Contemporary Psychodynamic Psychotherapy for Children and Adolescents by Sergio V. Delgado Jeffrey R. Strawn & Ernest V. Pedapati

Author:Sergio V. Delgado, Jeffrey R. Strawn & Ernest V. Pedapati
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

Boundaries in Two-Person Relational Psychology

Boundaries in the two-person relational model receive the most critiques from clinicians practicing from a one-person model. In this regard, gratifying a patient’s wishes is viewed as a slippery slope, as it not only contaminates the transference, it may also complicate countertransference phenomena. Common examples in two-person relational psychotherapy of a psychotherapist gratifying a patient’s wishes, so as to move along the psychotherapeutic process, include allowing a child in treatment to borrow a toy, hugging a patient before the psychotherapist’s vacation, sending birthday cards to a child or adolescent, and answering questions about the psychotherapist’s personal life. Importantly, these moments occur when the psychotherapist intersubjectively experiences that gratifying the wish is in the best interest of the patient, as it provides a new corrective experience that may have been lacking and, thus, would not be considered to be crossing a boundary (a deviation from a framework). Without a doubt, regardless to which psychotherapeutic theory one adheres, enactments occur and represent a continuum, from subtle issues helpful to patients to enactments with behaviors that are clearly harmful to the patient (e.g., exploitation, sexual involvement). Due to the complex nature of the psychotherapeutic work with children and adolescents, we suggest the psychotherapist to have regular consultation with a trusted colleague when they subjectively feel a dilemma regarding their interactions with their patients.

Exactly what behavior from the psychotherapist defines a boundary crossing or violation is clearly a complex matter in child and adolescent psychiatry, and it must be viewed within the context of developmental issues. The “American Academy of Child & Adolescent Psychiatry Code of Ethics” (2009) is designed to provide child and adolescent psychiatrists an ethical framework of practice. Boundaries in two-person relational psychology need to be flexible, intentional, and part of a well-thought-out enactment. Similar to a boundary crossing, in two-person relational psychology, the relaxing of a boundary occurs with forethought and intention and aims to advance the psychotherapeutic process. In the above example of the adolescent who forgot to lock his bike, the psychotherapist by going with the patient to lock the bike is enacting a form of relationship that he hopes will create a new and sustainable neuronal pathway stored nonconsciously in an implicit relational form. This is to say that the adolescent learns to defer to social etiquette over the safety of one’s own valuable property.

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