Boundary violations in therapy: the patient's experience of harm

Abstract

SUMMARY Harm in talking therapies, and in healthcare professionals’ relationships with patients generally, has received little attention in comparison with harm by medication and other treatments. There has been little research into causes, types and effects. Professionals behave as if it does not happen and tend to react defensively to complaints. We believe that it is essential for professionals to understand the potential for harm and evaluate their actions in order to make them safer. This article defines harm in the therapeutic context, discusses its prevalence and then focuses on adverse idealising transference: the adverse effects that may arise when a patient transfers idealising feelings onto the professional. LEARNING OBJECTIVES • Develop a greater understanding of the problem of harm in psychotherapy • Be aware of adverse idealising transference and its possible harmful implications • Be aware of therapist actions that may encourage the development of an adverse idealising transference DECLARATION OF INTEREST None.