14 Aug The Sense and Nonsense of Boundaries. Transference Remembering and Resistence to Psychotherapy by Lawrence Hedges
People with a prosecuting mentality who sit on licensing boards and ethics committees have long been seduced by the plaintiff bar into naïve and nonsensical moralizing with regard to the concept of boundaries as applied to the practice of psychotherapy. Clearly a spatial metaphor derived from ethological concerns of territoriality, the concept of boundary refers to an imaginary line that I claim demarks what is mine from what I am willing to acknowledge as yours. Ethologists such as Robert Audrey in The Territorial Imperative (1966)i and Konrad Lorenz in King Solomon’s Ringii have studied extensively how members of various species work to establish and maintain these ever-shifting imaginary lines and how the power to establish and maintain functional boundaries both within and between the species operates in rich complexity.
The clearest referent in human life to the concept of psychological boundaries is real estate where lines of possession can be arbitrarily concretized by geographical landmarks such as rivers, mountains, and lakes or by reference to magnetic compass points. Ethologists are fond of demonstrating, however, that even in sophisticated human life it is still primarily aggression and the capacity and willingness to subdue and dominate others that in the final analysis determines the placement of these arbitrary lines—lines that nonetheless remain in perpetual question according to prevailing social concords and discords. Contemporary psycho-biologists such as Humberto Maturana and Francisco Varela (1987)iii have been able to revise evolutionary theory considerably utilizing communication theory and the concept of an environmental niche that each group of creatures learns over time to exploit by auto poetic (self-creative) means. The confines or the fixed and flexible functional boundaries of such niches effectively define the species and the various members of the species—male, female, young, dominant buck, ruling hen, and so forth—and cannot simply be defined by concrete references to genetics, anatomy, or geography.
Consider, for example, the functional boundaries of the population of a community of predators living in an eighteenth century New England village lighting its nighttime merriments by virtue of various species that existed in the Indian and Pacific Oceans and were carried in metabolized form around the globe by whales. Or contemporary predators such as ourselves aggressively stealing land from native populations and harnessing their river waters, minerals, and hunting grounds to fuel the wheels of our ever-expanding civilization. Not to mention using the possession of gunpowder and sailing know-how to establish a flourishing Black slave trade or to impress native Americans and imported Asians into agricultural, mining, and railroad- building slave labor. Clearly the first principle in boundary setting is a physical one– “might makes right,” or “what’s yours is mine if I can figure out some way of coercing it from you.”
The further study of life space and boundaries inevitably takes us into the area of the signs and signals that are used to demarcate and to defend territorial claims. For example, a duck displaying the dark spot on the back of its head communicates fear and a willingness to retreat that marks the cessation of invasive-competitive aggression. An aggressive display on the part of a hen warns would-be predators that she will stop at nothing to protect her nest and brood. The possessor of a territory by virtue of his marks communicates to would-be invaders that he has the competitive edge with his aggressive intent to defend at all cost what belongs to him. A nation that drops an atomic bomb to defend its territories is to be greatly feared. If living human tissue itself as a boundary cannot be respected then all life on the planet is indeed endangered.
If the life and livelihood of a practicing psychotherapist means so little to people sitting on a licensing board or ethics committee naively and thoughtlessly moralizing about boundary violations then we are all in danger. And that, I maintain is our situation today. Most readers will be aware of my extensive work consulting with and defending psychotherapists against transference-based false accusations and my familiarity with how concepts such as “unethical dual relationships,” “professional boundaries,” “standards of care,” and “boundary violations” are carelessly bandied about—much to our detriment.
For example, the California Association of Marriage and Family Therapists has the strongest track record I know of for being the most alert, proactive, and aggressive professional organization ever in standing against abuses of power by the state— represented chiefly by The California Board of Behavioral Sciences that regulates, polices, and prosecutes MFT’s in the name of consumer protection. CAMFT is to be congratulated for sponsoring many profession-protective bills, one of the most recent being a bill that establishes statutes of limitation for licensing board prosecutions—three years from when the complaint comes to the attention of the board and seven years from the date of the alleged unprofessional incident.
