Ethics Question/Discussion - Boundary Violations

[Ceke2002]

So, just like it says on the tin - boundary violations. Always reportable under all circumstances no exceptions or do you fall more on the side of 'it depends'? Can all Psychiatrists/Therapists who violate boundaries be considered 'predators' to one degree or another, or is this an experiential fallacy* of sorts (*one patient's own experience of a violation as being predatory influencing other's perception, the harmful shrink trope in film etc)? If not predation, then what leads an otherwise ethical practitioner to engage in boundary violations?

I suppose at this point I should make it abundantly clear that I am not, in any way, shape or form, talking about my Psychiatrist or anything even remotely tied to him or our therapy sessions. The question/topic was inspired by a Psychotherapy forum I occasionally lurk at. One of the members has just experienced a boundary violation by their now ex therapist. Long story short, from what I can gather the therapist has/had been under some possible personal or emotional stress recently, developed feelings for/an attraction towards his patient, the patient admits to having transference feelings of their own, things came to a head about a week or so ago, therapist admitted his feelings to the patient in the midst of what sounds like it was heading towards a fairly passionate embrace, patient broke away, left the office, has since been back to discuss what happened, their report of the therapist's response seems to be a mixture of immature emotional attempts at justification followed by realisation of what they'd done, the patient has now decided to terminate therapy and end all contact with the therapist.

Now the story would probably have ended there, except for the hue and cry from the other members that clearly this therapist is a psychopathic predator who is probably out trawling for his next victim as they speak, and should therefore be metaphorically shot on sight by any means available (report him, bring in the lawyers, blackmail's always an option, etc etc). They've basically just stopped short of gathering pitchfork's and lighting torches.

The thing is though, I find myself disagreeing with them over all. I know what it's like to be predated upon by a Psychiatrist/Therapist who was basically a psychopath, and none of what has been told so far with this story would indicate it's anywhere near to the same thing. To me it sounds like this particular Therapist has obviously made some pretty clear mistakes, and had one heck of a momentary lapse of reason, but not to the point of rousing mob justice and stringing the guy up from the nearest lamp post. Should he undergo some sort of disciplinary action? Yes, in my opinion. Should he be required to complete some sort of intensive counselling course, preferably with someone in a supervisory capability? Yes, in my opinion. Should he be dragged from one arena of discipline to another and have his life and career completely ruined? No, I don't agree with that.

Am I wrong? Should having a 'zero tolerance' policy on boundary violations mean *all* therapists who violate boundaries should be made an example of? Is there any one right answer in a situation like this, or is that a little too much like reductionism?

I've already heard the patient(s) side of things, now I'm interested in hearing the professional's take on the situation.

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[whopper]

The health care provider falling for a patient, now that's inappropriate but it does happen to some people who mean well. What the therapist should've done was either keep the patient but maintain boundaries (in other words: not told about the attraction and dealt with it on his own), or if the therapist couldn't handle it, transfer the patient to someone else.

Was the provider wrong? IMHO yes but like you it might have been a one-time thing-where yes he's still wrong but not a predator (though still needing some type of intervention from above). It could've also been that maybe this guy is a predator and this admission of mutual feelings is a type of come-on line he has practiced on several others.

There's no way for me to tell.

What would happen if this guy was in an organization and the organization found out what happened is the boss or someone in authority would talk to the provider to hear his side of things. In such cases, the provider is judged but more so on their long-term performance given that severe misbehavior (e.g. assault, sexual aggression) did not happen. If someone severe happened the police would be contacted. Reason why long-term is taken into acct is frankly in our profession we providers could get falsely accused. A guy, for example with no prior bad reports on his record, plus the patient have a history of false accusations, well guess what? They're likely not going to believe the accuser.

The accuser could of course take up a complaint with the state board for the therapist, but they'd likely do the same thing the organization would do.

In our profession, we are full-aware of this type of thing and we are supposed to recognize when it happens before the crap hits the fan and do something about it before it gets to that.

 

[Ceke2002]

The health care provider falling for a patient, now that's inappropriate but it does happen to some people who mean well. What the therapist should've done was either keep the patient but maintain boundaries (in other words: not told about the attraction and dealt with it on his own), or if the therapist couldn't handle it, transfer the patient to someone else.

Was the provider wrong? IMHO yes but like you it might have been a one-time thing-where yes he's still wrong but not a predator (though still needing some type of intervention from above). It could've also been that maybe this guy is a predator and this admission of mutual feelings is a type of come-on line he has practiced on several others.

There's no way for me to tell.

What would happen if this guy was in an organization and the organization found out what happened is the boss or someone in authority would talk to the provider to hear his side of things. In such cases, the provider is judged but more so on their long-term performance given that severe misbehavior (e.g. assault, sexual aggression) did not happen. If someone severe happened the police would be contacted. Reason why long-term is taken into acct is frankly in our profession we providers could get falsely accused. A guy, for example with no prior bad reports on his record, plus the patient have a history of false accusations, well guess what? They're likely not going to believe the accuser.

The accuser could of course take up a complaint with the state board for the therapist, but they'd likely do the same thing the organization would do.

In our profession, we are full-aware of this type of thing and we are supposed to recognize when it happens before the crap hits the fan and do something about it before it gets to that.

