Gabbard G O
Karl Menninger School of Psychiatry and Mental Health Sciences, Menninger Clinic, Topeka, Kansas 66601-0829, USA.
Am J Psychother. 1996 Summer;50(3):311-22. doi: 10.1176/appi.psychotherapy.1996.50.3.311.
The study of sexual boundary violations, through the actual evaluation and treatment of therapists who have engaged in sexual misconduct, reveals that all of us are potentially vulnerable to violations of this nature. A number of lessons can be learned from the detailed examination of these cases. These lessons include the following: (1) There is a difference between the conscious and unconscious intent of the therapist. (2) "Love" in the therapeutic setting is fraught with problems, including the fact that it is often used as a defense against the therapist's own aggression. (3) Supportive therapy and boundaryless therapy often become confused when a therapist switches from an expressive to a supportive approach. (4) The thoughts, feelings, and behaviors that a therapist would most like to keep secret from a supervisor or consultant are the most important issues to discuss with that supervisor or consultant. These observations have a number of implications for prevention. Matters of technique are inevitably conflated with issues of ethical principles so that the teaching of ethics must include discussions of transference, countertransference, and the use of third parties, such as supervisors or consultants, to assist the therapist in the monitoring of professional boundaries.
通过对有性行为不端行为的治疗师进行实际评估和治疗来研究性边界侵犯问题，结果表明我们所有人都可能容易受到此类侵犯。从对这些案例的详细审查中可以吸取一些教训。这些教训包括：（1）治疗师的有意识意图和无意识意图存在差异。（2）治疗环境中的“爱”充满问题，包括它常常被用作治疗师自身攻击性的防御手段这一事实。（3）当治疗师从表达性方法转向支持性方法时，支持性治疗和无边界治疗常常会混淆。（4）治疗师最想对督导或顾问隐瞒的想法、感受和行为，恰恰是与该督导或顾问讨论的最重要问题。这些观察结果对预防工作有诸多启示。技术问题不可避免地与伦理原则问题交织在一起，因此伦理教学必须包括对移情、反移情以及利用第三方（如督导或顾问）协助治疗师监测职业边界的讨论。
