Chapter 4.The Role of Suicidality in Sexual Boundary Violations

Suicidal patients, by their very nature, touch on a special vulnerability that is an occupational hazard of analysts. Most of us prefer to think of analytic work as something other than a life-or-death matter. We visualize our ideal patient as an intelligent, reflective, attractive person, haunted by intrapsychic conflict but strongly motivated to understand (hopefully, a person somewhat like us). This much-desired patient embraces life and wants to make changes so life can be lived more fully. By contrast, suicidal patients have determined that life has little to offer and that analysis is a dubious proposition. What insight could possibly transform life into a journey worth traveling? These patients quicken the analyst’s pulse by rejecting a priori the notion that analytic insight has the potential to make life worth living. In cases of sexual boundary transgressions in which the analyst is male and the patient is female, it has been reported that more than 50% of the patients are actively suicidal (Celenza and Gabbard 2003). We often speak of such “widening scope” patients as being on the border of what analytic treatment can address, but my experience as a supervisor of candidates and a consultant to colleagues suggests that these patients are increasingly common and have moved from the borders to the heart of psychoanalytic work.