Thanks Whopper, I knew I could count on you to give a fair and balanced assessment of the situation. I'm refraining from saying anything in the thread in question myself, because on the one hand I don't want to sound like I'm coming across as dismissing the obvious distress the patient is experiencing (a lot of which I recognise as having gone through myself - fear, shame, self recrimination, anger, etc etc), but on the other hand, with the information provided thus far, I also don't feel I can, in all good conscience, join in with the mob cries of 'crucify the b*stard!'

I do absolutely agree that at the first sign of attraction to a patient, whatever the reason, the therapist in question should have either sought help to deal with the feelings and maintain boundaries, or immediately transferred if that was proving to be not possible. I'm certainly not defending the guy's actions, not in the least, he dropped the ball in a major way and a patient is now paying the price. Is there a particular climate of stigma or fear of litigation/losing one's reputation/career/etc in the US that leads to therapists not feeling able to seek assistance for issues such as developing feelings for a patient. or is it just that the resources aren't there to help a therapist deal with these types of situations before the slippery slope slides all the way down to a boundary violation? I know my own Psychiatrist, especially dealing with complex trauma cases and all manner of personality disorder presentations, has a union supplied therapist he can access at any time if he feels the need (whatever that need might be), as well as a private Psychoanalyst who is available to him as well. Is anything like this standard practice, or even in place in the US system?

 

[whopper]

I've never had any attraction issues happen to me in inpatient. A lot of it is easy-because most inpatients are on the dredges and show it. E.g. rotten teeth, no education, no bathing for weeks, etc.

But on outpatient private practice I've had quite a few times where I had to mentally say to myself, "don't go there." For example, imaging having a patient that is attractive, goes to the gym almost daily, is very intelligent, educated, and tells you her hobbies and they happen to match many of yours. Many private practice patients are types of people physicians tend to identify with such as someone with a graduate degree.

In PP I've had to set extra firm boundaries. Several of my former patients that I haven't seen in several months even have attempted to befriend me thinking that it's alright because I'm no longer their doctor and haven't been for over a year. Several have tried me to get me to date their sister or daughter even though I'm married. ("Yeah I know you're married doctor but if it doesn't work out I want you with my daughter. You're such a good guy!")

Many residents don't understand this because in residencies, all of which are funded by Medicare/Medicaid, you usually end up treating someone very socially undesireable by a physician's standard. In private practice it's very different.

For clarification I do not mean that I find mentally ill people socially undesirable. For example I worked with a very good NP that had mental illness and was on meds and doing very well. I very much liked her personality. But in inpatient psych in a downtown area, it's not the mental ilness so much as it is the homelessness, the lack of hygiene, the drug abuse, prostitution, antisocial attitudes, lack of education, etc.

 

[nitemagi]

Feelings are feelings. Actions are actions. Having feelings is expected, unless you're a robot. Having counter-transference should be expected in some circumstances, just like bias exists. DOING something with those feelings in the room is a problem. It's predatory if you're manipulating a patient for your own satisfaction, at the expense of their health (to be distinguished from getting satisfaction from helping someone get better). But where many lose persoective is when they cross boundaries and rationalize it to themselves.

Anecdotally, the most rigid boundaries were often maintained in the analytic community, and yet that's also where I've heard about the most egregious violations (like many analysts marrying their patients in the 60s/70s).

 

[Ceke2002]

I've never had any attraction issues happen to me in inpatient. A lot of it is easy-because most inpatients are on the dredges and show it. E.g. rotten teeth, no education, no bathing for weeks, etc.

But on outpatient private practice I've had quite a few times where I had to mentally say to myself, "don't go there." For example, imaging having a patient that is attractive, goes to the gym almost daily, is very intelligent, educated, and tells you her hobbies and they happen to match many of yours. Many private practice patients are types of people physicians tend to identify with such as someone with a graduate degree.

In PP I've had to set extra firm boundaries. Several of my former patients that I haven't seen in several months even have attempted to befriend me thinking that it's alright because I'm no longer their doctor and haven't been for over a year. Several have tried me to get me to date their sister or daughter even though I'm married. ("Yeah I know you're married doctor but if it doesn't work out I want you with my daughter. You're such a good guy!")

Many residents don't understand this because in residencies, all of which are funded by Medicare/Medicaid, you usually end up treating someone very socially undesireable by a physician's standard. In private practice it's very different.

For clarification I do not mean that I find mentally ill people socially undesirable. For example I worked with a very good NP that had mental illness and was on meds and doing very well. I very much liked her personality. But in inpatient psych in a downtown area, it's not the mental ilness so much as it is the homelessness, the lack of hygiene, the drug abuse, prostitution, antisocial attitudes, lack of education, etc.

