Physical touch in psychiatry

[zenmedic]

---

Members do not see this ad.

Hey all,

Just finished my first month of inpatient as a PGY-1 and I've gotten mixed feedback on whether or not it's appropriate to touch patients. I had a patient earlier this week break down in tears during the intake, to which my reaction was to put my hand on their back. Afterwards my attending commended me doing that, but said that type of physical contact in psychiatry is really not appropriate, especially inpatient when patients are so unstable. To me that makes sense if patients are manic, psychotic, have personality disorders, etc. This patient was admitted due to MDD with SI, so I thought maybe it was more appropriate? On my internal medicine rotations I would frequently hold patients hands, put my hand on their backs, when they felt overwhelmed or scared. It was really therapeutic for patients. I understand the counter argument, that psychiatrists are in a unique position with patients compared to other specialties and physical touch can cause ethical issues. Anyway, I would love some feedback on what you all think.

 

[Psyche0248]

I think it depends on the context and on so many factors that it’s hard to give a blanket opinion on whether it’s appropriate or not. I’m very conscious of my actions potentially being misinterpreted or later misrepresented by a patient. False accusations can be made at any time. All of this makes me refrain, 99% of the time, from any physical contact. However I will say there has been the rare occasion where it did seem appropriate and seemed to be therapeutic, but I think the only person who can judge this is you, in the moment, if you have good social awareness and ability to pick up on nuance… which most of us in psychiatry should. Sorry if this seems like a non-answer, but it’s the best I have!

 

[phonyreal98]

The only time I physically touch a patient is when on occasion I have to do a physical exam, and I'll narrate what I'm doing as I'm doing it so that there is much less room for misinterpretation.

 

[splik]

It has its place but yes you definitely want to be careful in the inpt setting and don't assume the pt doesn't have a PD. Even as an attending I have been burned by pts who I didn't realize were personally disordered who then pushed sexual boundaries. In general, it is also best to get pt consent before any touching as pts can react negatively (e.g. if trauma history) or make accusations of impropriety. A surprising number of patients have been abused by physicians/therapists.

And yes, it is very different in inpatient psychiatry wards to inpatient medicine. Part of this is the patient population, the acuity of psychopathology, the nature of the relationship, and the setting. On inpatient medicine, patients expect their doctors to touch them. it is part of the physical exam. Providing comforting support to patients with physical touch becomes a natural extension of that exam. Incidentally, I frequently held pts hands when doing C-L (usually geriatric pts), but I don't recall doing so while attending on the inpatient psych unit. In fact, we were usually not in very close proximity w/ inpatient to touch them.

I honestly used to think it was a bit ridiculous how much fuss attendings would make about touch in psychiatry but now have a more nuanced view. One of my mentors went as far as to say, (commenting on the movie Ordinary people) that "no therapist in their right mind would hug a patient." Well, I think that is extreme and I have hugged and been hugged by patients on occassion but these things are boundary crossings, and while they can be therapeutic, they can also be harmful and open you up to liability. Understanding the psychodynamics as well as medicolegal implications of our actions can help inform the propriety of therapeutic touch.

I will also note that as you go through your training, you will become more proficient at using your words and non-verbal non-contact communication to effectively comfort patients without the use of touch as well.

 

[TexasPhysician]

My goal is to not be touched in clinic. I can empathize without touching, and to those with trauma, me touching them could be very triggering. While I am not small, I have little interest in being hit whether by accident, misunderstanding, or on purpose.

While I won’t stiff-arm a child trying to hug me, I won’t initiate touch, and I will quickly redirect.

 

[Bartelby]

I agree with avoiding touch. As others mentioned, there are better ways for you as a professional to respond to distress. Touch can be misunderstood or provoke strong negative reactions.

The only time I touch patients is either when a physical exam is necessary (for instance testing for cogwheeling) or when the touch is something minor like a handshake and it would be obviously awkward or insulting to refuse.

 

[Sushirolls]

AIMS
Reflexes
Or if the patient at start of appointment or end of appointment assertively sticks their hand out for a hand shake, I'll shake it.
I don't volunteer my hand to prompt a handshake, but will reciprocate. All other contact is avoided.

