Limit setting: theory, techniques, and risks.

Abstract

Limit setting is a necessary aspect of clinical treatment but the professional literature on this subject is relatively sparse and does not address many core issues, including some countertransferential and ethical problems raised by the approach. Many clinicians struggle with the "authoritarian" nature of limit setting, especially when they have great power over patients as in a hospital setting. This paper traces the theory of limit setting back to Freud's conception of "acting-out in the transference" and the corresponding need by clinicians to manage nihilistic behavior which threatens the treatment process, whether inpatient or outpatient. When done properly, setting limits makes working with acting-out patients viable, enabling them both to master devastating early experiences and to replace restraint by others with self-control. Techniques are addressed which lead to the responsible and effective use of power, but at the same time observing the social and practical limits inherent in the approach.