I can definitely see that finding a particular client attractive would be one of the things a therapist would have to navigate at some point in their career, as I said to my Psychiatrist once it's not exactly like you're a couple of computers sitting there typing machine code at one another so invariably the very humanness of the therapeutic experience is going to come into play and obviously practicing therapists need to be prepared for that. I do personally differentiate between a therapist simply finding a patient attractive (or vise versa), and being attracted *to* that patient. If I'm perfectly honest I do happen to think my own Psychiatrist is an attractive man with a lot of very good and admirable qualities. I've told him as much, some years into the therapeutic relationship, and he has graciously returned the compliment - none of which ads up to either of us having any sort of actual attraction *towards* one another. Having been previously abused in therapy, and not just abused but abused in a very systematic way that involved a lot of psychological manipulation and grooming, I am highly attuned to any signs of inappropriateness in any sort of medical or therapeutic setting so I took my Psychiatrist's compliment in the manner it was intended - a matter of fact statement, with no rippling under currents of anything else, designed to simply be what it was, a polite compliment. I can see though how another patient, not having personal experience of the individual dynamic my Psychiatrist and I have, might interpret that as completely inappropriate and jump to the wrong conclusion. I can also see how a patient being paid the same compliment, even in the same manner, might also misinterpret the intent and feel it was a boundary crossing if not an outright violation. I suppose that's where it comes down to the skill of the therapist to be able to know and read their patients as individuals, and understand to what extent the therapeutic frame can be adjusted (whilst still remaining intact of course) on a case by case basis. Having said all that, and we're going to just slip into the twilight zone for a moment and pretend this would even be possible, if my Psychiatrist did develop an actual attraction towards me I would expect him to do the ethical thing and seek assistance in managing his feelings and retaining boundaries at the nearest possible opportunity (and I have no doubt he would). Obviously the therapist in the exampled situation given previously didn't do that, and for that the blame does lie squarely with him - he was aware of the situation, he chose to not address said situation, and by doing so allowed the situation to get out of hand.

 

[birchswing]

@Ceke2002 You might enjoy the television show In Treatment. The first two seasons in particular are really good. It's about a psychiatrist (I believe he's supposed to be a psychiatrist but he practices psychotherapy) and he himself sees a supervisor (another psychiatrist/psychotherapist). He deals with this exact issue. I saw the US version, which if I recall correctly was based off an Israeli show with the same premise.

 

[Ceke2002]

@Ceke2002 You might enjoy the television show In Treatment. The first two seasons in particular are really good. It's about a psychiatrist (I believe he's supposed to be a psychiatrist but he practices psychotherapy) and he himself sees a supervisor (another psychiatrist/psychotherapist). He deals with this exact issue. I saw the US version, which if I recall correctly was based off an Israeli show with the same premise.

Yep, seen it, enjoyed it, read some interesting commentary from a Psychotherapist on the series as well. Hang on, let me see if I can find the link...

*puts on waiting music*

Here we go, I forgot there are actually a couple of commentaries from a professional perspective - this one from a Jungian psychotherapist.

http://www.jung-at-heart.com/jung_at_heart/hbos_in_treatment/

And one from a contributor to the Online Journal of the International Forum for Psychoanalytical Education.

https://ifpe.wordpress.com/2008/04/08/critique-of-in-treatment-on-hbo/

And judging by some of the Laura/Paul shipper vids on YouTube, I think at least some of the show's audience kinda missed the point like whoa!

 

[CBSstalker]

@Ceke2002 You might enjoy the television show In Treatment. The first two seasons in particular are really good. It's about a psychiatrist (I believe he's supposed to be a psychiatrist but he practices psychotherapy) and he himself sees a supervisor (another psychiatrist/psychotherapist). He deals with this exact issue. I saw the US version, which if I recall correctly was based off an Israeli show with the same premise.

Very good show! Gabriel Byrne does a great job portraying the role of a psychologist.

 

[Ceke2002]

Feelings are feelings. Actions are actions. Having feelings is expected, unless you're a robot. Having counter-transference should be expected in some circumstances, just like bias exists. DOING something with those feelings in the room is a problem. It's predatory if you're manipulating a patient for your own satisfaction, at the expense of their health (to be distinguished from getting satisfaction from helping someone get better). But where many lose persoective is when they cross boundaries and rationalize it to themselves.

Anecdotally, the most rigid boundaries were often maintained in the analytic community, and yet that's also where I've heard about the most egregious violations (like many analysts marrying their patients in the 60s/70s).

Agreed on the first part, definitely. I've had a similar conversation in session with my Psychiatrist, along the lines of (paraphrased) 'It's okay for us to have feelings for one another within the confines of the therapeutic setting (as in feelings that are mutually beneficial for the therapeutic process), but once you step outside those confines you run the risk of entering into dangerous slippery slope territory, so boundaries, yay!'

I do know of one former therapist/patient interaction that did eventually end in what is now a 10 year marriage. It is the only case I've ever been aware of where I actually come down on the side of supporting the couple, regardless of the manner in which they met (as distasteful or objectionable as some people may find that). In this case it was the therapist of a mutual support group friend, situated in one of the European countries where patient/therapist relationships are allowed following a certain period of time after therapy has ended (2 years I think, but don't quote me on that). They abided by the law, had no contact during the required separation period, both sort individual counselling to determine whether or not their feelings for one another were real or a transferential/countertransferential construct of the artificial environment of the therapy room, and eventually determined that having fully and knowingly examined all aspects of themselves they did wish to engage in a committed relationship -- and by all accounts the therapist and her now wife are still enjoying a solid relationship, and the therapist is still in practice. Now of course having said all that I can also see how it would also become all too easy, given the same circumstances of allowing therapist/patient relationships after a cooling off period, for someone whose intent wasn't so honourable to use the excuse of 'but we're in love' to justify trapping their patient in a marriage that was based on an imbalance of power, and potential issues of control, manipulation and abuse. So as much as the diehard romantic in me goes 'Awww' when I hear the first example, the realist in me immediately pipes up with 'Wait a minute, if we allow Y to happen under X circumstances, then where exactly is the line?'

 

[psyche108]

In regards to ethical boundaries for American psychiatrists, I also have a few questions. I read somewhere that after the doctor-patient relationship has been terminated, the two are not allowed to intentionally come into contact for the rest of their lives. Apparently, the APA suggested at first that there should be no intentional contact for 10 years, but now they say that they need to keep away contact forever. Is that true?