The governor of California not long ago, however, deplorably vetoed the CAMFT-sponsored bill designed to insure a fair hearing for accused therapists by holding the administrative law judge’s opinion binding when the credibility of the accuser is in question. This bill was a measure to prevent in certain cases the politically-appointed, economically biased, and mostly non-professional state board whose members have never so much as laid eyes on the accuser or accused, from cavalierly overriding the judge’s opinion and prosecuting therapists solely on the basis of a single consumer complaint—which it regularly does.
The appalling situation thus remains that licensing boards simultaneously act as the accuser of the therapist, the prosecutor, the jury, the judge, the sentencer, the probation officer, and the collector of all fees including payment of the complete expenses for its investigation—all without ever so much as hearing a single direct word from either the complainant or the defendant. Further, the accuser remains in a virtually anonymous position totally protected by board secrecy and client confidentially— violating yet another constitutional provision which guarantees that the accused has a right to be publicly faced by the accuser. Would we have so many false accusations if clients knew that their names too would be in local newspapers along with the bogus charges they were pursuing against their therapists? I think not. The boards’ policies of control and secrecy over the consumer complaint process encourage false accusations and insure that they will be prosecuted. This same basic form of administrative law exists throughout the United States and Canada.
It is incumbent on every practicing professional psychotherapist that she or he remain in an alert and active watchdog posture against encroachments into our professional life by state boards attempting to regulate us individually and collectively with a police and prosecution mentality. CAMFT is forever pounding its fist on the door of the BBS and has even gone so far as to successfully demand the replacement of its executive director and to bring civil suits against its unfair practices. By way of contrast, The California Psychological Association has entered into a lucrative, and blatant conflict-of-interest contract colluding with the Board of Psychology in policing the state mandated continuing education programs for psychologists in the name of consumer protection. The state board through this move has successfully taken unto itself the power to homogenize psychological practice and to define the effective standards of care for psychologists through directly supervising CPA’s accreditation of continuing education programs, thus threatening to destroy specialization training and to limit diversity of practice in psychology in California while simplifying further its task of prosecution (Hedges 2000a).iv CAMFT wisely rejected the same conflict-of-interest contract offered it by the BBS and has stood firmly against all regulation of mandated continuing education by the state as well as any other kind of boundary violations of professional therapists and of the profession by the BBS.
The worst part about the irresponsible cry of “boundary violation” by state boards is that it is done in the name of an unenlightened and naïvely moralistic and dogmatic set of skewed prosecution concepts regarding dual relationships, professional boundaries and standards of care. After a century of professional research and advancement we have finally arrived at the knowledge that human minds evolve out of early human relationships. And that the only deeply transformative experiences we can offer as helping professionals arrive by means of personally engaging our clients in intimate emotional relationships that have the power to bring into sharp view how previously internalized destructive relationships persist to color our experience of our current significant relationships.
The central concept of the contemporary relational approach to transformational psychotherapy remains that of transference—called by whatever name. Transference simply means that we learned in childhood certain emotional patterns of perception andresponse to relationship dilemmas that we encountered at various stages of our development. And that we tend to repeat unwittingly those emotional patterns in later relationships. It is this tendency to repeat familiar perceptions and approaches to relationships that intelligently fuels the psychotherapy process by showing therapists how people have become caught in various symptom-producing dynamics and activities. And pointing toward fresh ways of transforming ourselves and creating new relationship possibilities.
The information about deeply engrained patterns of our very early emotional relationships which is required for successful psychotherapeutic work is only available through the revival of transference memories as they are actively relived in the here-and- now trust relationship of the present with the therapist. This in effect means that the client who has been abused or otherwise traumatized in early childhood can only be freed from crippling symptoms and limitations to the extent that she or he can be encouraged to re-experience in some form or another the therapist or outside parallel others as the perpetrator of subjective pain and injustice. And then enabled through the central tool of psychotherapy, transference interpretation, to realize that it is not the actual therapist or therapeutic situation as it exists today that actively persecutes, but the sense of the internalized perpetrator from the primordial past living on in the client’s relational and bodily memories. This is the essential meaning of transformational cure in dynamic psychotherapy that people with prosecuting minds fail to grasp out of ignorance, blindness, or maliciousness.
