Magazine article Psychotherapy Networker

The Slippery Slope: Violating the Ultimate Therapeutic Taboo

Magazine article Psychotherapy Networker

The Slippery Slope: Violating the Ultimate Therapeutic Taboo

Article excerpt

I doubt that I would fit many people's image of a therapist who would violate sexual boundaries with a client. Before it happened, I certainly did not fit my own. On the day I first met Cara, I was a well-respected social worker at a venerable psychiatric hospital in the Midwest. I viewed myself as a caring and conscientious professional. Yet, over the course of two years, I progressed from sympathizing with Cara, to over-sympathizing with her, buying her groceries, paying her rent and, finally, sleeping with her. At first, I did not think I was doing anything harmful--I was going the extra mile, helping Cara until she could take care of herself. But my previous dedication to all my clients became an obsession with one.    

It was as though I were skiing down a steep mountain in what seemed to be deep, safe snow. Blinded by arrogance, I traversed back and forth, each time taking a little more risk. There were unknown moguls under the surface and, as my speed picked up, I totally lost control of my skis.   

Starting Down the Slope

Therapy began routinely enough in the summer of 1993. Cara, the attractive mother of young, twin boys, had been hospitalized following the latest in a series of suicide attempts and self-mutilations. She and her husband were assigned to me during her hospitalization for marital therapy. Despite her troubles, I found her to be bright, sensitive and a talented visual artist. Subjected to severe physical abuse as a child, Cara had been given the diagnosis of Dissociative Identity Disorder, and her childlike alter-personalities and novel diagnosis intrigued me. I extended our meeting times in preparation for her marital sessions and took long walks with her on the hospital grounds. Overwhelmed by feelings of protectiveness, I doubted the competence of hospital staff to prevent her ingenious attempts to harm herself.

After four months of marital therapy, Cara's husband discovered she had had an affair before her hospitalization and, at his insistence, their marriage ended. Soon afterward, Cara was discharged. My job was now officially over: it required me only to provide short-term family therapy until a patient's discharge. But then, Cara called me at my hospital office a week later to discuss a personal problem, and in one of my first major boundary slips, I took her call.

Why did I encourage this first, seemingly minor, deviation from good clinical practice? I was vulnerable, ignorant, arrogant and lonely. I'd recently ended a 10-year relationship with another woman--a relationship so intimate that we'd both worn wedding bands. Depressed, numb and disconnected, I was drinking alone at night. My work provided me with my only emotional sustenance, and it, too, had become a dark and confusing place. It was the early 1990s, and our inpatient unit was fast becoming a world of its own--we were fascinated with childhood trauma and Multiple Personality Disorder, and convinced that other clinicians did not understand these clients. I spent many daylight hours listening to patients describe horrifying abuse, and at night I had nightmares of young children who were being sodomized.

At the same time, I was becoming isolated from the norms of my profession: I left my family therapy supervisor and began working under a charismatic psychiatrist who specialized in trauma. As a family therapist and a social worker, I'd been taught to pooh-pooh psychodynamic notions like transference and countertransference. I had never even taken a course in professional ethics or the need for boundaries. Over dinner one night, my new supervisor confessed to me that he was having an affair with one of his clients, and told me of the many founders of psychoanalysis (including Carl Jung, Otto Rank, Frieda Fromm-Reichmann, Fritz Perls and Sa´ndor Ferenczi) who had also had such affairs. The stage was set for me to do so as well.

Not long afterward, I gave Cara my beeper number, and within a couple of months, we were talking on the phone almost daily. …

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