Boundary issues in countertransference: A developmental perspective

In treatment, characterologically disturbed patients evoke affective and behavioral responses that are frequently antitherapeutic. Such responses reflect the therapist's involvement in a reciprocal relationship in which the patient attempts to communicate very early pathogenic experiences. In this process the therapist is induced to act in ways that replicate significant aspects of the patient's first reciprocal relationship. Problematic replications may be recognized and modified when therapists carefully monitor their own boundaries between thought, affect, and action. This developmental paradigm is particularly useful in resolving therapeutic impasses that result from the patient's need to use the therapist as a real rather than a symbolic object.