P0310 - Boundaries, ethics and chaos theory in psychotherapy

Abstract

Physicists tell us that to understand a phenomenon is to know its borders. To know where one entity ends, and another begins, is an essential component to living in harmony with the environment. At the same time, the maintenance of boundaries produces tension. There seems to be a natural urge to surrender boundaries and to merge with the universe. While initially exhilarating, this experience can also be damaging. Such is the case in psychoanalytic psychotherapy when boundaries are blurred between clinician and patient.

Through vignettes and personal observations of the author the impact of blurred boundaries in the psychoanalytic relationship will be presented. My previous research has shown that when clinicians allow boundaries to blur then there are often significant untoward treatment reactions that are interpreted as transference and resistance when they are not.

When negative treatment reactions are manifested during the course of treatment, the frame is rarely considered as the source of the problem. A psychoanalytic interpretation is often used to explain the phenomenon. This may be a technical error.

Concepts taken from chaos theory such as "sensitive dependence on initial conditions" (which means small changes in input can produce large changes in output) may better explain negative treatment reactions than psychoanalytic theories do. This may be particularly true in cases of iatrogenesis.