When Boundaries Betray Us: Beyond Illusions of What is Ethical in Therapy and Life

A story of psychodynamic therapy gone disastrously wrong. Psychodynamic therapy can generate violent sexual feelings directed at the therapist (irrespective of client/therapist gender or orientation, incidentally) and at the same time loosen the client's grip on reality, producing perceptual distortions and a feeling of depersonalization. When these become too powerful, the client attempts to relieve herself by "acting out". In Heyward's case, this took the form of an obsession with developing a friendship with her therapist. "Acting out" in this sense is not some form of adolescent misbehavior, but in many cases a very painful and damaging syndrome which can end in hospitalization or even suicide. I was very unimpressed with "Elizabeth"'s handling of the episode. Her main concern appears to have been to protect herself legally, which was excusable, and emotionally, which was not. From this book, one gathers that she hid behind a wall of denial, both of what was happening and of her client's suffering, and did not take any positive action to relieve that suffering, such as, for instance, arranging psychiatric care or some form of professional third-party involvement. The problem, of course, is that "acting-out" episodes are frequently attributed to therapist incompetence - "good" therapists are supposed to be able to contain them - whereas I suspect it may happen with anyone given the wrong conditions. The reason I did not give this book five stars is that I do not agree with Heyward's contention that "patriarchal" structures were responsible for her episode. Rather, the issues were informed consent - therapy clients should be properly notified of what may happen to them, emotionally and sexually, before embarking on such a venture - and therapist ethics, in this case the need for therapists to display a sense of responsibility when therapy-induced breakdowns do occur. In effect, "Elizabeth" turned up the heat, found she couldn't take it, and ran out of the kitchen, leaving her client in hell.

I found this book to be an excellent study as to how badly a psychotherapist can damage a clients emotional and psychological health, and then blame or discredit the client for bringing on that damage, instead of taking responsibility for harming the client. This is called counter-transference in the profession. I can also fully understand why many psychotherapists including social workers and psychologists would hate this book; many therapists do not like to take responsibility for counter transference, which is basically hate or abuse directed towards clients. It does not portray the profession in a good light. It does, however, bring out many unfortunate truths inherent within the psychotherapy industry, and also is a premier as to what kind of psychotherapists to avoid. It get's five stars from me!

Carter writes personally of her own experience in therapy, and the problems within it as a woman, lesbian, and person. Her therapy crashes, not because it failed AS A WHOLE, but because of the problems of the therapeutic model-i.e. Therapist as an authority. It is brilliant, as Carter challenges this model, which is rigid and, unfortunately, centuries old, and presses against fine boundaries which pretend to protect us but actually serve to subtley harm us. She is very sensitive, and anyone who would have strong feelings against this book either doesn't understand or has never felt the kind of passion for someone that Carter writes of. A brilliant book.

Heyward writes from her personal experience of a therapeutic realtionship that has gone bad and her struggle to reconcile herself and her feminist ideals with this experience. Her conclusions challenge the assumptions on which current professional ethical standards are based. She calls us to re-think the balance of power in therapeutic relationships and seek new ways to relate in feminist models of power and relationships. Mental health professionals will find her analysis disturbing as it shakes the foundations of our ethical codes. However, Heyward's analysis is an essential voice to be heard if feminist therapists truly seek to remove the patriarchal assumptions from our professional practice.

Carter Heyward has written a brilliant book on the failure of her psychotherapist, in essence, to own her issues. In contrast to another review I read about this book, it is not an 'embarrassing read on borderline behavior", but rather the very real development of a relationship. I actually identified t with this book as I had a very similar experience with a therapist. There are VERY few models that I have found that deal with the "patient" BECOMING, and maturing and being able to challenge the therapist. This is precisely because therapy is built on a patriarchal model, and this is what Ms. Heyward very thoroughly (perhaps a tad redundant at times) describes. Either health exists inside a person, and needs healing, or it is "given" to the person, as the patriarchal model suggests. There needs to be mutuality for development of health and relationship. She is extremely insightful, and articulate in her writing, and describes the push- ! ! pull of a relationship developing very accurately. I think if one is a psychotherapist in a traditional sense, it is almost impossible for one to understand this book, for precisely the reason that Carter suggests. She is way beyond her colleagues, and any genius in this world that shines, is always in the beginning, harshly criticized. Excellent book, and the critiques in the end are excellent as well.