April 1995
Therapist Misconduct: Relationships at Risk
The relationship between therapist and patient is unique. Building on trust, an individual shares his or her most personal thoughts with the therapist.
"When a patient really opens up to the therapist, a strong bond is established and it's easy for boundaries to become blurred," notes psychoanalyst Mark Levy, M.D., "but for the psychotherapist to really provide assistance and support, the very personal professional relationship must not become a social one."
Glen O. Gabbard, M.D., from the Menninger School of Psychiatry, warns that boundary violations are gradual and hardly noticeable at first. "It's a slippery slope," he says, "that may begin with letting a patient exceed his or her 50 minutes and progress to a virtual 24 hour, on call relationship."
Dr. Gabbard tells the story of an analyst who ended up seeing a man five times a week and spending hours on the telephone with him every night. "Many of us become analysts because we are genuinely interested in people," Levy adds. "We want to help them work through their issues, and it's sometimes hard for us to set limits on the patient/analyst relationship."
Dr. Gabbard feels that a major factor that contributes to the problem is the "terrible isolation of therapists. Many individuals arrive at 6 or 7 a.m. to see patients before work and don't get home until 7 or 8 at night because they're still seeing patients. That doesn't leave much time for a personal life," he notes.
According to Dr. Gabbard, "Many therapists do not interact with anyone outside of the office all day; they get starved for human contact and begin to socialize with their patients." He urges therapists to structure their practices so that isolation does not occur.
Dr. Levy suggests that the psychotherapist clearly define the boundaries between patient and doctor at the outset and communicate that information to the patient. "That includes the office setting, financial and payment issues and in fact everything that constitutes their relationship together."
To interview Mark Levy, M.D. about the patient/therapist relationship, please call Media Consultant, Mary Tressel at 1-800-260-2663.
Sexual Misconduct: Likely Victims
Sexual misconduct is rapidly becoming a major concern among mental health professionals. "No matter what the patient does, it's always the therapist's responsibility to act ethically," says psychiatrist Glen O. Gabbard, M.D., "but there is also a profile of patients who are most likely to become victims."
Incest Victims
Mostly women, the patient's experiences growing up lead her to
assume that caring is always accompanied by sex and that any closeness
with male authority figures involves physical contact. These individuals
have the highest rate of victimization.
Patients with borderline personality disorder, major mood shifts
and a distorted sense of self
Up to two-thirds of these patients are also victims of sexual
abuse; many of these individuals are also incest victims.
Patients with a history of previous hospitalizations, suicide
attempts, substance abuse
These patients are often treatment resistant, and a therapist,
becoming frustrated by a lack of progress, may escalate contact
until there is a more personal, even sexual relationship.
Other Patients
Several other types of patients are candidates for a more personal
relationship with their therapist than is appropriate. These individuals
include attractive patients with chronically low self-esteem and
patients with dependent, masochistic and histrionic personality
disorders.
The media is welcome to use the information above; please credit the San Francisco Foundation for Psychoanalysis for the material.
Battling for Adulthood
The healthy emotional growth of adolescent girls is in jeopardy. "The developmental goals of a teenage girl make conflict with her parents almost inevitable," describes psychoanalyst Lynn Ponton, M.D. "Because so many mothers today are working, it is harder for mothers and daughters to find the time - and energy - to resolve their differences."
Because the very heart of growing into adulthood involves testing the nature and boundaries of relationships, mothers who are unwilling or unable to allow the struggle to take place may be setting the stage for more serious problems later on. Alternatively, if a mother is able to validate the changes a young girl is experiencing and encourage her identity as a separate individual, a daughter is more likely to develop a healthy sense of herself in relation to others. "When the mother and daughter both understand the importance of the separation process, hostility may diminish and understanding may be reached."
Separation from her parents is an important part of a girl's maturation. "While common conflicts surround the separation process, jealousy, different value systems and an inability to empathize with each other can also cause arguments and problems."
The testing process is often accompanied by a certain amount of conflict. "The manner that the daughter uses with her mother may be brusque or even hostile, and the mother may be so surprised by the argumentative nature of the testing of boundaries that she becomes angry or refuses to participate," Dr. Ponton explains. "It frequently happens that the mother and daughter do not see the utility of the growth process; the mother may say she cannot understand why her daughter is abusing her, and the daughter complains that her mother doesn't understand her."
It is interesting to note that the relationship between mothers and daughters is marked by the highest degree of harmony as well as the most conflict. Dr. Ponton wonders if adolescent male aggression might be curbed if there were more healthy conflicts between fathers and sons. "Arguments can be healthy outlets during the process of growing up."
To interview Dr. Ponton about conflicts between mothers and daughters, please call Media Consultant, Mary Tressel at 1-800-260-2663.
Fighting Fair
The relationship between husband and wife is very personal, private and complex. Analyst James Storm, M.D., observes, "With the current discussions about what makes a good marriage, it's important to understand as much as possible about the structure of this fascinating institution, of which psychological boundaries are an important part."
Each party brings to a marriage his or her own psychological history and personal quirks, which are jealously protected. These attributes are separated from the rest of life by psychological boundaries, which are often unconscious. "When a spouse crosses one of these boundaries, arguments and fireworks can erupt. These arguments can't be settled rationally because the actual causes are irrational and also usually not known to the participants."
Dr. Storm cites the slightly disguised example of a woman who controls her anger and rage at her own mother by being exceptionally neat and orderly. Her husband leaves his shoes on the living room rug one night, and by doing so he has accidentally and unknowingly crossed a psychological boundary and disturbed his wife's control of her anger. A bitter argument then breaks out which they can't settle, because it's not really about the shoes but about the way her boundaries have been crossed; her unconscious controls have been disturbed.
Dr. Storm suggests that the solution to these irrational arguments is to figure out the nature of the boundaries, the controls and the other forces involved so that they may be respected and possibly softened by understanding. A trained, impartial marriage therapist can often help in this process."
To interview James Storm, M.D. about relationships between couples, call Media Consultant, Mary Tressel at : 1-800-260-2663.