*Hug, once, initiated by octogenarian woman at final visit when leaving Big Box shop job, and proceeded to lecture with stereotyped advice - get married, have kids, etc, etc

 

[clozareal]

I do a neurological and physical exam and get my own vitals where I'll have to touch the patient. I always let them know before the appointment and then ask permission again at the appointment right before each exam maneuver. Because I'm CAP, I typically have the family members there while I do the non-invasive examination so nothing is misconstrued. I don't use touch for comforting in my outpatient practice.

I think we have to be mindful of the historical aspects of the abuses from psychiatrists and therapists that may give context to any physical interaction with the patient.

 

[smalltownpsych]

I think of touch similarly to self-disclosure or giving advice. It should be used rarely and is often an easy go to when therapy skills are limited. As @splik was alluding to, our words and ability to communicate with people in extreme distress is our skill. Severe inpatient and ED settings is where I got the best practice with that. More likely to hug a long term patient in outpatient setting and almost always at end of last session. Also, pat on the back or should could get you hit and I try to keep arms length. Final thought is that a good RN can provide some of the more physical aspects of comforting and this is more in their skill set and role so at times I would ask one of the nice nurses to offer a little reassurance or comfort when that seemed indicated.

 

[annoyedpsychiatrist]

I agree with avoiding touch. As others mentioned, there are better ways for you as a professional to respond to distress. Touch can be misunderstood or provoke strong negative reactions.

The only time I touch patients is either when a physical exam is necessary (for instance testing for cogwheeling) or when the touch is something minor like a handshake and it would be obviously awkward or insulting to refuse.

I agree.

Sometimes in my patients who are really distressed and higher functioning, on rare occasion i may do a small guesture and extend my hand (like a small handshake or fist bump sort of deal) and offer validation for what they're going through and reassurance that we will keep working hard. That way by offering the physical gesture, its up to the patient if they're receptive to it. I would not directly touch patients without ample warning, as people respond differently to this and it can be easily misinterpreted.

 

[Celexa]

I agree.

Sometimes in my patients who are really distressed and higher functioning, on rare occasion i may do a small guesture and extend my hand (like a small handshake or fist bump sort of deal) and offer validation for what they're going through and reassurance that we will keep working hard. That way by offering the physical gesture, its up to the patient if they're receptive to it. I would not directly touch patients without ample warning, as people respond differently to this and it can be easily misinterpreted.

I agree, a well timed fist-bump can be an excellent therapeutic tool outpatient. And I also accept outpatient handshakes but don't initiate them.

Inpatient, I echo what those above said. It is a particular type of environment and best to steer clear of physical touch outside of brief physical exams with explicit consent.

On CL, which is also it's own slightly unique environment, I don't think I use physical touch very much outside physical exams either, but thinking back I think occasionally I may use a brief comforting touch with a patient family member. Still, it's a fairly rare occurrence.

As a trainee, with something so fraught and nuanced and working almost exclusively in inpatient settings, I think your attending was giving you good advice at this point.

 

[Merovinge]

I think gender plays a role in this as well. As a male, I actively avoid any touch in the adolescent/adult space to avoid any potential misunderstandings or allegations but would accept handshakes on most occasions (this dropped off a cliff after COVID so less to consider).

When I was seeing school aged kids, I would certainly respond to fist bumps and high fives in the presence of parents. Some of my patients would come to hug me, particularly those with neurodevelopmental disorders, and I would redirect them to a fist bump or high five and that almost universally goes well.

I have seen females touch more in the CAP space and it did not feel inappropriate when I witnessed it, but being as I will never have that experience I am not one to comment on if I would or would not recommend it.

 

[FlowRate]

I trained in a heavily psychodynamically-oriented program and we were pretty much instructed to never touch patients, even as far as to decline handshakes.

As an attending who's no longer anyone's dedicated therapist and now in a different geographic region where handshakes are very expected, I no longer decline handshakes. I'd still note, however, some patients do use handshakes to try and cause harm or assert dominance. I'm tall but not buff and will not win grip competitions against someone who's trying to harm with a handshake. (Have learned this from both intentional and unintentional behavior by patients.)

