Book Review: Boundaries,Boundary Crossings,and Boundary Violations

It is difficult not to wonder if psychoanalysis isn’t inherently tied to the mobilization of something transgressive that exists within all of us [Levine, p. 1].

In the introduction to Boundaries, Boundary Crossings, and Boundary Violations, Howard Levine, as editor, reminds us that even across theoretical orientations, psychoanalysts share the common goal of attempting to seek truth. At the same time, we appreciate the human tendency to avoid encountering difficult truths in ourselves and in our patients. This text, originally a special edition of the International Journal of Controversial Discussions, includes nine essays by North American, European, and Latin American analysts who, by Levine, were given “carte blanche to write about boundaries, boundary crossings, and boundary violations and their vicissitudes in the clinical or educational situation, in our institutions and organizations and in the culture at large” (p. 4). The broad prompt was intentional, according to Levine, with the hope that authors would expand beyond discussions of sexual boundary violations alone, as several authors ended up doing.

Many of us who have experienced porous boundaries or clear violations in our analyses, as well as those of us who have experienced the disruptive aftermath that clinical transgressions cause in our institutes and societies, know all too well that the question “How did x violation happen?” plagues both the particular individual affected and the group within which the violation occurred. Under Levine’s editorship, the authors of this book’s chapters contribute evocative and unique perspectives with which to consider this question. Several authors in the book (e.g., Andrea Celenza, Heribert Blass, Charles Levin) consider the role of the psychoanalytic community, its culture, complicity and overall group functioning, on boundary violations. Some contributors to this volume address individual aspects of the analyst and patient dyad thought to increase the liability for transgressions (e.g., Celenza, Guillermo Bodner, Viviane Chetrit-Vatine, Blass, Marina Altmann de Litvan). Other topics include the history of psychoanalytic boundary violations, spatial boundaries of telehealth with children, the role of civilization in the psychoanalytic frame, and how to think about boundary violations in “post-truth” times.

Levine foregrounds the volume with the reminder that psychoanalysis was established in the context of a bourgeois society valuing propriety and sexual inhibition. Within this context, Freud conceived the theory of psychoanalysis, with its initial emphasis on the unconscious, repression, and infantile sexuality. These discoveries gave birth to a new understanding of what “truth-seeking” means in light of unconscious resistances. As psychoanalysts, we understand that repetition is one way we work through painful experiences, and psychoanalysis as a profession is not outside of the risk of perpetuating boundary transgressions and institutional mishandlings via repetition in our own collective histories.

To this point, the book begins with an essay by Berman and Mosher that provides a sobering historical account of known boundary violations beginning with Carl Jung and Sabina Spielrein, in the nascence of psychoanalysis. They discuss the evolution of Freud’s writings, which seem to demonstrate how he was grappling with the concept of transference as an essential component of the efficacy of psychoanalysis and also its potential for danger when misconstrued as “real.” Berman and Mosher provide several examples of historical boundary violations, and in an unusual move, perpetrating and transgressing analysts are referred to by name, some analysand victims are as well, and institutes with documented histories of repeated transgressions are discussed. Alongside Bodner’s essay, these two chapters both make the argument that sexual boundary violations or other transgressions between analyst and patient may even result in equal or greater psychic harm and considerably more life disruption than sexual violations in childhood.

In her essay, Andrea Celenza, well known for her scholarly contributions about boundary violations, offers a framework which considers the larger social and cultural moment. Drawing on her clinical work and research with transgressors and victims over several decades, Celenza argues that the prevalence of “psychopathic predation” (analysts who exploit multiple patients, sometimes referred to as Don Juans or Svengalis) has largely decreased since the 1980s. And she draws an interesting parallel, comparing the first wave of patients who spoke up against their violating analysts with how the #MeToo movement involved the widespread naming of celebrity transgressors. ¹ Celenza contends that the naming and reporting of infractions within psychoanalysis helped curtail such egregious violations, with many of these perpetrators expelled, losing their licenses or leaving the field.

Celenza believes that beginning in late 20th century and in response to the reduction in psychopathic predation, the profession has been able to expose more covert, yet still problematic, boundary troubles. Unlike psychopathic predators and criminal violators, Celenza has found that often that these kinds of boundary crossings are committed by analysts who defensively consider their transgressions as helpful and/or necessary, or by analysts who are overidentified with aspects of their patients, though these convictions likely remain unconscious until after they occur and/or are reported.

Along with Levin and Blass in their own essays, Celenza urges those in the field to consider the group and institutional factors that contribute to the perpetuation of boundary transgressions, including the undervaluation of self-care and work boundaries, harsh training environments, institutional abuses of power, opaque communications, and veils of secrecy around transgressions. Their arguments led me to consider how these experiences can foster an identification with the institutional aggressors, which can carry forward via repetition. Speaking directly to group dynamics, Blass describes how thinking is disrupted in a group when members lose their ability to self-differentiate from a leader or leader figure, creating a false sense of security, via idealization and identification with the leader. Other members of the group may feel afraid to express their differing opinions. Fear may lead some members to bolster idealizations in an unconscious attempt to avoid exclusion. In his essay, Bodner uses the concept of the “third” object to spotlight the importance of the analytic community, as it has been shown that a good-enough training environment or personal analysis alone does not provide a guarantee of safety against transgression. When working well, the larger community would fill the mediating or containing function of the third, offsetting the dyad’s pull toward the “twoness of complementarity” where recognition of the patient’s separate subjectivity breaks down (p. 96). Blass identifies something similar and recommends that an outside psychoanalytic authority should intervene (a ‘third’ party) when transgressions create institutional catastrophes and the local group loses its ability to usefully think about what’s happened.

