Psychoanalytic Psychology © 2017 American Psychological Association

2017, Vol. 34, No. 2, 151–156 0736-9735/17/$12.00 http://dx.doi.org/10.1037/pap0000079

Sexual Boundary Violations in Psychoanalysis: A 30-Year Retrospective

Glen O. Gabbard, MD
Baylor College of Medicine and Center for Psychoanalytic Studies, Houston, Texas

The author looks back on his 30 years of treating, evaluating, and consulting on over 300 cases of sexual
boundary violations. He describes how his previous optimism about the potential to prevent such
transgressions has given way to a pessimistic view in light of the pervasive self-deception of analysts and
therapists. He also has reconsidered his longstanding categorization of these practitioners as a result of
his observations about the idiosyncrasies of superego functioning and the capacity to view ethics
considerations differently when applied to oneself compared to how they apply to others. Finally, he
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presents his impressions of how group phenomena in analytic organizations may contribute to the
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development of sexual boundary transgressions.

Keywords: psychoanalysis, boundary, violation, love

In the mid-1980’s I found myself encountering a number of
patients who reported sexual relationships with previous analysts
or therapists. I listened carefully to their accounts and tried to make
sense of what had happened. As a relatively inexperienced analyst,
only recently graduated from psychoanalytic training, I was per-
plexed by these accounts and wondered how psychoanalysts and
other therapists could rationalize sexual involvement with patients.
As I began to study this phenomenon, I tried to articulate in writing
what I was seeing. My early publications on the subject led to the
referral of many practitioners who had transgressed sexual bound-
aries with patients. Some came on their own, while others were
referred from ethics committees of psychoanalytic institutes, li-
censing boards, and professional societies. A number of publica-
tions (Celenza and Gabbard, 2003; Gabbard, 1989; Gutheil and
Gabbard, 1992; Gabbard, 1995; Gabbard and Lester, 1995; Gab-
bard, 1996; Gabbard, 1999; Gabbard and Peltz, 2001; Gabbard,
2002; Gabbard, 2003; Gabbard, 2008; Gabbard and Hobday, 2012;
Gabbard, 2016) followed over the next 30 years reporting on my
experiences as an evaluator, analyst, therapist, consultant, super-
visor, and educator in the area of sexual boundary violations
between clinicians and patients. During those three decades I have
seen over 300 cases where therapists, analysts, or other helping
professionals have crossed sexual boundaries with persons whom
they are treating.
In addition to my writings on the subject, I have spent many
years teaching seminars, presenting at national and local meetings,
and engaging in other educational efforts to raise consciousness
about a topic that was once taboo. Despite my efforts and those of
others to bring sexual boundary violations into the light of day and
encourage prevention through seminars, regular consultation, and
institutional awareness and reporting, sexual transgressions with
patients continue to occur on a regular basis, often among analysts
Glen O. Gabbard, MD, Department of Psychiatry, Baylor College of
Medicine and Center for Psychoanalytic Studies, Houston, Texas.
Correspondence concerning this article should be addressed to Glen O.
Gabbard, MD, 6750 West Loop South, Suite 460, Bellaire, TX 77401.
E-mail: glen.gabbard@gmail.com
and therapists who are well regarded, thoroughly familiar with the
risks and dynamics of boundary issues, and well educated. As a
result, I have become increasingly pessimistic about our capacity
to prevent the occurrence of sexual relations between those who
practice psychoanalysis and psychotherapy and their patients. Per-
sonal analysis, education, and the use of consultants have undoubt-
edly prevented some clinicians from transgressing sexual bound-
aries, and these efforts certainly must continue. However, my
former optimism has waned over the years. My growing pessi-
mism has emerged from the recognition of the numerous ways that
individual clinicians can rationalize why their situation is some-
how different from others, the failure to utilize consultation or
supervision, and the inability of institutions to see what is in front
of their eyes. In this communication I will elaborate on my
understanding of how sexual boundaries develop and how they are
processed by individuals and groups.