 

[whopper]

This is a zone where there are benefits and risks but because of the risks, social stigma, there's not a good evidenced-based trove of data, and professional standards, pretty much never do this other than something superficial like a handshake.

Physical touch does have proof it can improve health, (don't believe it look up anaclitic depresion), but the use of it by a provider for that purpose is poorly defined (at least to my knowledge).

 

[comp1]

The risk so dramatically outweighs any potential benefit in the VAST majority of mental health settings. We spend so much time on here agonizing about liability for medication side-effects or suicides, but forget that a huge chunk of claims against psychiatrists in specific are for inappropriate relationships or "touch." You have a heck of a lot more control over touch than you do the patient killing themselves or having an adverse medication reaction. Touch patients for specific, very limited, physical exam purposes within your scope and do it with a chaperone/witness, regardless of your gender.

 

[Stagg737]

Generally agree with the above. I don't do physical touch outside of physical exams/vitals or if a patient offers a handshake or fist bump. Even hand shakes I try and redirect to fist bumps unless it's an older patient. I had 2 (both older ladies) insist on giving me a good-bye hug at our last outpatient appointment when I left residency, but I'd worked with them for over 2 years and they'd made huge progress. Also had one of my outpatients run up and hug me while she was admitted to the medical hospital and I was on consults in residency, but I basically just patted her back and then broke off the hug (attending and nurse were present). The fact that so many of us recall the specific times we've done this (outside of handshakes/fist bumps) should tell OP how uncommon this is.

I'll add that there can be a cultural caveat. I've spent a fair amount of time in Central and South America, some of which was medical trips. Had a doctor straight up tell us that if we can't console patients with an appropriate physical touch (hand on shoulder/upper back), we shouldn't call ourselves healers, which was echoed by other docs we worked with there. Latin American culture it was expected that you console them with physical touch. Granted, those were all PCPs and this was before I entered psychiatry, so may be different with psychiatrists down there, but just be aware that this may be much more (or much less) appropriate depending on the patient's culture as well. Physical touch may be fine depending on the situation, but that can be extremely difficult to tell unless you really know the patients.

I think gender plays a role in this as well. As a male, I actively avoid any touch in the adolescent/adult space to avoid any potential misunderstandings or allegations but would accept handshakes on most occasions (this dropped off a cliff after COVID so less to consider).

I'll slightly disagree. I think it's still often inappropriate even when done by female therapists or docs. I saw a therapist before I entered psych who put her hand on my shoulder. I didn't really care, but did mentally think "the f***?" when she did it.

 

[Sushirolls]

Now on the flip side, I've definitely observed ARNPs giving hugs after appointments, walking patients down halls form office to front desk with hand on back.

 

[Ceke2002]

From a patient's point of view, I'd say it's complicated, I don't think there is one true answer, and if in doubt zero touching is better. I have known other patients, through support groups, who had a bad habit of sabotaging therapy by developing erotic transference very early on, at which point even the most innocuous of physical contact was going to be completely misinterpreted - situations like this is why I tend to think the zero touch policy should be the default.

In my own experience I did have a therapist (Psychologist) in the early 90s who used appropriate touch sparingly (appropriate to me meaning something like the occasional brief pat on the shoulder at the end of a session, whilst saying "well done, good session") and I did personally find it helped strengthen the therapeutic bond without feeling as if there was any sort of boundary crossing occurring. Unfortunately in the later 90s I ended up in an abusive therapy situation with a Psychiatrist who sexualised therapy through increasingly inappropriate comments and physical contact.

Because of my prior (extremely) negative experience with touch in therapy my immediate default preference now would be zero touching at least until I developed a very high level of trust at which point I may be amenable to accepting something like a hand shake, or even a brief hug right at the very end of a therapeutic collaboration. Of course that then begs the question, "So how would a therapist know when that level of trust had been reached", and my answer would be, "You probably won't, so a zero touch policy really should remain your default position".

 

[mistafab]

There are many non-contact, physical gestures you can use during interactions/therapy to generate/establish empathic alliance. I would avoid physical contact outside of a physical exam until you are better trained.