In that case, what do psychiatrists do in case they run into their patients outside of the office (as in they run into them while grocery shopping or in a movie theater or church or whatever)? Does that also mean psychiatrists should not take patients that they might have some sort of relationship with? As in say a friend asks you to treat one of their relatives or your spouse has someone in their family that requires psychiatric treatment, would it be considered a violation to treat those people because there's a high chance you're going to run into them outside of the office at various events or functions?

 

[Shikima]

Are the ethical boundaries different for psychiatrists in other parts of the world?

 

[Bartelby]

In regards to ethical boundaries for American psychiatrists, I also have a few questions. I read somewhere that after the doctor-patient relationship has been terminated, the two are not allowed to intentionally come into contact for the rest of their lives. Apparently, the APA suggested at first that there should be no intentional contact for 10 years, but now they say that they need to keep away contact forever. Is that true?

In that case, what do psychiatrists do in case they run into their patients outside of the office (as in they run into them while grocery shopping or in a movie theater or church or whatever)? Does that also mean psychiatrists should not take patients that they might have some sort of relationship with? As in say a friend asks you to treat one of their relatives or your spouse has someone in their family that requires psychiatric treatment, would it be considered a violation to treat those people because there's a high chance you're going to run into them outside of the office at various events or functions?

Sexual feelings in psychotherapy are, sadly, a taboo topic even within psychotherapy training (if you don't believe me, imagine discussing sexual fantasies about your patient in case conference). Check out the book Sexual Feelings in Psychotherapy by Pope, Sonne and Holroyd for a great analysis of this. In short we as a field have shied too much away from the topic which can lead to refusal to acknowledge and appropriately process sexual feelings when they arise, failure to seek appropriate supervision in these cases, guilt and/or withdrawal from the patient and therapy, or in the worst cases acting on these feelings and having sex or another inappropriate relationship with the patient. Of note, as Whopper alludes to above, finding a patient attractive is not wrong; where you get into trouble is acting on those thoughts in a damaging way.

In terms of avoiding sexual contact forever, the answer is yes, that is the current consensus. It is really better to consider a patient off-limits forever sexually. With regard to avoiding treating members of your social circle, I would recommend that as well. Obviously treating a friend's family member is not a boundary violation or akin to having sex with a patient, but it may create unnecessary awkwardness for you if you are privy to the private business of your social circle. Really it is more for your protection/wellbeing in my mind, but it is something to work out case by case.

As for the OP therapist, it seems obvious the therapist made a mistake. I think there is not enough information to know the therapist's intentions, though nothing in that narrative makes me think "wow, that person must be a psychopathic predator." This outcome could be the result of anything from inadequate processing of emotions on the therapist's part to a genuinely predatory attitude, who really knows?

 

[nitemagi]

Avoiding sexual relationship forever, yes. There are no rules about avoiding "contact" forever. You have a relationship. It's silly to pretend like treatment didn't exist.

 

[Ceke2002]

Are the ethical boundaries different for psychiatrists in other parts of the world?

In Australia there is a zero tolerance policy on all proven sexual boundary violations and some pretty strict guidelines and ethics otherwise that Psychiatrist's are expected to adhere to.

This is RANZCP's (Royal Australian and New Zealand College of Psychiatrist's) general code of ethics for Psychiatrists.

https://www.ranzcp.org/Files/Resources/College_Statements/code_ethics_2010-pdf-(1).aspx

 

[Ceke2002]

I've never had any attraction issues happen to me in inpatient. A lot of it is easy-because most inpatients are on the dredges and show it. E.g. rotten teeth, no education, no bathing for weeks, etc.

It's predatory if you're manipulating a patient for your own satisfaction, at the expense of their health

Anecdotally, the most rigid boundaries were often maintained in the analytic community, and yet that's also where I've heard about the most egregious violations (like many analysts marrying their patients in the 60s/70s).

That is one thing I find interesting, although 'interesting' isn't exactly the right word, in examining my own situation - the fact that the Psychiatrist in question didn't adhere to just abusing any sort of particular patient type in terms of attractiveness, or social status, education, intelligence, etc, none of that. It wasn't like okay here's this lecherous old man who completed his training in the early 70's, and one can imagine he might have been part of that whole 'encounter' therapy movement back then, and now here is some 28 or so years later choosing the cream of the crop from his patient list and creating his own little harem of abuse, his only criteria for whether or not he made sexual advances towards patients seemed to be 'exactly how vulnerable is this person and can I use that vulnerability to my advantage' (although in the cases of the patients he assaulted whilst they were under conscious sedation I don't think he gave a monkey's about their actual level of vulnerability when they were awake, once they were knocked out they were fair game like all the rest). I know he derived satisfaction, if not outright pleasure, from inflicting pain and humiliation on patients and then watching the results of that, so I have very little doubt that for him the sexual abuse was more of a power and control trip than any actual need to satisfy an itch, so to speak.

My understanding though, at least from the little research material I have been able to access, is that these types of more extreme end of the scale, psychopathic predators within the medical profession are actually quite rare, thank the gods!

 

[Shikima]

In Australia there is a zero tolerance policy on all proven sexual boundary violations and some pretty strict guidelines and ethics otherwise that Psychiatrist's are expected to adhere to.