Anyone who has taken the time to fully understand how the transference mechanism operates in human life and how each person desperately resists the revival of deeply traumatic transference experience will readily understand how at all points of transference elaboration—but especially well along in the therapeutic relationship—the client is highly motivated to externalize blame onto the therapist and the therapeutic process for the agony and misery she or he is currently experiencing, rather than to continue to allow an escalation of the pain and terror in the transference feelings until the sense of the internal persecutor can be successfully ferreted out, defined, and worked through. Experience with the ubiquitous and clamorous accusations against the therapist for doing this, for failing to do that, for not being there when I need you, for not giving enough, for failing to contain me, etc., that characterize the long-term, in-depth psychotherapy process with early trauma-based transferences, reveals that complaints which go awry and end up in an investigation or litigational process are most often triggered by out-of-therapy fluke incidents. Incidents that tip the delicate balance of desire and fear operative in ongoing transference development in the direction of a negative therapeutic reaction that effectively functions to put an end to the confusing and agonizing process of transference and resistance remembering (Hedges, 2000b).
There are four different developmental levels or kinds of early relationship experience that are distinctly different from each other and that require different therapeutic understandings and approaches as they appear in the course of transference and resistance remembering.
1. that relational memories from the triangular family life of the four to six-year-old child are generally revived by means of words, stories, symbols, and impulses that were painfully repressed at the time;
2. that the self-consolidation and self-fragmentation relationship memories from the three-year-old relationship era are later remembered in the ways that people seek out, demand, and utilize or fail to utilize self-confirming interpersonal resonances in the present;
3. that the four to twenty-four month relational bonding memories become available in the therapeutic interaction through the affective ways in which the client experiences the therapist and interactions with the therapist as good, ideal, and enhancing or as bad, abandoning, and damaging;
4. and that relational traumas from the last trimester of intrauterine development and the first four months after birth are somato- psychically recalled later in life by people coming to experience intimate trust relationships as being characterized by cruel neglect, terrifying rejection, and life-threatening, body-shaking, and mind- shattering confusion and hatred which become systematically projected into the therapeutic situation and onto the person of the therapist.
Anyone who seriously cares to understand the dynamics of transference remembering and the desperate resistance to the here-and-now emotional revival of relational and bodily traumas will quickly realize the tremendous motivation clients develop to abort the therapeutic process and to externalize the blame for experienced pain, terror, and damage onto the therapist and others with whom the person has or has had trust relationships. This was what the recovered memory fiasco of the early to mid-1990’s was all about. We had a nation of therapists trained to help people focus on the symptomatic physical and mental manifestations of anguish, terror, pain, betrayal, and damage that their clients had experienced as children. But therapists who had not schooled themselves in the subtleties of remembering by means of transference and resistance experience naively colluded with their client’s wish to externalize the blame by helping them point the finger at past perpetrators. And to act out the resistance to here-and-now transference remembering by actually confronting the remembered perpetrators—usually parents, relatives, neighbors, and others involved in early trust relationships.A decade of successful prosecution against such irresponsible therapists and tactics of “recovered memory therapy” has now established for all time:
1. that it is possible for the human mind to construct vivid and terrifying memories of events which never happened in the ways that people recall them,
2. that people who have been abused and traumatized in childhood have generally always retained memory for some or all of the abuse, and
3. that taking memories recovered in psychotherapy, hypnosis, or truth serum interviews literally is to fail to take the person who has been traumatized and/or abused in childhood seriously.
