Clinical dilemmas in psychotherapy: A transtheoretical approach to psychotherapy integration.Therapeutic Neutrality, Self-Disclosure, and Boundary Management: Dilemmas of Therapeutic Engagement.

Abstract

The ambiguities of the patient's transference and the therapist's countertransference, as well as the self-protective uncertainties of the patient's resistances in the therapeutic process, have made the establishment of therapeutic neutrality and the respect and observance of the professional boundaries of the psychotherapeutic relationship important methods for infusing measures of certainty and definition into what is, at times, a highly equivocal interpersonal process. As discussed in chapter 2, Freud (1912/1958c, 1917/ 1963, 1937/1964a, 1940/1964b) made recommendations regarding various ground rules of psychoanalytic treatment that have had a long history in this field of study. Included among these ground rules are that the therapist remain relatively anonymous to the patient and neutral with respect to the patient's particular life problems, as well as maintaining the boundaries surrounding the confidentiality of the patient's treatment. Freud in later years acknowledged: "The 'Recommendations on Technique' that 1 wrote long ago were essentially of a negative nature. I considered the most thing was to emphasize what one should not do, and to point out the temptations in directions contrary to analysis" (see Jones, 1955, p. 241). As also noted earlier, Freud himself, on numerous occasions varied substantially from these published recommendations (Lynn & Vaillant, 1998). But, what dilemmas make it so difficult to uniformly apply these seemingly reasonable and straightforward, black-and-white rules or recommendations to treatment in each and every case? (PsycINFO Database Record (c) 2009 APA, all rights reserved)