This is RANZCP's (Royal Australian and New Zealand College of Psychiatrist's) general code of ethics for Psychiatrists.

https://www.ranzcp.org/Files/Resources/College_Statements/code_ethics_2010-pdf-(1).aspx

That's my point. It's across all countries and cultures.
I think it was the 11th commandment. Thou shall not taking advantage of your Pt/Client/whatever.

 

[Ceke2002]

That's my point. It's across all countries and cultures.
I think it was the 11th commandment. Thou shall not taking advantage of your Pt/Client/whatever.

Yeah, sorry that was actually meant as a backing up of your statement not to indicate you were seriously questioning whether or not the ethics differed.

 

[whopper]

I don't know where the recommendation is in writing but for relationships, a psychiatrist is never to have one with a former patient, ever. Now how does one enforce it? I don't know.

The rule is more relaxed with non-psychiatric physicans but I don't know the exact policy. It's either something to the effect of a relationship could exist after the treatment relationship ends, or a year after that, or something like that.

Closest I ever came to a boundary violation, and it wasn't with a patient, was a nurse. I really liked her personality and while my marriage was going through one of those periods where it was redefining itself (anyone married for over 5 years knows what I'm talking about), the nurse saw this as her chance to pounce on me. I never cheated on my wife but let's just say that actions this nurse took to make me a conquest would've made for some great scenes in the movie American Pie.

A few years later she ended up marrying a guy that looked almost exactly like me. What bugged me was that she really was a great nurse and I would've loved to have been good friends with her but after an incident where I literally was fighting her off of me (while also saying to myself-why didn't this happen to me all those years I was single!) I figured we couldn't be friends.

 

[Ceke2002]

I don't know where the recommendation is in writing but for relationships, a psychiatrist is never to have one with a former patient, ever. Now how does one enforce it? I don't know.

The rule is more relaxed with non-psychiatric physicans but I don't know the exact policy. It's either something to the effect of a relationship could exist after the treatment relationship ends, or a year after that, or something like that.

Closest I ever came to a boundary violation, and it wasn't with a patient, was a nurse. I really liked her personality and while my marriage was going through one of those periods where it was redefining itself (anyone married for over 5 years knows what I'm talking about), the nurse saw this as her chance to pounce on me. I never cheated on my wife but let's just say that actions this nurse took to make me a conquest would've made for some great scenes in the movie American Pie.

A few years later she ended up marrying a guy that looked almost exactly like me. What bugged me was that she really was a great nurse and I would've loved to have been good friends with her but after an incident where I literally was fighting her off of me (while also saying to myself-why didn't this happen to me all those years I was single!) I figured we couldn't be friends.

Wow, rule number one - never sleep with friends or colleagues, that is just asking for trouble. Not to mention coming on that strong, I would have felt uncomfortable even if I were single.

And agreed with the enforcement of ethics as well. It's a very good question, if you're going to have clearly stated rules and ethics in place, then those rules and ethics should be enforced when someone steps outside of them, as with a boundary violation. A lot of the time they're not though, or they're enforced haphazardly. It's a problem here as well.

On a lighter note, I think my clothes were trying to commit their own boundary violation last session with my Psych. Awkward wardrobe malfunction resulting from a mismatch of under and outer garment materials, meaning the outer garment (a semi wrap around V neck top) kept getting pulled down way lower than where it's actually meant to sit, and of course by the time I noticed anything was wrong I was already running late and didn't have time to change, so hellllooooo cleavage! I'm just grateful my extremely professional and morally grounded Psychiatrist doesn't tend to pay much attention to things like that (or if he does he's extremely good at hiding it).

 

[whopper]

I've never seen ethics enforced unless the violation of them were just so over the line and illegal.

Robert Kehoe was one of the first guys in science to have a conflict of interest and was being heavily funded by grants by corporations that were dumping lead into the environment. He made a lot of money stating lead wasn't a big deal in public health. Yet at U of Cincinnati, despite that most there know now what the guy was doing and that it was damn-well unethical they still have a chair named after him and talk about him in a meritorious sense.

http://eh.uc.edu/about/donate/

Gallery in Kehoe Hall – $50,000:
As you enter the building you are met with the Kehoe Hall lobby named for Dr. Robert Kehoe, a pioneer in Occupational and Environmental Medicine. The year before Dr. Kehoe’s retirement in 1965, the third wing of the present complex was dedicated as Robert E. Kehoe Hall and the Department assumed its present name, the Department of Environmental Health. The Kehoe Hall would include a historic timeline gallery including the portraits and synopsis placard noting the contributions made by these various individuals.

http://www.prnewswire.com/news-rele...eticist-joins-uc-medical-center-73718487.html

The Kehoe Chair has a total endowment of $2 million and supports research
and growth in the field of environmental health and preserves the memory of
the lasting and invaluable accomplishments of Robert Kehoe. A committed
faculty member of the Medical Center for over forty years, Kehoe helped
pioneer the techniques and research that developed into the field of
environmental health at UC. Upon his death in 1992, he left a bequest of
$1.3 million, which provided the base for the Kehoe Chair.

They of course neglect to mention the millions of children that suffered neurotoxic effects from lead because this guy lied through his teeth.

The only two times I ever saw a guy lose a license was a psychiatrist that was giving patients rectal exams, and an ER doctor that gave a patient a muscle paralyzer and then molested her in the ER. I mentioned the first guy before in this thread. The other one showed up to the psych ER suicidal.

