3, 1996
INTRODUCTION
Address correspondence to Robert S. Pepper, 110-50 71 Road, Forest Hills, New York 11375.
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Surely, Tausk and Deutsch were ultimately responsible for their own
choices. One can only imagine the enormous pull toward unconscious grati-
fication that must have been exerted so close to the master's feet. The wish
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to be emotionally fed by Freud and the fear of displeasing him, may have
blinded both Deutsch and Tansk to the dangers of blurred boundaries.
In a previous paper, I described the seductiveness of these types of
incestuous arrangements in the psychoanalytic community (Pepper, 1990).
Under such conditions, the demarcation between reality and transference
can become so diluted as to render the analysis hopelessly contaminated.
To believe that one is beyond the dangers of blurred boundaries simply by
virtue of one's brilliance is an act of hubris.
In the following example, the work of a contemporary clinician is pre-
sented. Once again issues of blurred boundaries and the contamination of
the treatment seem to be directly linked to the personality and character
of the therapist. This case posits a particularly thorny ethical issue, since
the clinician consciously decides to operate outside the bounds of the wis-
dom of the field.
for the patient, the negative consequences of this wild arrangement are
apparent in their way first session.
The patient, Lisa, makes what seems to be an oblique reference to
him when she describes her feelings about doctors: "I hate doctors they're
all ugly, really" (Weinberg, 1990 p. 12). Weinberg tries to reassure her that
he only wants to help but he seems to miss the unspoken message that
Lisa is communicating.
In compromising that treatment through blurring the boundaries, he
has lost considerable leverage as a therapist and has created a situation of
mistrust (of his motives) that no amount of reassurance could assuage. The
patient unconsciously knows she is in danger but is helpless to verbalize
this awareness directly. Instead, she tells him indirectly about her feelings
toward him through her reference to feelings toward doctors.
My interpretation of this episode appears consistent with Robert
Langs' theory of deviate frame therapy (Langs, 1989). Langs believes that
patients are exquisitely sensitive to violations of the frame of treatment but
are not able to directly respond. Instead, patients communicate symbolically
through encoded messages and dreams. Amazingly, Weinberg's description
of what appears to be bizarre digression by Lisa, is actually a predictable
response to a frame violation according to Langs' theory. Lisa asks him,
apparently out of nowhere "Did you know that termites, when they're un-
der attack, create more soldiers than usual? In one week, they give birth
to ten percent warrior termites instead of two" (Weinberg, 1990, p. 14).
Weinberg encourages Lisa to describe the details of the termite behavior,
apparently thinking that this is only a metaphor for Lisa's relationship to
her mother who is characterized as the "queen termite." However, it might
also be that Lisa's presentation is an example of what Langs calls iatrogenic
paranoia which is "reflected in stories of spies, intruders, unwanted com-
pany, inept people who can't function for themselves and so on" (Langs,
1989, p. 123). Lisa says that her job is to protect her mother from intrusive
men. Given the incestuous nature of the relationship between Weinberg,
Lisa and her mother, it would seem that Lisa may in referring to him.
Weinberg himself appears to confirm this conjecture. In pressing Lisa for
details about Susan's life, he admits" in retrospect, I'm sure I would have
asked, even if I'd had no residue of curiosity about Susan and the way she
lived" (Weinberg, 1990, p. 15).
Perhaps the most glaring disregard for the ethics and wisdom of the
profession appear in an episode in which Weinberg gives Lisa money so
that she can take her sick cat to the vet. Weinberg, apparently aware that
some readers might have a problem with this, responds to his unseen critics
by using an ad homonym argument. Rather than defend his position on a
theoretical basis, he justifies his behavior by contemptuously dismissing
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daughter. The giving of money frees him from feeling helpless and provides
a false sense of power. However, Lisa is left in the unenviable position of
having to contain the feelings of impotence that both she and Weinberg
share in relation to her mother. In other words, the clinician's narcissism
is gratified at the expense of the patient's need to separate and to struggle
with life's problems autonomously.
The prime dictum of any professional code of ethics is: "above all
else, do not harm." However, the clinician who acts on feelings of omnipo-
tence in the treatment, can do harm. Such therapists often believe that
they can breach the boundaries without consequence. Therein lies the dan-
ger.
The rules of analysis protect everyone, the clinician included. Adher-
ence to the frame minimizes the potential for the most destructive forms
of unconscious contamination from entering the treatment. While adher-
ence to the rules alone does not necessarily guarantee good therapy, it
seems that violation of the frame increase the risk of iatrogenic treatment
reactions.
Clinically, the valuation of gratification above analysis that is often
reflected in breaking the frame of the treatment, robs the patient of the
therapeutic need to experience the fully intensity of the negative transfer-
ence. Even under ideal conditions, patients tend to protect the therapist
from the extremes of their angry feelings. When the patient is overly grati-
fied through a deviation of the frame, there is a greater tendency for the
patient to disown these negative feelings. But these feelings do not just
disappear, what often happens is the patient acts these feelings out in their
life, or they act them in, in the treatment through some form of treatment
destructive, or self-destructive behavior.
Omnipotent therapists do not often see the connection between their
own behavior and these types of resistances. Herein lies an ethical danger
of acting out omnipotent feelings by the clinician. The therapist who breaks
the frame of treatment is under moral obligation to be alert to any regres-
sion on the patient's part and to be prepared to determine the extent to
which the regression is iatrogenic. If the clinician is unwilling to consider
this as part of the problem, then patients are in great danger. When pa-
tients are held responsible for all impasses in treatment, serious decom-
pensation can occur (Temerlin and Temerlin, 1982). The need for
boundaries then is the need for accountability. In breaking the frame the
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REFERENCES