...And most people better trained rarely make physical contact at all. Take that as you will.

 

[zenmedic]

I think it's true that my verbal consoling is lacking so my default is physical consoling, just who I am and how I was raised. As I develop my verbal skills I think this reflex will go away. I think I'll work on these skills sooner rather than later since the overwhelming consensus is to never touch patients and so many on the inpatient side do require that consoling. Thanks for the responses everyone!

 

[FlowRate]

I think it's true that my verbal consoling is lacking so my default is physical consoling, just who I am and how I was raised. As I develop my verbal skills I think this reflex will go away. I think I'll work on these skills sooner rather than later since the overwhelming consensus is to never touch patients and so many on the inpatient side do require that consoling. Thanks for the responses everyone!

Often in psychiatry the answer isn't quite as much consoling as it is either tolerating or reflecting. That is, either silence or empathic restatement or inquiring further. Other fields console in part to shorten the duration and intensity of emotional experience (which is ultimately secondary to their clinical task) whereas often we are primarily concerned with exploring it.

 

[MedMan80]

I would say a physical hug routinely is probably a boundary violation, but an occasional quick hug for a patient who had a big loss for example may not be a violation but an crossing. Always safer to avoid it though. I remember a chairman of my dept told us a story about his hesitation to engage in play therapy as a trainee with a child who had made multiple allegations of sexual abuse in the past, it pays to be paranoid in our field sometimes.

 

[Taddy Mason]

The only digital rectal exam I did beyond a sim lab second year of med school was while on inpatient psych as a PGY-1 at a VERY psychodynamic heavy program. Pragmatically, sometimes you’ve gotta touch your patient…

 

[Ceke2002]

I think it's true that my verbal consoling is lacking so my default is physical consoling, just who I am and how I was raised. As I develop my verbal skills I think this reflex will go away. I think I'll work on these skills sooner rather than later since the overwhelming consensus is to never touch patients and so many on the inpatient side do require that consoling. Thanks for the responses everyone!

As FlowRate said, sometimes it's not about consoling so much as tolerating or reflecting. Not everything difficult in therapy, or life experience, requires a verbal or physical consolation, sometimes just being present in the moment with someone is enough. Consider an example of a patient who has trouble with emotional regulation, and who would benefit from an approach that involves them learning to sit with difficult emotions. Consolation in this case wouldn't be a helpful tool, but being fully present and/or empathically reflectively would. In terms of a situation where consolation was the correct approach, for example a patient had experienced a sudden and profound loss, I think a simple and genuine, "I'm sorry for your loss, would you like to talk about it" has more impact than a flourish of words or physical gestures.

 

[Candidate2017]

I had a patient earlier this week break down in tears during the intake, to which my reaction was to put my hand on their back.

Why do tears elicit this reaction from you?

BTW lots of depressed patients with SI cry (unlike patients who go on to commit suicide). If I patted every crying patient on the back, my hand would fall off from MRSA. Or at least smell funny.

Afterwards my attending commended me doing that, but said that type of physical contact in psychiatry is really not appropriate, especially inpatient

Compliment, then critique. Psych attendings love this.

To me that makes sense if patients are manic, psychotic, have personality disorders, etc. This patient was admitted due to MDD with SI, so I thought maybe it was more appropriate?

New intern in early August can tell from a single initial intake that a patient does not have a personality disorder? I'm never 100% certain as to diagnoses for many patients I've seen for a while. Things unfold over time.

On my internal medicine rotations I would frequently hold patients hands, put my hand on their backs, when they felt overwhelmed or scared. It was really therapeutic for patients.

How did you know it was therapeutic? For whom was it therapeutic?

Touch in medicine/surgery is different because patients expect their bodies to be acted upon. Touch is divorced from imputed emotions. As a psychiatrist, you do the opposite. You deal with emotions divorced from their bodies. When you touch both emotions and bodies, things get jumbled in patients' (disordered) minds and bodies.

Arguably, all patients harbor sexual feelings toward their psychiatrist. Of course, more so if you are good looking or female (and you're probably not female or you would have run into sexual comments and propositins your entire life, physician or not). Patients are affected by perceived power dynamics, parent-child transference, the sharing of inner thoughts and feelings that are hidden from family and lovers, etc.