The state medical boards do actually take a few peoples licenses away per year but from my knowledge these are only for very egregious violations such as someone repeat offending after several warnings on issues that shouldn't have been violated in the first place. It's a reason why I back up the idea of getting professionals such as doctors or nurses to pretend to be patients to evaluate questionable doctors and report their results to state medical boards.

I brought up that idea in a non-psych forum in SDN and a lot of the other doctors were ready to rip my head off for even suggesting that idea.

 

[watto]

The only two times I ever saw a guy lose a license was a psychiatrist that was giving patients rectal exams, and an ER doctor that gave a patient a muscle paralyzer and then molested her in the ER.

I thought that guy was an OB-GYN who lived in New York and always wore those wild sweaters.

 

[whopper]

The ER guy I'm talking about, I didn't believe his story so I put his name through a google search and there were several newspaper and news videos on this guy. I told the resident with me something to the effect of, "geez, how do you make this guy better? It's not like he can get his license back? Here we have a former workaholic doctor and he can't work anymore. I think he'll be a high risk of suicide no matter what we do."

The resident told me "I hope he doesn't end up on my unit and my patient cause I don't know what we're going to do either."

Next day that patient was assigned to that same resident-by coincidence. I saw him later and told him, "you know what? Better you than me!"

 

[smalltownpsych]

Great discussion. I agree that it is a taboo subject and I wasn't about to be the one person to acknowledge an attraction of any sort to a patient during my training. One of my professors was a former licensing board member and she was pretty clear that most boundary issues are about the psychologist's own vulnerabilities and trying to make up for lacking in their own life more so than a predatory stance. That makes sense as most things most people do wrong are more about human weakness than something more sinister. When it comes to my own interactions with patients, I am always on guard about getting my own needs met verses the patients, not just the sexual either. In other words, i do enjoy the interactions with my patients and i need to ask myself questions such as, "Was that lighthearted session because I felt that was what the patient needed today because we had been doing some deep emotional and cognitive processing last couple of sessions or was it because I was on-call this week?" "Are we talking about sex because the patient should be talking about this as it connects to their intimacy issues or am I deriving some benefit from this interaction?"

Part of the work of a good psychotherapist is this constant observation of self and other while having a connected/genuine interaction that is directed at accomplishing specific treatment goals. At times, I might let patient know about my process because that can help them understand what we are doing and help them learn to develop their own awareness of self and other, but only with more innocuous material and never sexual. The potential harm to the patient and the treatment way outweighs any potential benefit. So if I feel attracted to a patient, she does not need to know that - ever. Part of healthy psychological functioning is appropriate level of disclosure. Some of my patients tend to be over-sharers and some are under-sharers, too open or too closed off, too emotionally dysregulated or too emotionally overcontrolled. My job is to model healthy self-regulation and the ability to withhold information for the benefit of another is part of that and it is also something I teach parents.

Of course, then there are the psychologists who fill up a no-show hour by going on and on in a web post! Don't know how to help them.

 

[Ceke2002]

It's a reason why I back up the idea of getting professionals such as doctors or nurses to pretend to be patients to evaluate questionable doctors and report their results to state medical boards.

I brought up that idea in a non-psych forum in SDN and a lot of the other doctors were ready to rip my head off for even suggesting that idea.

They have done that here in South Australia, with a GP who's colloquially known among his patients as 'Dr Groovy'. I've spoken about him on here before, but in essence he's basically a drug dealer with a prescription pad (he's the one that supplies dealers with pills, in exchange for money or sexual favours, and then takes a cut of the profits). They could never get any patients to make a complaint against him, so they eventually started sending in members of the State Board at the time to pose as patients wearing hidden recording devices. Still didn't manage to catch him doing anything untoward, he might be corrupt as all hell, but he isn't stupid. I don't know if he's even still practicing, or if he is whether they're even bothering to go after him anymore - it's one of those cases where everyone knows what he's doing, but no one has ever been able to gather enough evidence against him to actually take him to tribunal or court.

 

[Ceke2002]

Great discussion. I agree that it is a taboo subject and I wasn't about to be the one person to acknowledge an attraction of any sort to a patient during my training. One of my professors was a former licensing board member and she was pretty clear that most boundary issues are about the psychologist's own vulnerabilities and trying to make up for lacking in their own life more so than a predatory stance. That makes sense as most things most people do wrong are more about human weakness than something more sinister. When it comes to my own interactions with patients, I am always on guard about getting my own needs met verses the patients, not just the sexual either. In other words, i do enjoy the interactions with my patients and i need to ask myself questions such as, "Was that lighthearted session because I felt that was what the patient needed today because we had been doing some deep emotional and cognitive processing last couple of sessions or was it because I was on-call this week?" "Are we talking about sex because the patient should be talking about this as it connects to their intimacy issues or am I deriving some benefit from this interaction?"

Part of the work of a good psychotherapist is this constant observation of self and other while having a connected/genuine interaction that is directed at accomplishing specific treatment goals. At times, I might let patient know about my process because that can help them understand what we are doing and help them learn to develop their own awareness of self and other, but only with more innocuous material and never sexual. The potential harm to the patient and the treatment way outweighs any potential benefit. So if I feel attracted to a patient, she does not need to know that - ever. Part of healthy psychological functioning is appropriate level of disclosure. Some of my patients tend to be over-sharers and some are under-sharers, too open or too closed off, too emotionally dysregulated or too emotionally overcontrolled. My job is to model healthy self-regulation and the ability to withhold information for the benefit of another is part of that and it is also something I teach parents.