The recovered memory movement of the 1990’s clearly paralleled a social movement to lift the cultural veil of denial from our growing awareness of how widespread abuse of children, women, and other marginalized people has truly been through the ages—and how horribly destructive this abuse is to individuals who have experienced it as well as to our social order that has been willing to sustain it. As a civilization we are slowly coming to acknowledge the ravages of destruction inherent in the maxim, “might makes right.” And to bring into public awareness how people can and often do use whatever power differentials they have at their disposal to exploit and damage others by violating their human rights and personal boundaries.
But the most subtle and elusive of the many issues involved in understanding interpersonal boundaries and boundary violations is how extraordinary, idiosyncratic, and diverse the personal structures and vulnerabilities of each individual person’s sense of boundaries truly are. To even begin to do justice to the richness and diversity we now realize to be the subject of personal rights and boundaries—given the infinity of kinds of boundary-building experiences available to developing human beings—and how easily individually structured personal boundaries can be unwittingly violated would require an entire book with a detailed theory of internalized interpersonal relationships and extensive case illustrations showing what in various instances might conceivably constitute violations of personally established boundaries.
It is absolutely absurd and audacious for people sitting on a licensing board or for anyone else to pontificate moralistically on this complex realm of private human experience in such a way as to imply that they have the slightest idea of what anyone else’s personal boundaries are and what does and does not constitute a boundary violation for any given individual in any given situation. Naïve and irresponsible moralizing such as we see today in the name of prosecuting psychotherapists and policing consumer complaints can only lead to endless travesties of justice. I can only suggest here for further mediation and investigation several illustrative situations that may serve to challenge the naïve moralizing about boundaries that now characterizes the prosecuting mind. Consider how an infant who was damaged by never being held might well demand and legitimately need various kinds of holding in a transformative therapeutic experience of adulthood. And that far from some form of physical or mental holding by a therapist being a violation of that person’s boundaries the failure, because of doctrinal restrictions, for a therapist to reach out for meaningful moments of interpersonal contact might well constitute an even worse violation of the client’s need to develop fresh forms of interpersonal trust with newly formed boundaries.
Or consider a person who was so traumatized in infancy that personal relationships have been impossible for a lifetime until safety and trust was developed with a therapist who could attune to the ways in which neglect and hatred had been experienced in her early milieu and were repeatedly experienced in all subsequent relationships including the therapeutic one. As a result of her therapeutic experience the client is at last able to negotiate a love relationship that leads to an engagement and wedding plans. The only person on the planet who truly knows what this strenuous adventure has been for her must be present to celebrate this supreme and victorious moment of a lifetime. The therapist wants to attend the wedding and feels it vitally important to give a meaningful gift signifying her recognition of the crucial importance of this life passage. But because the state licensing board naively moralizes and removes therapist’s licenses for engaging in these kinds of “unethical dual relationships,” she feels prohibited from either attending the wedding or giving a gift. The massive violation of trust and replication of infant abuse which the bride-to-be now re-experiences destroys five years of therapeutic relationship-building along with valuable parts of the minds of both client and therapist. Because it is only possible for this woman who was so badly damaged in infancy to experience certain kinds of events in very concrete ways, she relives in a most agonizing and destructive way the cruel hatred she once knew at the hands of her infant caregivers. What a massive violation of delicately formed boundaries thoughtlessly perpetrated by members of the board in their absurd and blanket policies adopted in the name of policing therapists and protecting consumers.
Or consider a therapist seeing over a period of several years a deeply vulnerable person damaged by early birth trauma and repeated hospitalizations and surgeries in early childhood. As the relationship builds over time panic attacks and deep dissociative reactions with self-destructive gestures escalate frightening both client and therapist. The therapist has been well-schooled in the pervasive forms of holding and containing treatment for borderline clients widely practiced today and has regularly sought expert consultation and psychiatric backup, but the panic attacks, PTSD symptoms, and suicidal gestures become more frantic. Friends tell the client in her pain that she isn’t improving and that she should seek a new therapist. Members of her eating disorder group feel she doesn’t need therapy at all and that the seemingly heroic holding measures of her therapist violate her boundaries, are unethical, and should be reported. Seeking relief, she accepts weekend hospitalization where the emergency room psychiatrist, who has a cognitive-behavioral orientation, tells her she has been in therapy entirely too long with no signs of progress. He questions the ethics and practices of such a therapist, re- diagnoses her, prescribes medication and takes her into his practice. Deliverance from the pain and agony of remembering infant trauma is now at hand as the rage left from infancy surfaces and takes a vengeful turn against the therapist. Therapy abruptly ends and a complaint is filed against the therapist.
