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The author of this book notes at the outset that her book focuses on sexual boundary violations, but does so within the context of an examination of broader boundary issues. She observes that boundaries in the professional milieu facilitate the effectiveness of work and help protect the integrity of the relationship when there is a power differential, for example between doctor and patient, employer and employee, or supervisor and student. Celenza reviews, with great scholarship, the literature on her subject, but because her thesis rests upon her own psychoanalytic background and a faith in a single doctrine, the slippery slope argument, she opens herself to negative criticism. The two: psychoanalysis and the idea of the slippery slope are, I propose, pretty well intricately entwined.
Psychoanalysis emphasizes neutrality, distance and rigid boundaries. The slippery slope argument situates itself in the assumption that any boundary crossing, however minor, inevitably leads to sex and other boundary violations. Though Celenza concedes that there is a distinction between boundary crossings and boundary violations and that one does not lead inevitably to the other, she claims we are ‘all always on the slippery slope’ (p.17). I dispute this. I am a psychotherapist who works within a non-psychoanalytic framework, using the insights of Gestalt therapy as well as narrative practice, where some of the prohibitions implicit in psychoanalysis, such as therapist-client touch, is understood, I suggest, more thoroughly than psychoanalytic practitioners. The slippery-slope idea is not only, as Lazarus (1994) has put it, ‘an extreme form of syllogistic reasoning,’ but one provoked by a school of thought that actively denies therapist touch clients under any circumstance.
The slippery slope argument is based on the finding that most therapists who were engaged in boundary violation had been engaged in boundary crossing prior to their engagement in boundary violations. However, to assert that a hug, a touch to the arm, a self-disclosure, a home visit, or accepting a gift are actions likely to lead to sex is similar to saying that doctors’ visits cause death because most people see a doctor before they die. Throughout our school experience, we learn that sequential statistical relationships (correlations) cannot simply be translated into causal connections, so why accept this one? The slippery slope notion that touch, or whatever, of any kind will inevitably end up with sex is more a case of an idea of psychoanalysts sexualizing all boundaries, rather than maturely identifying which actions may in fact be effective tools of psychotherapy.
That said, the author of this book makes some very interesting observations. She notes, for instance, that sexual violations tend to occur when a therapist reaches an impasse and seduction of the patient arises from a ‘defensive reaction to a difficult patient at a stressful time in the therapist’s life.’ (p. 13) It is at this point, Celenza says, that the line is crossed. She has identified eight risk factors for therapists, thus: long-standing narcissistic vulnerability, grandiose (covert) rescue fantasies, intolerance of negative transference, childhood history of emotional deprivation and sexualization, family history of covert and sanctioned boundary transgressions, unresolved anger toward authority figures, restricted awareness of fantasy (especially hostile/aggressive), and transformation of countertransference hate to countertransference love. (p.14)
Knowledge of professional ethics, she suggests, has not been found to prevent boundary violations, nor is the profile of a therapist who engages in sexual boundary violations likely to be a psychopath. Rather, violators are just ordinary people, motivated by unconscious, denied, or compartmentalized conflicts that are generally only identifiable through intensive evaluation or therapy (p. 29).
This book is a valuable addition to the examination of sexual boundary violations and should form part of any study of ethical practice, as well as providing insight into the mindstuff of therapists who commit them. Recommended.
© 2010 Elizabeth McCardell
Elizabeth McCardell, BA, BA (Hons), M. Counselling, PhD, Independent scholar, Australia.