Kroll J
University of Minnesota Medical School, and Head Psychiatrist, Community-University Health Care Clinic, Minneapolis, USA.
J Am Acad Psychiatry Law. 2001;29(3):274-83.
A backlash against the self-actualizing psychotherapy movements of the 1960s and 1970s in concert with recent concerns about professional sexual misconduct has led some forensic psychiatrists to redefine many routine components of therapy as boundary behaviors. This concern has been followed by the development of conservative guidelines for how therapists should conduct themselves at the newly-defined boundary crossings so as to avoid "violations." The slippery-slope argument that seemingly innocuous boundary crossings may lead inexorably to professional sexual misconduct has lent an urgency and legitimacy to the guideline enterprise, obscuring the perspective that the newly postulated boundaries do not represent the consensus of practitioners in the field. Otherwise highly controversial claims about what is ethical and proper behavior in psychotherapy gain a mantle of incontrovertibility when linked to predictions that ignoring published boundary guidelines will result in damage to patient and litigation against therapist. In this article, three widely advanced boundary guidelines are examined (therapist neutrality, therapist anonymity, and stable fee policy) for coherence and relevance to the richly diverse practice of psychotherapy.
20世纪60年代和70年代对自我实现心理治疗运动的强烈反对，再加上近期对专业人员性行为不端的担忧，导致一些法医精神病学家将治疗的许多常规组成部分重新定义为边界行为。这种担忧之后，针对治疗师在新定义的边界跨越中应如何行事以避免“违规”，制定了保守的指导方针。看似无害的边界跨越可能会不可避免地导致专业人员性行为不端的滑坡论点，为指导方针的制定赋予了紧迫性和正当性，掩盖了新假定的边界并不代表该领域从业者共识的观点。否则，关于心理治疗中何种行为符合伦理和恰当的极具争议的主张，当与忽视已公布的边界指导方针将导致患者受损和对治疗师提起诉讼的预测联系起来时，就会获得一种无可争议的外衣。在本文中，对三个广泛提出的边界指导方针（治疗师中立、治疗师匿名和稳定收费政策）进行了审查，以考察其与丰富多样的心理治疗实践的连贯性和相关性。