Where did the holding and containing therapy so widely practiced go wrong the therapist wants to know? From a cutting edge perspective we are able to discern that because of the massive trauma the client had experienced in infancy and early childhood, at each stage of intimacy-development with the therapist a fear of connection was gradually building. And that the holding and containing techniques employed—which are certainly well within the community standard of practice—have only served to escalate the terrifying transference left by therapeutic replications of the unspeakable pain, the debilitating fragmentations, and the unbearable rages once experienced in infancy. The frantic attempts on the part of the therapist to hold, to calm, and to contain that invariably work well on borderline clients fail miserably when the yet lower levels of organizing transference formation are activated. The therapist is then fused and confused in transference with the perpetrator experience of infancy—the parent who failed to protect the child from the unspeakable agonies and experienced abandonments of her infantile hospitalizations, surgeries, and recuperation periods. The therapist will undoubtedly loose her license or have it suspended for her many heroic efforts that can so easily be interpreted by outsiders as boundary issues, dual relations, failure to uphold community standards of care, unprofessional conduct, misdiagnosis, and faulty technique—all pointing to gross negligence on the part of the therapist.
Following the above suggestive possibilities we can quickly see that in virtually every aspect of relationship development of the psychotherapeutic process any event that can be conceivably be seen as a boundary violation can equally well be seen as a potentially healthy and crucial boundary development in delicate and nascent form. Only other experts with extensive experience in the practice of long-term transformational therapy should ever be allowed to stand in judgment of what any particular activity or event may or may not have represented in the moment of the therapeutic engagement!
Civil courts have long insisted that a heavy burden of proof be required of the prosecution when charges of professional malpractice are made since the life and practice-sustaining stakes for the defendant are so great. Courts regularly insist that both exploitation and damage be in clear evidence in order to establish malpractice. And that there is a clear, impelling, and unambiguous causal link between damage sustained by the accuser and the actions or inactions of the accused. When licensing boards prosecute simply because such-and-such an activity is interpreted by their uninformed and unprofessional opinion as indicative of such things as an “unethical dual relationship,” or a “boundary violation” and therefore a failure to uphold the community standard of care, they are failing to keep in mind that what needs to be in clear evidence is damage and exploitation—not simply specific questionable actions and activities that may or may not have occurred in the course of the therapy. When untrained boards sentence a therapist harshly on the basis of a consumer complaint without a fair trial and without regard to upholding an appropriately rigorous burden of proof, they operate on the absurd and un- American principle that the therapist is guilty until proven innocent.
The careless prosecutions currently being pursued by licensing boards and to a lesser extent by ethics committees are all the more alarming because of the re-strategizing by the plaintiff bar after the malpractice insurance carriers’ recent refusal to fund the investigation and litigation of sexual complaints. The result is that false accusations of sexual contact are carefully avoided now in favor of a potpourri of ill-sounding non- sexual complaints that are bandied about under such headings as dual relationships, failure to uphold the community standards of practice, unprofessional conduct, and professional negligence. The prosecution strategy, of course, is to win a licensing board conviction–which isn’t too difficult to do these days considering that the routine operations of licensing boards are heavily biased in favor of conviction. Then the judge and jury in the anticipated upcoming civil malpractice trial can be informed that the state licensing board which is vested with the sacred task of consumer protection has already found the therapist guilty in the administrative law court and voted unanimously to convict the therapist of unprofessional conduct and gross negligence. The judge and jury are told that the reasons for the state’s prosecution have to do with unethical dual relationships and illegal boundary violations—whatever the hell those are! And, after all,what does the ordinary citizen sitting on a jury know about such things compared to the austere governmental process of protecting the public from unscrupulous practices and fraudulent professional perpetrators?
