Magazine article Clinical Psychiatry News

Enactments Can Open Door to Sexual Misconduct

Magazine article Clinical Psychiatry News

Enactments Can Open Door to Sexual Misconduct

Article excerpt

NEW ORLEANS - Beware of enactments in the course of psychodynamic therapy, Dr. Eric Plakun warned at the annual meeting of the American Academy of Psychoanalysis.

While enactments aren't inherently bad, they can be one of the mechanisms through which sexual misconduct emerges during the course of therapy-even in well-meaning clinicians, said Dr. Plakun, psychiatrist and director of admissions at the Austen Riggs Center in Stockbridge, Mass.

In the context of psychoanalysis or therapy, enactment occurs when the therapist unwittingly colludes with the patient in the process of a mutual and complementary projective identification organized around significant past events from the lives of both participants, he explained.

"In enactment, the therapist may be thought of as joining the patient in a process that moves the therapist away from the neutral acceptance of transference. The unfolding mutual projective identification of an enactment becomes a slippery slope on which the therapist is in danger of sliding away from the component of the therapeutic role that requires accepting the patient's transference," said Dr. Plakun, also of Harvard Medical School.

When this occurs, the therapist becomes as active a participant in the process as the patient.

Enactment doesn't happen only to "bad" therapists. In fact, the process is probably inevitable in a relationship as complex as that between therapist and patient. The key is to recognize the enactment, and to use it to deepen and enrich the therapist's work with the patient.

An early manifestation of enactment often is refusal or actualization of the patient's transference.

Enactment should be recognized as an opportunity to find meaning and a new way of looking at things. It can be used by therapists to enrich their grasp of the patient's inner world as it intersects their own. …

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