I think it's true that my verbal consoling is lacking so my default is physical consoling, just who I am and how I was raised.

What do you mean your verbal consoling is lacking? What does consoling mean to you? Why do you feel the need to console at all? Do patients really need consoling? In what ways can consoling do more harm than good? Do you have a good, psychodynamically oriented supervisor? Because these are things useful to explore.

Often in psychiatry the answer isn't quite as much consoling as it is either tolerating or reflecting. That is, either silence or empathic restatement or inquiring further.

The patient can only tolerate what I can tolerate.

I had a patient the other day say they were getting lightheaded and about to experience a panic attack. I didn't take my eyes off the computer, told them to take a breath because we need to keep things moving. No panic attack occurred.

 

[Candidate2017]

While I won’t stiff-arm a child trying to hug me, I won’t initiate touch, and I will quickly redirect.

I'm not CAP, so I'm more than happy to do a Heisman trophy pose on rando kids running up to me.

 

[hallowmann]

Why do tears elicit this reaction from you?

BTW lots of depressed patients with SI cry (unlike patients who go on to commit suicide). If I patted every crying patient on the back, my hand would fall off from MRSA. Or at least smell funny.

Oh man, half my patients yesterday cried during their visits (?is it me?). That said, I think I still prefer that to the half of my patients today who were annoyed I wasn't giving them Xanax or Klonopin, because "its the only thing that works". I'm sorry, I do not want to give you a benzo and a stimulant for your... <checks chart> anger and fatigue <checks chart again> or your personality disorder for that matter.

Compliment, then critique. Psych attendings love this.

Seeing this and getting flashbacks to training was honestly the best (worst?) part of the thread for me.

New intern in early August can tell from a single initial intake that a patient does not have a personality disorder? I'm never 100% certain as to diagnoses for many patients I've seen for a while. Things unfold over time.

Man if I can get even some of the 3rd year residents comfortable with diagnosing BPD in clinic, I'd be happy. As a 1st year, I knew nothing.

How did you know it was therapeutic? For whom was it therapeutic?

Touch in medicine/surgery is different because patients expect their bodies to be acted upon. Touch is divorced from imputed emotions. As a psychiatrist, you do the opposite. You deal with emotions divorced from their bodies. When you touch both emotions and bodies, things get jumbled in patients' (disordered) minds and bodies.

Arguably, all patients harbor sexual feelings toward their psychiatrist. Of course, more so if you are good looking or female (and you're probably not female or you would have run into sexual comments and propositins your entire life, physician or not). Patients are affected by perceived power dynamics, parent-child transference, the sharing of inner thoughts and feelings that are hidden from family and lovers, etc.

I do want to emphasize that although there are more allowances on the medical side, it is still wrought with perceived power dynamics and risks, and even there, there are clear boundaries that can get blurred and shouldn't be crossed.

What do you mean your verbal consoling is lacking? What does consoling mean to you? Why do you feel the need to console at all? Do patients really need consoling? In what ways can consoling do more harm than good? Do you have a good, psychodynamically oriented supervisor? Because these are things useful to explore.

One of the biggest things I try to teach to the med students is being comfortable with silence. You don't have to fill the gaps, try as best you can not to in fact, no matter how uncomfortable it is for you. Just let the patient sit in it for a bit and feel that the world didn't end.

I'm sure all this stuff is 2nd nature to all of us, but I could see a PGY1 struggling with this, so OP I hope you can take some of this advice to heart and practice some of these techniques.

 

[comp1]

Oh I love that concept of us being mostly about tolerating and reflecting. That is so true. If you spend most of your day consoling by touching or talking...you're not exactly functioning like a clinician, more like a parent or friend. My problem is turning off the clinician mindset with the other people in my life.