Of course, then there are the psychologists who fill up a no-show hour by going on and on in a web post! Don't know how to help them.

*nodding enthusiastically in agreement* Yep, yep exactly. My Psychiatrist and I have spoken a few times about the process he goes through when conducting a session, in terms of not only connecting with the patient in an appropriately empathetic manner, but also remaining aware of his own responses and self observations and examining them in the moment to see if they line up with the goals of therapy, or whether they're being driven by something else (preconceived ideas, subconscious reminders of past interactions that need to be bought to the conscious level, and so on). I know he has (or had) one patient who spent most of her sessions flirting with him in a pretty obvious manner (he has spoken about other patients with me in order to illustrate certain points, but never to any degree where I'd be able to tell who they were) - he described the process of therapy with her as being very easy for him to slip into a state where he was receiving ego gratification from his patient's actions, but then he would need to self examine why he felt the need to derive ego gratification from a patient's behaviours, reset/reaffirm boundaries, and at the same time try to ascertain why this particular patient felt the need to present herself the way she did. Mind you he doesn't talk about stuff like this with me unless he knows it's benefiting me therapeutically - I think probably like most survivors of childhood trauma/abuse I have a tendency to slip into a caretaker role a bit too readily when it isn't healthy or appropriate for me to do so, so my Psychiatrist has chosen to be at least partly open about his own internal processes with different patients in a therapy setting so I can be aware of the types of things his training allows him to do in order to both take care of himself/be aware of his own emotions in the moment, as well as remaining therapeutically available to his patient. That way I can relax more and not feel like I have to be constantly aware of the needs of someone else, to the point that it becomes detrimental for the goals of treatment. I certainly don't expect my Psychiatrist to be perfect though, I know he's human and not some sort of omnipotent being who never makes a mistake, so if we do have the odd session where he seems a little off (tired, stressed, preoccupied, etc), and we're not connecting as well as we usually do, I'm happy to give him the occasional pass.

I do think appropriate levels of disclosure also depends on appropriate tone and affect. To me there's a difference between my Psychiatrist disclosing stuff like the example given above, and maintaining more of an affect of education and helping me to understand his own processes in therapy for my ultimate benefit, and him just unloading on me. Same with him paying me a compliment on my physical appearance - a lot of people might think that's inappropriate disclosure, but again to me there's a big difference between my Psychiatrist just suddenly coming out with something like "Have I ever told you how attractive I find you?" ("No, no you haven't. By the way, I'll be leaving now ) and having a conversation along the lines of (paraphrased) "(Psych) I know you had a little slip recently with the Anorexia and lost some weight, I've noticed you seem to have put some of the weight back on, are you okay with me acknowledging something like that?"..."(Me) Yeah, of course, that's fine, no worries. I'm glad to be back on track"...."(Psych) I'm glad too, I was getting worried about your physical health there for a while, you should be proud of yourself for turning things around like you have, do you feel proud of yourself?"..."(Me) Yeah, yeah I do actually, I'm glad to have the weight back on, I feel so much better"..."(Psych) Well you look better, the weight suits you, you look good, really attractive"..."(Me) Aw, thanks Doctor "
Now to me there's nothing inappropriate in that exchange, because it was offered in an appropriate manner (ie with an appropriate tone and affect). In contrast my prior abuser gave compliments in a completely inappropriate manner, even when he wasn't just being out right crude (think stereotypical type leering across the desk at a patient - Creep! )

 

[OldPsychDoc]

I thought that guy was an OB-GYN who lived in New York and always wore those wild sweaters.

Philadelphia, actually.

 

[Doctor Bagel]

One thing to note is that sexual boundary violations don't always happen with patients you would normally be attracted to (or patients who are traditionally attractive to others). It could be secondary to the counter transference. This person gave a speech in my town, and I read her book -- it's pretty interesting stuff. One thing she pointed out is that sometimes these boundary violations occur with patients we find the most frustrating or difficult to treat -- having sex with them is a desperate attempt to make them better or an expression of our anger at them. She also mentions characteristics that make one more prone to commit these sexual boundary violations.

The predatory psychopathic type of stuff happens, but I think most of these events aren't that. That's also the least interesting situation to think about. As far as support for American psychiatrists, we can generally seek out and find supervision in our community, although it's not free. No union to provide it to us unlike I guess our Australian counterparts. Doing your own psychotherapeutic work is probably a good idea, too, if you're going to do intensive work with others that might trigger some of this stuff.

Amazon product

 

[Ceke2002]

One thing to note is that sexual boundary violations don't always happen with patients you would normally be attracted to (or patients who are traditionally attractive to others). It could be secondary to the counter transference. This person gave a speech in my town, and I read her book -- it's pretty interesting stuff. One thing she pointed out is that sometimes these boundary violations occur with patients we find the most frustrating or difficult to treat -- having sex with them is a desperate attempt to make them better or an expression of our anger at them. She also mentions characteristics that make one more prone to commit these sexual boundary violations.

The predatory psychopathic type of stuff happens, but I think most of these events aren't that. That's also the least interesting situation to think about. As far as support for American psychiatrists, we can generally seek out and find supervision in our community, although it's not free. No union to provide it to us unlike I guess our Australian counterparts. Doing your own psychotherapeutic work is probably a good idea, too, if you're going to do intensive work with others that might trigger some of this stuff.