Love in the Analytic Setting
Almost every analyst would acknowledge that some form of
love in its broadest sense is involved in the therapeutic action of
psychoanalysis. The problem we encounter is attempting to artic-
ulate what we mean by love in the analytic setting. Do we mean
patience, caring, and empathy? Do we mean parental love for a
child? Do we mean some form of transcendent love associated
with spiritual traditions?
In an optimal analytic process, the analyst’s love for the patient
is ultimately processed and metabolized into what Loewald (1970)
referred to as analytic love. Although Loewald himself did not
elaborate on this concept in his writings, Schafer (1992) has
proposed that Loewald was referring to the idea that the analyst
believes in the potential of the patient to benefit from the process
of analysis and safeguards the future of the analysand and the trust
within the analytic relationship so that development can take place.
Lear (1990) suggested that inherent in Freud’s writings about cures
of love is that psychoanalysis promotes individuation. “In that
sense,” he concludes, “psychoanalysis itself is a manifestation of
love” (p. 28).

151
 152 GABBARD
While most of us can relate to these notions about the role that
love plays in psychoanalysis, few of us would maintain that the
analyst can sustain a form of love that is “pure” – one that
transcends undercurrents of eros. In tracing Freud’s thought, Lear
(1990) noted that sex ultimately metamorphoses into love. Freud
throughout his career developed a growing awareness that libido
was what invests in objects. Hence sexuality was co-opted in the
service of other longings. Freud finally reached the conclusion that
what psychoanalysis referred to as sexuality was similar to the
all-inclusive love described by Plato.
To add a further complication, love in the analytic setting is
frequently used as a defensive posture against hatred or anger at
the patient (Gabbard, 1996). Many psychotherapists and psycho-
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analysts who have fallen in love with patients, sexually exploited
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patients, and otherwise destroyed the treatment relationship de-
scribe their feelings towards the patient as “love.” I have become
convinced that love is perhaps the most complicated word in the
psychoanalytic lexicon. Ferenczi (Dupont, 1988) was able to get at
the heart of this matter in an entry in his diary, where he acknowl-
edged that his own childhood feelings of aggression and hatred
towards his mother were often displaced onto his patients. He
noted that through a tremendous effort he was able to develop what
he termed an “intellectual super-kindness” in an attempt to over-
come such feelings and to be as loving as possible toward his
patients. In a May 5, 1932 entry, he courageously accepted that his
patient’s perception of feelings of hate coming from him was
accurate: “The patient’s demand to be loved corresponds with
analogous demands on me by my mother. In actual fact and
inwardly, therefore, I did hate the patient in spite of all the
friendliness I displayed” (Dupont, 1988, p. 99).
Freud, of course, had said 17 years earlier that the opposite of
love is not hate but indifference. Brenner (1982) even suggested
that the term erotic transference should be discarded because it
refers only to the surface or the phenomenology of the patient’s
attitude toward the analyst— he stressed that love is invariably
mixed with hate and vice versa as a matter of empirical observa-
tion. The same could, of course, be said about erotic countertrans-
ference. In those situations where we see an analyst in love with
his patient, we also see the potential for destruction of the analytic
treatment. Stoller (1985) noted that in normal sexual excitement,
there is almost always a measure of hostility. We want to use the
other to get something for ourselves. Hence no matter how altru-
istic the analyst’s efforts may be, it is impossible to completely
divorce eros/sexual desire and hate/aggression from love in the
analytic setting. In line with the fundamental psychoanalytic prin-
ciple that all close relationships are ambivalent, love and hate are
inextricably intertwined.
Psychoanalytic work has convinced me that loss, despair, and
grief are additional undercurrents in many cases of erotic and
erotized transferences and countertransferences, as well as in many
cases of sexual boundary violations (Gabbard, 1996). Sexualiza-
tion of the therapeutic relationship transforms painful feelings of
limits, loss, and disillusionment into exciting, pleasurable feelings
of longing. Many analysts have been told by patients, explicitly or
implicitly, “Don’t you see that your words do not help me?. I need
to be held and loved”. While there are many ethical and clinically
useful ways to intervene in these situations, some analysts who
succumb to a desire to rescue the suffering patient cannot face the
thought of increasing the patient’s dysphoria. The thought of
sending the patient into a downward spiral may fill the analyst with
dread— or even a sense of sadism and cruelty. Some analysts and
therapists may respond to their own descent into a black hole of
despair by projective disavowal, i.e., it is the patient who has
despair, not “me”. Analysts in this state may then attempt to
breathe life into the patient by rescuing her or him from the
perceived despair and showing the patient that he or she is desired
by the analyst. In effect, they are managing their own sense of
hopelessness through the analytic (or pseudo-analytic) work with
the patient.