 

[Mad Jack]

I generally avoid physical contact with my patients unless absolutely necessary. You never know their history, and a simple hand on the shoulder may be remind them of past abuse or be taken as some sort of advance, amongst any number of other possibilities. Even something as benign as shaking hands can be rather dicey on the inpatient unit. The details of why I would rather not recount, but knowing what some of the patients had been doing before asking to shake the hands of staff on a couple of the units I've worked has left me with an avoidance of it

 

[futureapppsy2]

I generally avoid physical contact with my patients unless absolutely necessary. You never know their history, and a simple hand on the shoulder may be remind them of past abuse or be taken as some sort of advance, amongst any number of other possibilities. Even something as benign as shaking hands can be rather dicey on the inpatient unit. The details of why I would rather not recount, but knowing what some of the patients had been doing before asking to shake the hands of staff on a couple of the units I've worked has left me with an avoidance of it

Plus, handshakes can actually make you surprisingly physically vulnerable. I trained in martial arts for years and learned a lot of throws and pins originating from a hand grab.

 

[Ceke2002]

I generally avoid physical contact with my patients unless absolutely necessary. You never know their history, and a simple hand on the shoulder may be remind them of past abuse or be taken as some sort of advance, amongst any number of other possibilities. Even something as benign as shaking hands can be rather dicey on the inpatient unit. The details of why I would rather not recount, but knowing what some of the patients had been doing before asking to shake the hands of staff on a couple of the units I've worked has left me with an avoidance of it

I think I've mentioned this before, but one of the things the abusive Psychiatrist used to do in session was come up behind me and start playing with my hair, stroking my neck, and massaging my shoulders and upper chest. If my other former Psychiatrist, ie the first male Psychiatrist in over a decade that I learnt to actually trust, had placed his hand on my shoulder, no matter how innocuous or well meaning the gesture, I honestly don't know how I would've reacted, I just know it would not have been good. As it was a colleague of my former Psychiatrist accidentally walked in during a session, and the very first thing I did was throw my hands up ready to fight him. My brain just automatically registered that this was a male Psychiatrist I did not know, did not have trust with, and my body instinctively went straight to fight mode. I felt terrible about it later on, and asked my former Psychiatrist to please explain and apologise on my behalf, but in that initial moment the only thing I could think of was, "I'm in danger, I have to defend myself'. In that moment if the other Psychiatrist had attempted to come over to me and even offer something as seemingly simple as a handshake, there's a very high chance I probably would've physically attacked him.

 

[TheRightMedication]

Lots of excellent advice and comments above. I'll add my experience.

Handshakes - as a male in my region, if not the US entire, handshakes are expected culturally. I do my best to not offer my hand first to avoid signaling "Now I expect us to touch," but usually I won't refuse a handshake if offered. I'm not perfect in this, it's very, very culturally ingrained in me to shake hands. In trauma or PD cases I have refused a handshake, observed how that may seem rude but I have a reason, and asked that we discuss it.

Hugs - This one is easier for me culturally. No hugs. I'm usually not fast enough to stop someone when they go for one so I build an A frame, arms out a bit, hips back. I don't hug back, not even for the sweetest of old ladies.

 

[tr]

I wouldn't do physical touch on inpatient psych under any circumstances (other than necessary physical exams - e.g. AIMS, with clear explanation beforehand of what I will be doing and why). It's just too unpredictable how that will go with someone in such a severe phase of illness.

I have hugged my outpatients but it's always patient initiated, usually when we are terminating. A fair number of patients have asked if they can hug me at the last visit. I'm fine with this. It seems ungenerous to refuse and we won't be meeting any longer anyway so there's no argument that it would interfere with the therapeutic relationship.

For comforting a patient who is in distress but hasn't solicited physical touch from you, I agree with above posters that verbal witnessing/reflective types of responses are the safest and most therapeutic way to go.

 

[forchinet121]

I think I've mentioned this before, but one of the things the abusive Psychiatrist used to do in session was come up behind me and start playing with my hair, stroking my neck, and massaging my shoulders and upper chest. If my other former Psychiatrist, ie the first male Psychiatrist in over a decade that I learnt to actually trust, had placed his hand on my shoulder, no matter how innocuous or well meaning the gesture, I honestly don't know how I would've reacted, I just know it would not have been good. As it was a colleague of my former Psychiatrist accidentally walked in during a session, and the very first thing I did was throw my hands up ready to fight him. My brain just automatically registered that this was a male Psychiatrist I did not know, did not have trust with, and my body instinctively went straight to fight mode. I felt terrible about it later on, and asked my former Psychiatrist to please explain and apologise on my behalf, but in that initial moment the only thing I could think of was, "I'm in danger, I have to defend myself'. In that moment if the other Psychiatrist had attempted to come over to me and even offer something as seemingly simple as a handshake, there's a very high chance I probably would've physically attacked him.

