Altruism and Boundary Violation

ABSTRACT

The desire to help others is a common motivation for becoming a therapist, and boundary crossings are an expectable part of psychotherapeutic work. However, progression to boundary violation is rare. The concept of an altruistic boundary violation is presented and illustrated with detailed clinical material drawn from the analysis of Mrs. A,¹ a generally ethical therapist, whose violation of the therapist/patient boundary with her patient, M, began as an altruistically motivated enactment and boundary crossing. In Mrs. A’s case, and arguably in all similar altruistic boundary violations, a specific fit existed between patient and therapist. The intense need to rescue this particular patient was fueled by Mrs. A’s history of early physical and abandonment trauma, which increased her vulnerability to overidentification with her traumatized patient. The stress of relocation to another city and closing her practice further magnified her susceptibility. The complex clinical, professional, ethical, and legal issues inherent in consulting on such a case are discussed. I describe my countertransference and my parallel enactment, an initial crossing of the boundary between the roles of supervisor and therapist.

Acknowledgments

A much earlier version of this article was presented as “Inhaling Mom: The Atmosphere of Maternal Altruism” at the 94^th Annual Meeting of the American Psychoanalytic Association in Seattle, Washington, June 11, 2005. Material from the case of Mrs. A was presented at the Margaret Mahler Symposium in Philadelphia, Pennsylvania, April 26, 2014 and is published as Seelig, B. (2015), A therapist’s maternal altruism. In: Human Goodness: Origins, Manifestations, and Clinical Implications. ed. S. Akhtar. Latham, MD: Rowman and Littlefield, pp. 61–73.

Notes

1 Mrs. A has read this article and agreed to its publication. In it, her identity is disguised.

2 For a scholarly, encyclopedic, and highly readable treatise on altruism bringing together Buddhist teachings and Western science, see Ricard (2015).

3 See Batson (2011).

4 In his discussion of Winnicott’s work in “The Intuition of the Negative in Playing and Reality” (Green, 1997), André Green illustrates the similarity between his conceptualization of the “dead mother” (Green, 1986, p. 142), who is dead even though present and physically alive, and that of Winnicott.

5 See Batson (2011) for a summary of 35 years of rigorous experimental support of the hypothesis thatempathic concern produces altruistic motivation. Empathic concern is defined as other-oriented emotion elicited by and congruent with the perveived welfare of someone in need. Altruistic motivation is a motivational state with the ultimate goal of increasing another’s welfare-or in the present context, with the ultimate goal of removing the empathy-evoking need. [pp. 79–80]

6 I am indebted to Frances Baudry (personal communication) for bringing my attention to this aspect of my work with Mrs. A. See Baudry (1993) for his discussion of parallel process in supervision and the difficulties inherent in acceding to the supervisee’s request for the supervisor to also function as therapist.

Additional information

Notes on contributors

Beth J. Seelig

Beth J. Seelig, M.D., is Clinical Professor of Psychiatry, Columbia College of Physicians and Surgeons, and Training and Supervising Psychoanalyst, Columbia University Center for Psychoanalytic Training and Research. She is Professor Emerita, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, and Training and Supervising Psychoanalyst, Emory Psychoanalytic Institute.