Chetrit-Vatine, in her evocative essay, takes a theoretically different approach to consider thirdness and its protective factors. Drawing on Laplanche’s concept of the Sexual (the ethically seductive aspect of the analytic situation) and the philosophical contributions of Levinas (who views ethics as the asymmetrical responsibility toward the other), Chetrit-Vatine theorizes a matricial third. The matricial third is developed through the process of the ongoing, (i.e., over and over again) “ethical shock” that occurs in the encounters between patient/analyst, supervisee/supervisor, and candidate/instructor. Chetrit-Vatine argues that the ethical seduction of these encounters is inherent not only to the analytic situation but the supervisory and instructional settings as well, as all three are also asymmetrical relationships, and can engage the infantile sexual.

Considering the role of the group and its ethics, Levin’s chapter provided what I found to be a comprehensive, well-thought-through, and daring challenge to the psychoanalytic collective. Levin puts pressure on the psychoanalytic group’s patriarchal idealization of the Father/Lord/Leader and how these defensive idealizations assist in a premature binding of destructive states. Levin convincingly argues that when under stress, a patriarchal group’s dormant monstrous qualities will emerge—qualities like omnipotence, delusional denial, entitlement without bounds, paranoia, rage, envy, and beyond.

In another key takeaway, Levin highlights the psychoanalytic collective’s resistance to developing a justice process that demands responsibility and accountability from the wider psychoanalytic community. Levin insists that institutional psychoanalysis is content to protect itself with the belief that the transgressions are the fault of a few rogue members, leading to collective denial and scapegoating of a few to hide the narcissistic investment of many. In an important comparison, Berman and Mosher, as well as Levin, consider the parallels between the sordid history and ongoing violations in the psychoanalytic community to those perpetrated by the Roman Catholic Church. Berman and Mosher specifically wonder if child victims of priests and patient victims of analysts may both be “targets of opportunity” (p. 51). They speculate that this may be related to character deficits in the transgressing priests or analysts and the power of the transference that each of these roles evoke. Regarding psychoanalysis, Levin asks us to consider the possibility that “the profession attracts mainly those looking to cloak their wish to go where angels fear to tread” (p. 179).

The comparison with the Catholic Church brought up for me the chilling question of whether patients of psychoanalysis are particularly vulnerable to being victims of transgressions, or if analysts are particularly in danger of tempting transgressions. For the patient (and the analyst who is, or was once, a patient) the depth of pain, desperation, or other psychic discomfort was substantial enough to agree to participate in an experience that is often inconvenient, uncomfortable, time intensive, and expensive. Consciously, this requires some level of considerable trust and faith in an analyst and in a process that has not yet been experienced, perhaps eliciting a skewed sample of people more easily impressionable, narcissistically vulnerable, or frankly those aware of more psychic pain. Similarly, the promise for a life dedicated to God requires an immense act of faith too. Both professions require considerable integrity and restraint; the analyst and the priest each repeatedly coming up against the tension between their infantile polymorphous desires, and their ethical and moral obligations. There may be similar destructive elements too, as Levin suggests, in the patriarchal structure of the Roman Catholic Church and institutionalized psychoanalysis, which insidiously fuel transgressive acts. Both professions require (and often lack) a well-functioning community viscerally aware of the human conflict imposed by the nature of the profession and a community not afraid to face these violations head on when they inevitably occur.

The therapeutic relationship is built upon the mutual agreement between patient and analyst that the patient will do their best to express, without censorship, the contents of their mind. In turn, the analyst undertakes the responsibility of understanding these expressions as psychically real, and must be resolute in knowing the transference is a manifestation of the analytic situation and the result of forces mobilized by the treatment itself. Yet at the same time, the analyst can harm the patient in materially real ways. In his chapter, Bodner reminds us that it is precisely those limits in the analytic relationship that allow analysts to receive unconscious communications from patients without the call to gratify, instead providing the opportunity for representation and symbolic thought. Similarly, as Blass argues, if the fantasy character or make-believe state of the analytic situation is abandoned, the climate becomes ripe for boundary crossings. Drawing from his clinical and organizational experience, Blass has found evidence that the analyst’s use of language often signifies the breakdown of the fantasy nature of the analysis. If the analyst’s language becomes too realistic (i.e., responding to the patient’s wishes with the possibility of gratification) the patient’s ability to associate freely is influenced. In talking with victims of boundary violations, Blass observed that some patients identified a shift in their analysts’ language before the transgression occurred where, looking back, they identified these shifts as evidence that the transgression was inevitable.

During the process of reading the text and writing this review, an association came to me from adolescence—a memory of my first solo trip as a licensed motor vehicle driver. Stopped at a red light at an empty intersection, I recalled having had the thought, “I could run this light and no one would know.” I remember I did not feel overly tempted to run the light, yet what strikes me as important in that surprising moment was the I could in my newfound freedom. Levine and his contributors invite us into a conversation about what stops us, instead of the less useful question why do we want to? This volume not only offers a variety of perspectives on the individual factors; it offers the opportunity for the reader to grapple with the collective and historical impact of boundary transgressions within the field and the crucial role that institutions and societies play in prevention, justice, and repair.