The Case Against
Allen Fay, MD
In the 1960s, when I was a psychiatric resident, there was rampant unaccountability in the psychotherapy professions, for both therapeutic results and therapist conduct. With regard to the latter, therapists could have sex with patients almost with impunity. As a reaction to this deplorable situation, trends have developed to deal with the problems in ways that approach the opposite extreme. A number of prominent psychiatrists, psychologists, social workers, and counsellors have taken a strict and narrow view of professional ethics that would sharply restrict therapists’ behavior with patients. Whereas this trend potentially has value in heightening awareness and accountability and correcting the abuses of the past, it also has adverse and potentially dangerous consequences. In a way, what is now insisted upon in some quarters is preposterous, if not impossible.
The chapter title, “The Case Against Boundaries in Psychotherapy,” might seem absurd because of the obvious existence of limits in all relationships. The basic difference as I see it between the pro and antiboundary positions is in the orientation to the patient-therapist relationship. In the former case, predetermined boundaries are applied to all patient-therapist dyads, whereas in the latter, the possibility for