Amazon product

Yes, the psychopathic predatory Psychiatrist is more of a Hollywood type cliche, not that they don't exist, but to immediately jump to the conclusion that any Psychiatrist/Therapist who commits a sexual boundary violation is some sort of predator devoid of the normal range of human emotions is, well, a tad ambitious a leap to make, in my opinion. The little I've managed to read from David Mann on erotic transference and countertransference has been far more interesting as well, especially when discussing the interaction between patient and therapist as a sort of Hieros Gamos of mental and emotional creativity. The true predator types do seem a little one note when compared to the actual complexities of something like countertransference driven boundary violations - see patient, target patient, abuse patient, lather, rinse, repeat. The only real interest I have in understanding my abusers's strategy or thought process is for the benefit of my own healing, I find other cases of sexual boundary violations that don't involve the stereotypical 'Dr Evil' cliche to be far more interesting to actually look at and study. And I do believe it should be looked and studied and discussed far more than what appears to be happening. I'll have to ask my Psychiatrist in session on Wednesday what the climate in Australia is like in terms of therapists feeling able to be open and seek help when erotic countertransference arises in the clinical setting, I mean it's all very well and good that in South Australia at least, depending on where you work, therapists get provided with access to a Union appointed counsellor, but if no one feels able to discuss such issues because of a certain culture of fear or 'we don't talk about that', then it kind of becomes a bit of a moot point. I do know when the RANZCP introduced a zero tolerance policy on proven sexual boundary violations there was some backlash from a small segment of those in the field who were concerned that it might actually increase the rate of violations if a climate of fear was induced whereby a practitioner at risk might be too afraid of repercussions if they were to seek help.

I'm still not responding the thread on the other forum that inspired this discussion. I just can't. On the one hand I don't want to come across like I'm dismissing this persons obvious pain and anger over the situation, but like I said earlier I also can't really condone the hue and cry of 'predator!' 'psychopath' 'crush, kill, destroy!'. Mind you this is on a forum where at the same time as they're getting ready to string one therapist up for what very well may have been a momentary lapse of reason, there are other patients openly admitting to having tracked down their therapist's home address, and they're currently 'benignly' stalking their therapist, and they've gotten half a dozen replies to the tune of 'don't feel bad about what you're doing, these therapists bring it on themselves by making us feel attached to them in the first place'. Like seriously, WTF? I keep swinging past there every so often hoping to have some interesting academic and experiential discussions on psychotherapy from a patients perspective, and instead the majority of posts are a quagmire of transference and cluster B types acting out.

 

[Ceke2002]

Whilst we're on the subject of sexual boundary violations, this was a case in Melbourne that hit the headlines in 2014. The Psychiatrist in question was first suspended from practice in 2012, and then later jailed for three years with a 2 year non parole period after taking a plea deal to lesser sexual charges. This is all a matter of public record as well, so the video naming the Doctor in question isn't breaching any sort of privacy laws or contingency.

 

[Shikima]

Whilst we're on the subject of sexual boundary violations, this was a case in Melbourne that hit the headlines in 2014. The Psychiatrist in question was first suspended from practice in 2012, and then later jailed for three years with a 2 year non parole period after taking a plea deal to lesser sexual charges. This is all a matter of public record as well, so the video naming the Doctor in question isn't breaching any sort of privacy laws or contingency.

Happened not long ago near me where a psychologist was busted for sexually abusing a court-ordered client. Complete with pictures which sealed his fate.

 

[Ceke2002]

Happened not long ago near me where a psychologist was busted for sexually abusing a court-ordered client. Complete with pictures which sealed his fate.

First of all, ugh! Second of all...why on earth with the pictures? I mean if you're going to commit a crime you don't leave that sort of evidence in your wake, so was it part of a fetish, a compulsion, taking souvenirs, he wanted to get caught, he was arrogant enough to think he wouldn't get caught, etc...?

edited to add: And I know predatory psychopath types are the rare exception rather than the norm, but assuming they don't respond to supervision or counselling like other therapists at risk of sexual boundary violations (or they're able to successfully fake their way through anything like that), then how do you stop them from committing crimes before the crimes are committed, is there a way? Or is it more a case of you really do have to wait for them to slip up and do something wrong before anything can be done?

 

[michaelrack]

One thing to note is that sexual boundary violations don't always happen with patients you would normally be attracted to (or patients who are traditionally attractive to others). It could be secondary to the counter transference. This person gave a speech in my town, and I read her book -- it's pretty interesting stuff. One thing she pointed out is that sometimes these boundary violations occur with patients we find the most frustrating or difficult to treat -- having sex with them is a desperate attempt to make them better or an expression of our anger at them.

Amazon product

In theory you are right, of course. However, I have a feeling (not supported by any evidence) that the statement "sexual boundary violations don't always happen with patients you would normally be attracted to (or patients who are traditionally attractive to others)" applies to attractive/unattractive psychological traits. In other words, I believe sexual boundary violations occur with patients that tend to be more physically attractive (at least in reference to the physical attractiveness of the psychiatrist). I doubt there are many violations with 400 lb patients (unless the psychiatrist had a fetish for obese people).

 

[Ceke2002]

Speaking of the elements, or traits of attraction in the therapeutic setting. I know, anecdotally at least, that same sex erotic transference can occur within the patient/therapist dyad even when the patient is heterosexual. So can a heterosexual therapist, operating within a same sex dyad of therapy then develop erotic countertransference?