I began here by considering the common sense of boundaries which belongs to all living creatures and moved to consider how the concept of interpersonal boundaries and boundary violations when thoughtlessly and carelessly used by prosecuting licensing boards and ethics committees can easily become itself a nonsensical and destructive boundary violation of professional psychotherapists. My purpose is to call attention to how easily we can slide from common sense understandings of boundaries into nonsensical moralizing about boundary violations that can then be used to justify mindless prosecution. And further, to suggest that it is ironic that those most loudly crying “boundary violation!” are doing so at the level of accusing therapists in a most unfair manner that appallingly violates all of us as individuals and as a profession.
By Lawrence E. Hedges, Ph.D
Remembering, Repeating, and Working Through Childhood Trauma: The Psychodynamics of Recovered Memories, Multiple Personality, Ritual Abuse, Incest, Molest, and Abduction. Infantile focal as well as strain trauma leave deep psychological scars that show up as symptoms and memories later in life. In psychotherapy people seek to process early experiences that lack ordinary pictorial and narrational representations through a variety of forms of transference and dissociative remembering such as multiple personality, dual relating, archetypal adventures, and false accusations against therapists or other emotionally significant people. “Lawrence Hedges makes a powerful and compelling argument for why traumatic memories recovered during psychotherapy need to be taken seriously. He shows us how and why these memories must be dealt with in thoughtful and responsible ways and not simply uncritically believed and used as tools for destruction.”—Elizabeth F. Loftus, Ph.D.
Working with Transference Remembering at Trauma Recovery Institute
Trauma Recovery Institute offers unparalleled services and treatment approach through unique individual and group psychotherapy. We specialise in long-term relational trauma recovery, sexual trauma recovery and early childhood trauma recovery. We also offer specialized group psychotherapy for psychotherapists and psychotherapy students, People struggling with addictions and substance abuse, sexual abuse survivors and people looking to function in life at a higher level. Trauma recovery Institute offers a very safe supportive space for deep relational work with highly skilled and experienced psychotherapists accredited with Irish Group Psychotherapy Society (IGPS), which holds the highest accreditation standard in Europe. Trauma Recovery Institute uses a highly structured psychotherapeutic approach called Dynamic Psychosocialsomatic Psychotherapy (DPP).
Dynamic Psychosocialsomatic Psychotherapy (DPP) at Trauma Recovery Institute Dublin
Dynamic Psychosocialsomatic Psychotherapy (DPP) is a highly structured, once to twice weekly-modified psychodynamic treatment based on the psychoanalytic model of object relations. This approach is also informed by the latest in neuroscience, interpersonal neurobiology and attachment theory. As with traditional psychodynamic psychotherapy relationship takes a central role within the treatment and the exploration of internal relational dyads. Our approach differs in that also central to the treatment is the focus on the transference and countertransference, an awareness of shifting bodily states in the present moment and a focus on the client’s external relationships, emotional life and lifestyle.
Dynamic Psychosocialsomatic Psychotherapy (DPP) is an integrative treatment approach for working with complex trauma, borderline personality organization and dissociation. This treatment approach attempts to address the root causes of trauma-based presentations and fragmentation, seeking to help the client heal early experiences of abandonment, neglect, trauma, and attachment loss, that otherwise tend to play out repetitively and cyclically throughout the lifespan in relationship struggles, illness and addictions. Clients enter a highly structured treatment plan, which is created by client and therapist in the contract setting stage. The Treatment plan is contracted for a fixed period of time and at least one individual or group session weekly.
“Talk therapy alone is not enough to address deep rooted trauma that may be stuck in the body, we need also to engage the body in the therapeutic process and engage ourselves as clients and therapists to a complex interrelational therapeutic dyad, right brain to right brain, limbic system to limbic system in order to address and explore trauma that persists in our bodies as adults and influences our adult relationships, thinking and behaviour.”