Most patients harbor a version of what Sydney Smith called the
golden fantasy (Smith, 1977), namely, that somewhere there is a
person who will fulfill all their needs in a relationship hallowed
with perfection. This fantasy, activated by the presence of the
analyst, is doomed to failure. First and foremost, the relationship
will end. The end of the relationship is inherent in the beginning
because both parties know from the first session that it is a means
to an end, not an end in itself. One of the most poignant aspects of
termination was noted by Martin Bergmann (1997), who once
commented that transference love may have been the best love a
patient has ever known. It is understandable, then, that some
patients are highly reluctant to give it up. In other situations that
life presents, the relationship is likely to continue if love is felt by
both parties. Hence, what I am suggesting is that manic defenses
may be marshalled by both parties in the analytic enterprise to
deny the painful and inevitable loss that was etched in granite from
the beginning of the treatment. The shared unconscious fantasy
may be that “we may triumph over death.”
When there are personal losses in the analyst’s life, the analyst’s
despair and grief may be heightened so that he or she is likely to
be more vulnerable to the use of erotization as a way out of the
abyss. In these situations, analysts do not see the fundamental
paradox--namely that this way out of bleakness is actually a deeper
descent into darkness. The probable consequences of the actions of
loving the patient, hugging the patient, kissing the patient, or
taking the patient to bed, are career ending. However, manic
defenses may obscure the obvious aggression and contempt for the
patient. Years ago, an analyst who had engaged in sexual miscon-
duct with a suicidal patient said to me with completely serious
intent, “Everyone focuses on the negative aspects of our relation-
ship. No one can see the positive dimensions of it—after all, I
saved her from suicide.” I raised questions about his certainty on
this matter, and I pointed out that he had destroyed himself in his
quest to save her. He recounted a session with his patient when she
wept as she shared her despair about her marriage. Her husband,
she said, was oblivious to her needs. Her parents were both
deceased. She looked at him and said, “I have no one who loves
me.” He said, almost reflexively, “I love you.” She became angry
at him and said, “You’re a professional. I pay you. It’s not the
same thing”. He felt a sense of rage boiling up inside him. He had
been through this before with her. He thought to himself “What do
I have to do to convince her that she is loved?” He reached out and
held her as she sobbed. This session was a turning point that
initiated a profound change in their sessions. Each time they met,
he held her. Soon the holding turned into kissing and fondling.
Finally, it descended down the “slippery slope” to sexual relations.
As he later reflected about this descent, he recognized that he felt
a sense of despair at ever reaching her and grew increasingly
frustrated with her failure to respond to his analytic efforts. He was
 SEXUAL BOUNDARY VIOLATIONS
deeply concerned that she would kill herself, and he couldn’t bear
the thought that all his efforts were failing and he would lose her.
I pointed out to him how he had projected his own despair and rage
into her and tried to manage it in her rather than within his own
private self-analytic process. Moreover, in this scenario, like many
other desperate attempts to save the patient’s life, there is a failure
of mentalization and collapse of analytic space (Gabbard, 2003).
By holding her and loving her, there is an equation between the
symbol and the symbolized. He fails to recognize the “as if”
dimension of the countertransference and simply actualizes the
role of the loving parent.
