A phenomenology of closeness and its application to sexual boundary violations: a framework for therapists in training

Sexual boundary violations remain a persistent problem in psychiatry despite increased attention, disciplinary activity, and educational efforts. Currently, therapists in training are often overwhelmed by a sense of danger in every direction, including the risk of false accusation. The authors present a framework for understanding experiences of closeness that can help overcome a trainee's paralyzing bewilderment and attendant longing to retreat from the practice of psychotherapy. Eight characteristics of ordinary psychotherapeutic engagement effectively maximize the intensity of interpersonal closeness between patient and psychotherapist while simultaneously reducing the experience of closeness outside the treatment setting for both patient and clinician. An important consequence is that drifts toward sexual boundary violations can arise from the everyday dynamics of closeness, even in the absence of individual pathology or intent. The implications for the practice of psychotherapy and personal lives of psychotherapists are explored.