier in the progression down the
'slippery slope,' inner boundaries between self and object representation are
eroded." (p. 88). They look at how this progression can
develop. In looking at extensive case studies they suggest there are four
categories of therapists who have sex with patients. The first, psychotic
disorders, is rare and more likely to be a therapist in a manic phase of
bipolar disorder. A group they call "predatory psychopathy
and paraphilias" (p. 92) they see as possibly
incapable of rehabilitation. The majority of the therapists who have sex with
patients they categorize as lovesick. These therapists mistake the
transference love of the patient for real love and believe they feel real love
for the patient while being unable to see the harmful effects of their
actions on the patient. The last group of therapist they categorize
as engaging in a masochistic surrender to the patient. They list
some commonalities of the therapists in boundary violation
cases: narcissistic issues, grandiosity, sadomasochistic core issues,
tendency toward action over reflection, thick inner boundaries, superego
disturbance, and perception of the patient as having a deficit which requires
enactment. They also discuss the idea that these therapists overvalue
love and concretely expect it to heal the patient rather than insight or
In the chapter on nonsexual
boundary violations the authors discuss things like receiving or giving
inappropriate gifts. They talk about role of projective identification
in confusing boundaries and about countertransference
enactments. There is an extensive case analysis. They also discuss
instances where the therapist acts inappropriately and concretely in a
It is rare to see discussions of post-termination
issues and this book has a chapter on boundaries and post-termination. Looking
at follow-up studies, the authors suggest that the transference continues as a
latent structure after the termination of therapy and
that a significant number of patients may ask for consultation of their former analysts
after termination. They suggest there may be value in former therapists
maintaining sufficient distance to allow the patient to resume therapy if
needed. This is more difficult where the patient is a mental health
professional and may well subsequently work or supervise at the same workplace
as their former analyst. Gabbard and Lester
suggest that allowing hope of gratifying the patient's wish for a relationship
after the analysis is done may make a full working through of grief and loss
There are chapters on boundaries in
supervision and a look at the history of institutions responses to the boundary
While this book is written about
psychoanalysis, it is applicable to psychodynamically-oriented
psychotherapy and may be useful to therapists of other orientations as
well. All in all, this book is highly recommended for all
clinicians practicing psychotherapy.
© 2003 Marilyn Graves
Marilyn Graves, Ph. D. is a clinical psychologist and topic editor of
Psychology and Fiction at suite101.com.
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