Hence, in addition to the use of love as a defense against lust and
hate, analysts and therapists may use love as a manic defense
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against the hopelessness at the patient’s core, as well as against the
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loss and grief in the analyst’s life. A key point underlying every-
thing I have said so far is that we all rationalize, deny, and
otherwise try to find arguments to do what we know is out of
character for us and perhaps unethical. Yes, I use the word “all” to
stop us in our tracks from pointing a finger at a convenient
scapegoat—the “Unethical Analyst”, who we may insist is funda-
mentally different from the rest of us, thus projecting all of our
own vulnerabilities into a convenient container. We analysts can
rationalize any extraordinary enactment with a patient as somehow
acceptable. Isolation, enforced by confidentiality concerns, is the
analyst’s Achilles heel. Certainly there are some psychopathic
analysts who have been unscrupulous predators on vulnerable
patients. However, the majority I have seen do not fit that model.
Inability to Predict
Another source of my pessimism regarding the wholesale pre-
vention of sexual boundary violations is that we are not able to
predict which analysts or therapists are likely to sexually exploit a
patient in the future. During the course of my career as a consul-
tant, I have frequently received a call from an ethics committee or
professional society in another state where the caller says, “Dr.
Gabbard, this is the last person we ever would have expected to
engage in a sexual relationship with a patient.” Prominent analysts
who are highly regarded as clinicians, teachers and supervisors are
commonly involved in these kinds of behaviors as well as more
marginal individuals about whom many had concerns. Early in my
career, I made an effort to classify clinicians with a history of
sexual boundary violations with the idea that it was possible to
stratify these colleagues according to their position on a spectrum
of superego pathology. Those who felt they were in love with a
patient, i.e., the “lovesick”, or those who masochistically surren-
dered to a demanding patient who was threatening suicide, seemed
to have a more highly developed or mature capacity for superego
functioning (Gabbard and Lester, 1995). On the other hand, the
severely narcissistic individual with psychopathic/predatory fea-
tures was viewed as someone with significant superego lacunae or
even more primitive pathology— basically a thoroughly unethical
person. I have long had concern that this classificatory system
lends itself to moralizing about those who are “good” versus those
who are “bad.” While these categories continue to have some value
in thinking through the potential for rehabilitation and treatment,
over the last decade or so, I have come to the conclusion that they
are schematic at best. The multi-layered complexity of the motives
153
and psychopathology lying behind sexual boundary violations is
striking.
A growing body of research suggests that many people who are
considered ethical will be dishonest or unethical under certain
conditions. The notion of moral hypocrisy (Batson et al., 1997) is
defined as an individual’s ability to hold a belief while acting in
discord with it. Thoughtfully-designed investigations in this area
underscore the pervasiveness of moral hypocrisy—i.e., they indi-
cate that moral reasoning tends to be context dependent and that
people who are generally moral or ethical find it fairly easy to
justify immoral behavior (Valdesolo and DeSteno, 2006). Most
people tend to assess their own moral transgressions as less egre-
gious than the same transgressions when committed by others.
Hence in my more recent writing (Gabbard and Hobday, 2012,
Gabbard, 2016), I have argued for a less binary approach to
understanding those who violate boundaries with patients. In other
words, it is oversimplified to suggest that there is one group of
reasonably ethical practitioners and another group of purely un-
ethical practitioners. As long ago as 1982, Arlow made the fol-
lowing observation: “The superego is by no means a uniform,
coherent, integrated, harmonious structure. It is a mass of contra-
dictions, fraught with internal consistency, or, as we say in our
technical language, intrasystemic conflicts. It’s functioning is nei-
ther uniform nor reliable and it is in this respect that the idea of a
superego representing the policeman of the psyche holds up best.
Like the policeman in real life, the superego is hardly around when
needed most” (p. 234).
In an earlier era, the term “superego lacunae” was often used to
describe the capacity for corruption in basically honest persons.
However, even this term implies a fixed “hole” in one’s con-
science— hence, the slang term “swiss cheese superego”. In the
everyday reality of clinical experience, we find that the superego
is actually a fluid structure that involves a variety of identifications
from multiple developmental levels (Gabbard and Hobday, 2012).
As Arlow (1982) aptly put it: “The superego is very discriminating
in the treatment of the self. Like any judge in real life, it can be
corrupted, seduced, deceived, beguiled, distracted and seques-
tered” (p. 235).
In contemporary psychoanalysis, the tripartite structure of ego
psychology has become less and less useful in our psychoanalytic
work, and the notion of intrapsychic conflict has been supple-
mented, and to some degree, surpassed, by notions of a highly
complex set of internal object relations. In addition, the notion of
a self-structure that is consistent over time has been challenged as
well. Mitchell (1991), for example, notes that a unitary self is
largely a mythic construct, and the outcome of a good analysis is
often a more thoroughgoing recognition of the multiple selves of
the patient that vary depending on context. Hence, in an analytic or
therapeutic setting, different intersubjective configurations are
likely to trigger different internal self-object constellations that
may lead to ethical engagement in one particular analytic couple
but corrupt behavior in another, even though the same analyst is
present in both situations.
The ways that breaches of ethics are rationalized can assume
many forms. A common variation is “the rules don’t apply to me”,
a perspective suggesting that seniority or expertise has its privi-
leges. Some analysts and therapists have a sense of omnipotence
leading to the certainty that they can engage in unorthodox tech-
niques that might be problematic in the hands of others but are
 154 GABBARD
effective in their own hands (Gabbard and Hobday, 2012). Others
may contend that the power differential inherent in the clinical
situation simply does not apply to a particular treatment relation-
ship. They may argue that the analytic relationship has gone on
long enough such that the interactions primarily involve the “real
relationship,” and therefore no transference-countertransference
phenomena are relevant. More to the point, the analyst may assert
that there was no coercion or persuasion whatsoever used to
engage the patient in a sexual relationship. Still others may defend
themselves by saying that they have devoted themselves through-
out their careers to an altruistic and self-sacrificing approach in all
their professional work. They may feel that they have earned one
small transgression with one patient that others might characterize
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as unethical, but it is counterbalanced by a lifetime of unimpeach-
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able professional behavior (Gabbard and Hobday, 2012). Finally,
some analysts and therapists have adamantly maintained that if
they had not acceded to the patient’s demands for sexual relations,
the patient would certainly have committed suicide (Gabbard,
2003).
Pairing in Dyads and Groups
As noted above, times of loss and grief for analysts may be high
risk periods for boundary violations. A middle-aged analyst once
consulted me after his wife’s death. He said for the first time in his
career he could finally understand how it was possible for someone
to even think about a sexual relationship with a patient. He told me
that his loneliness was so intolerable and his neediness so intense
that he found himself looking to his patients to take care of him. He
told me that several of his patients were thrilled at the possibility
that they could reverse roles and take care of him for a change after
he had been so helpful to them. He stopped short of embarking on
an ill-advised relationship with one of his patients by seeking out
consultation after the temptation became hard to resist.
In these instances when grief and loss are prominent in one or
both parties, such as the time of termination of the treatment, I
have observed that Bion’s (1961) concept of pairing is frequently
a useful way to understand the phenomenon (Gabbard, 2016). Bion
noted that there are unconscious fantasies that lead groups to
behave in a predictable way that divert them from the task at hand.
His basic assumptions fell into three categories: dependency, fight/
flight, and pairing. These discrete emotional states were regarded
as unconscious in origin but could be inferred from the behavior of
the group. Bion’s initial observations were simply at a descriptive
level but he gradually recognized that the basic assumptions were
clusters of defenses against psychotic anxieties that are ubiquitous.
He also noted that the mechanisms associated with the paranoid/
schizoid and depressive positions were also present in the basic
assumptions.
The pairing basic assumption is a cluster of defenses against
depressive anxieties. The assumption in this instance frequently
revolves around two group members who will reproduce and bring
forth a “messiah” to rescue the group (Rioch, 1970). There is a
pervasive atmosphere of optimism and hopefulness, a belief that
love will prevail against all odds. This excessively Polyanna-ish
attitude may be viewed as a manic defense against the group’s
concern that destructiveness, hate, and hostility also exist within
the group. It may also be a defense against the spectre of impend-
ing loss that is too much to bear. In brief, pairing can be viewed as
a manic reparative effort (Ganzarain, 1980).
As the name implies, pairing can occur simply in a dyad, but
there is often an unconscious group process that contributes to the
phenomenon. Over time I have noted that analysts who have
become sexually involved with a patient have often become dis-
illusioned, bitter, and resentful about their analytic training, their
analytic organization or the analytic field in general. There is also
a deep narcissistic wound in such analysts who think that they have
not been treated in the way that they deserve to be treated by their
analytic colleagues. They may have been denied a promotion as a
training analyst or an administrative position. They also may feel
bitter about their training analysis itself. Ferenczi, for example,
was bitter toward Freud for never analyzing his negative transfer-
ence and said so in a letter to Freud (Dupont, 1988). He expressed
his anger by rejecting Freud’s technique and developing his own,
more indulgent methods, in which he would give the patient
maternal love (and even physical affection) that they did not
receive as children.
Hence, in a significant number of cases an analyst is uncon-
sciously expressing something about the group of which he is a
part, and there may be a pairing fantasy to deal with his painful
sense of having lost his faith, lost his position, or lost his soul in
the context of his analytic work. In some cases, the fantasy of
creating something new with a patient may be quite literal. I have
encountered a number of cases where a senior analyst who fell in
love with his patient had discussed with the patient the possibility
of their having a child together.
As I have argued elsewhere (Gabbard, 1999, Gabbard and Peltz,
2001), a comprehensive understanding of boundary violations and
their prevention requires an incorporation of the analyst and pa-
tient as members of a group or analytic community. In many cases
where boundary violations come to light, the analytic community
will react with such comments as, “Well, that’s no surprise. I saw
him with the patient at a restaurant a year ago.” Others may react
by saying, “This analyst has been boundaryless for years—in
supervision he tried to hug and kiss me.” Still others will retort, “I
always knew he was a lawsuit waiting to happen.” One can
speculate why this information had not been shared with col-
leagues in the analytic community at an earlier point so that
something might have been done. While such reluctance to be-
come involved has multiple determinants, there is often an uncon-
scious collusion in which the analytic dyad is acting out for the
group. It is useful to remember, as John Steiner (2000) has noted,
that we analysts hate analysis as well as love it. We may have
secret admiration for the analyst who throws off the shackles of
ethical prohibitions and superego restraints and indulges himself in
a manner that everyone else would love to do. The pairing fantasy
is broader than the dyad, and may include a wish that someone can
get away with what is unacceptable.
The Role of Consultation
While education about the risk of boundary violations may be
useful for some, the power of our own rationalizations is extraor-
dinary, and many will think that such concerns do not apply to
them since they are fundamentally ethical persons. Moreover, the
power of group forces may be difficult to address when one is
immersed in those forces as a member of the analytic community.
 SEXUAL BOUNDARY VIOLATIONS
A fundamental tenant of psychoanalytic life is that the unconscious
will always be resisted. Hence, our best hope for the prevention of
boundary violations involves regular consultation with a trusted
colleague. An outside observer of an analytic dyad often sees a
variety of vulnerabilities that are invisible to the analyst immersed
within that dyad.
Despite the wisdom of seeking out consultation to address the
blind spots that are universal in analytic work, we often encounter
formidable resistances to seeking consultation. The analyst will
lose an hour of income and spend a substantial fee for the consul-
tation from a colleague. The potential consultant may be viewed as
unable to understand the complexities of the particular treatment
that requires consultation because in one forty five or fifty minute
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consultation session, it would be impossible to convey years of
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treatment that has a myriad of dimensions to it that defy simple
explanation. The quasi-incestuous arrangement inherent in analy-
sis, where the secrecy of the sessions can resemble forbidden
activity, reality or fantasy, with a parent, may also serve as an
obstacle. One could even argue that the practice of analysis rep-
resents an unmentalized enactment of the wish to have a parent
exclusively to one’s self outside of the awareness of the other
parent (Gabbard, 2000). One can even avoid consultation under the
banner of protecting confidentiality of the patient. However, one
can use a consultant outside of one’s city via telephone such that
the patient’s name and the identifying features of the case are not
known to the outside analyst.
Even in the best of circumstances, where an analyst seeks
consultation, there are numerous ways that the consultation pro-
cess can be corrupted. The simplest way is to avoid revealing
everything that is going on in the treatment. Perhaps the major
resistance to regular consultation is the fear that one will look like
an incompetent or foolish clinician to the consultant. There are
numerous instances where someone seeks consultation after a
physical or sexual relationship has begun and simply leaves out the
fact that the sexual boundary has already been violated at the time
the consultation is started. Another form of corruption is so called
“curbside consultation,” in which the analyst or therapist simply
grabs a colleague for a cup of coffee or a chat and provides the
consultant a hastily thrown together abridged and brief version of
what is going on in the analysis while also asking for reassurance:
“Do you see any problem with what I am doing?” The person
selected as consultant under such circumstances is generally a
friend or well-known colleague who is known to respond with a
reassuring pat on the back.
Even if the consultation is more prolonged, the consultant can
still be selected according to the criterion that this particular
consultant will probably validate that “what I am doing is fine”. In
every analytic community, some analysts are known for being
“flexible” or “unorthodox” and are glad to endorse what others are
doing as a way to sanction expansions of technique rather than to
function as a professional superego. Hence the selection of a good
consultant is an endeavor that requires considerable thoughtful-
ness. The consultant must be an individual with whom the analyst
feels that he or she can share anything. On the other hand, one
must be wary of a consultant who is so accepting that he or she
might uncritically agree with whatever the analyst presents rather
than offer constructive criticisms where necessary. In the optimal
situation, the analyst carries the consultant into the analytic hours
with him or her as an internal presence. This internal consultant, a
155
variation of the “third” is in an ongoing dialogue with the analyst
throughout the session as the analyst contemplates various inter-
ventions with the patient.
Concluding Comments
Despite my concerns, I am not totally pessimistic about the
value of education. While many analysts and therapists are not
amenable to rehabilitation, I have been encouraged by the large
number who do have the capacity for rehabilitation after commit-
ting sexual boundary violations, acknowledging their transgres-
sion, and devoting themselves to a program of education, treat-
ment, and close monitoring (Celenza and Gabbard, 2003; Gabbard,
2016). These clinicians have endured the horrific experience of
letting down their families and colleagues, damaging their patients,
and publically humiliating themselves. Their omnipotence has
been punctured. Their professional—and human—vulnerability
has been accepted by them. They are often deeply committed to
avoiding any future breaking of the frame.
The majority of analysts and therapists –those who are not living
in the shadow of such a professional censure and embarrassment—
may still live with denial of the vulnerability we all share. More-
over, retreat into orthodoxy and rigidity is not a helpful solution.
One cannot avoid the risk of sexual boundary transgressions by
simply suppressing countertransference and emphasizing absolute
restraint. As Mitchell (1997) noted, “Excessive emotional detach-
ment is just as fertile ground for sexual violations as excessive
intimacy” (p. 198). What is disavowed (and often projected else-
where) may not appear on the analyst’s radar screen--out of sight,
out of mind. The analyst’s systematic self-awareness of fantasy
and desire can serve as a way of processing and contextualizing
feelings so they are not enacted. They can also be discussed with
a trusted colleague. However, the decisions regarding whether to
consult, whom to consult, and when to consult must be made on the
basis of a thoroughgoing desire to uphold the ethical standards of
the profession. Alas, like everyone else, we are consciously con-
fused and unconsciously controlled. The propensity for rational-
ization and lying to ourselves is formidable, and even those who
are ordinarily ethical may succumb to passion, contempt for the
patient and the profession, and misguided attempts to rescue.
Hence the reasons for personal analysis are clear.
Despite my reservations about the future elimination of this
Achilles’ heel of our profession, we cannot abandon our efforts to
encourage personal treatment for those who are presumptuous
enough to ask others to say whatever comes to mind. Similarly, we
must continue to teach and supervise, even though these efforts are
not going to put an end to sexual transgressions. We cannot
legislate consultation, but we can encourage it. However, preven-
tion of boundary violations depends largely on an individual
decision to put the patient’s needs before those of the analyst. The
psychoanalyst practices in a radically private and an unusually
intimate situation. Even more important, we are all masters of
self-deception.
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