You had a psychiatrist play with your hair and stroke your neck..? What in the actual balls

 

[Ceke2002]

You had a psychiatrist play with your hair and stroke your neck..? What in the actual balls

Yeah. His modus operandi was to basically groom his female patients to start sexual relationships with them. He also ran an unlicensed Naltrexone clinic and molested patients under sedation. It never got that far with me, but there was definitely extremely inappropriate comments and physical contact that was made. Stuff like commenting on my breasts, telling me I should wear certain tops more often so he could get a better look, saying I was making him think bad things, graphic descriptions of sexual fantasies, prolonged full body pelvic contact hugs, him rubbing his hand over my backside or playing with my hip when I was walking out of the room. He's the reason I refused to see a male psychiatrist for more than a decade, and the reason why it took me well over a year to even tentatively start to trust the one I did eventually end up seeing. By essentially removing an entire gender from any possible treatment plan I have no doubt that my mental health treatment suffered, and any sort of recovery or progress I may have made was severely disrupted. I'm okay now, I no longer default to a position of 'anything that identifies as male and a psychiatrist is an immediate threat' and I did eventually build a really good therapeutic rapport with the Psychiatrist who eventually helped me through a lot of stuff and helped me to achieve a really good level of happiness and stability. It took time though, a lot of time.

 

[forchinet121]

Yeah. His modus operandi was to basically groom his female patients to start sexual relationships with them. He also ran an unlicensed Naltrexone clinic and molested patients under sedation. It never got that far with me, but there was definitely extremely inappropriate comments and physical contact that was made. Stuff like commenting on my breasts, telling me I should wear certain tops more often so he could get a better look, saying I was making him think bad things, graphic descriptions of sexual fantasies, prolonged full body pelvic contact hugs, him rubbing his hand over my backside or playing with my hip when I was walking out of the room. He's the reason I refused to see a male psychiatrist for more than a decade, and the reason why it took me well over a year to even tentatively start to trust the one I did eventually end up seeing. By essentially removing an entire gender from any possible treatment plan I have no doubt that my mental health treatment suffered, and any sort of recovery or progress I may have made was severely disrupted. I'm okay now, I no longer default to a position of 'anything that identifies as male and a psychiatrist is an immediate threat' and I did eventually build a really good therapeutic rapport with the Psychiatrist who eventually helped me through a lot of stuff and helped me to achieve a really good level of happiness and stability. It took time though, a lot of time.

Wow very sorry to hear that did he get in trouble?

 

[smalltownpsych]

Wow very sorry to hear that did he get in trouble?

I hope he ended up in prison at the very least.
😡

 

[Ceke2002]

Wow very sorry to hear that did he get in trouble?

I hope he ended up in prison at the very least.
😡

He got the equivalent of a slap on the wrist. Loss of medical license for 2 years for running an illegal outpatient clinic and something along the lines of 'conduct unbecoming'. He was allowed to return to work under supervision after those 2 years. Last I heard he was retired and living in another country. There was talk among some of his former patients about launching a class action suit against him, but I don't know if that went anywhere.

The whole situation was really messed up. He was one of a group of 5 Doctors in Adelaide who were all dodgy af, who all played golf together, and who watched each other's backs. Besides him there was also two GPs who were supplying scripts to addicts in exchange for money or sexual favours (I knew who they both were, and at least they were upfront about how dodgy they were), and two Doctors who worked in the hospital system and were stealing schedule 8 narcotics (I'm pretty sure they were also regulars when I was working the streets). If a patient bought any sort of complaint against them then it would turn into a case of, 'Well who are you going to believe? This junkie with a long history of mental health issues, or this 'respected' