Sexual boundary violations are considered the most series ethical infraction in the mental health profession, as well as in higher education and pastoral counseling. Recognized as unethical due to the power imbalance inherent in the structure of the therapist-patient and teacher-student dyads, erotic contact between therapists and patients has been revealed in prevalence studies to occur at an unacceptably high incidence rate (9 to 12 per cent) among mental health practitioners. There exist few programs, teaching methods, and preventative measures that adequately address the problem of sexual boundary violations, despite the fact that discussing this problem openly is no longer taboo. Sexual Boundary Violations addresses this gap, providing educators, trainers, and clinicians with a resource to aid in developing programs, ethics workshops, seminars, and other educative or clinical teaching projects.
Andrea Celenza is one of a handful of mental health professionals who has studied the problem of sexual boundary violations in the helping professions. Where others speculate, she brings years of clinical experience to bear on the subject. The result is a highly informative and comprehensive overview of the causes, consequences and casualties of sexual boundary violations. She maintains a humane perspective and offers valuable strategies for rehabilitation and treatment. All mental health professionals would be wise to spend some time with this superb new book.
— Glen O. Gabbard, M.D., chair of psychoanalysis, The Brown Foundation; professor of psychiatry, Baylor College of Medicine, Houston, Texas
An outstanding book that belongs in every therapy training program, but not just to help the trainees. It is a humanely and well-written reminder of our own vulnerability and the unjustified, moralistic attitudes that keep more people from seeking help when they are losing control.
Dr. Celenza holds the various phenomena involved in sexual boundary violations by therapists and clergy to a multi-faceted lens of clinical psychoanalysis, supervisory consultation, psychological testing, empirical research, ethics, law—and that metapsychologically elusive human attribute called decency. She extends and deepens the existing knowledge in this realm while introducing many intriguing and useful novel concepts of her own. Avoiding the pitfalls of sentimentality and moralizing, Celenza unmasks the ubiquitous vulnerability to such transgressions and the profound damage caused by them. She delineates ameliorative and preventive strategies aimed at minimizing such betrayals. Unerringly compassionate in its approach, Celenza's work is a shining tribute to the essential humanity at the heart of the psychotherapeutic enterprise.
— Salman Akhtar, M.D., professor of psychiatry, Jefferson Medical College; training and supervising analyst, Psychoanalytic Center of Philadelphia
Sexual Boundary Violations is an essential text for the mental health field and should become required reading for therapists, analysts, teachers, and clergy. I am sure that we will use it in our training program as part of the required course on professional ethics. Comprehensive, well organized, clearly written, with numerous and often gripping clinical illustrations, the book not only reviews the literature but provides practical and helpful guidance for clinicians and clergy as well as for those who teach and supervise them.
— Lewis Aron, Ph.D., New York University Postdoctoral Program in Psychotherapy and Psychoanalysis
Andrea Celenza eloquently captures the damage—to themselves, their victims, their professions, and the wider social fabric—inflicted by professionals and clergy who transgress sexual boundaries. Her incisiveness about the non-negotiable need for sexual integrity is achieved, however, without unnecessarily demonizing those who cross lines that never should be crossed. Rather, she combines clarity tempered with compassion in addressing the characteristics of perpetrators. Most importantly, Celenza insists upon differentiating among transgressors. She challenges us to appreciate the unique humanity and circumstances of people many of us wish to lump together and dissociate from consciousness. She challenges us instead to hold in mind paradox and contradiction. This book is a vital component of continuing education and consciousness-raising for all of us who vow first to "do no harm."
— Mary Gail Frawley-O'Dea, Ph.D., author, Perversion of Power: Sexual Abuse in the Catholic Church
Sexual Boundary Violations is an outstanding book that belongs in every therapy training program, but not just to help the trainees. It is a humanely and well-written reminder of our own vulnerability and the unjustified, moralistic attitudes that keep more people from seeking help when they are losing control. Andrea Celenza writes and thinks clearly and explores her sensitive material in an evenhanded and matter-of-fact way. She manages to educate us about a moral dilemma while adeptly modeling and encouraging us to view even the gravest missteps with curiosity and compassion.
Her work spans training, consultation, supervisory, therapeutic, rehabilitation, and research contexts, and thus she is able to write from a position of highly specialized experience and expertise.
— Psychologist-Psychoanalyst Division 39 Newsletter
The author of this book notes at the outset that her book focuses on sexual boundary violations, but does so within the context of an examination of broader boundary issues. She observes that boundaries in the professional milieu facilitate the effectiveness if wirj and help protect the integrity of the relationship when there is a power differential, for example between a doctor and patient, employer and employee, or supervisor and student. Celenza reviews, with great scholarship, the literature on her subject.... The book is a valuable additino to the examinatino of sexual boundary violations and should form part of any study of ethical practice, as well as providing insight into the mindstuff of therapists who commit them. Recommended.
— Metapsychology Online Reviews
Part 4 I. Nature and Scope of the Problem
Chapter 5 1. How Do They Happen?
Chapter 6 2. This Couldn't Happen to Me
Chapter 7 3. Precursors to Therapist Sexual Misconduct
Chapter 8 4. When is a Couch Just a Couch?
Chapter 9 5. The Therapeutic Context
Chapter 10 6. Academic and Supervisory Contexts
Chapter 11 7. Sexual Misconduct in the Clergy
Part 12 II. Reporting, Fallout, and Recovery
Chapter 13 8. Reporting and Other Ethical Responsibilities
Chapter 14 9. Collateral Damage and Recovery
Chapter 15 10. Helping the Victims
Part 16 III. Rehabilitation
Chapter 17 11. Therapy of the Transgressor
Chapter 18 12. Helping the Helpers: Supervision of the Transgressor
Part 19 IV. Prevention
Chapter 20 13. Responsible Responsivity
Chapter 21 14. Love and Hate in the Countertransference: Preventing Violations Through Supervision
Chapter 22 15. Boundary Violations Vulnerability Index (BVVI)
Chapter 23 16. Teaching Boundaries, Experiencing Boundaries
24 Appendices: Empirical Research
25 Appendix A: Personal and Interpersonal Characteristics of Transgressors: Co-investigator: Mark Hilsenroth
26 Appendix B: A Rorschach Investigation: Co-investigator: Mark Hilsenroth
29 About the Author
About the Author:
Andrea Celenza, PhD, is an assistant clinical professor at Harvard Medical School. She has authored and presented numerous papers on therapists who have engaged in sexual misconduct with a focus on training, supervisory, and rehabilitation issues. She is the recipient of several awards, including the Karl A. Menninger Memorial Award, the Felix & Helena Deutsch Prize, and the Symonds Prize. She is in private practice in Lexington, Massachusetts.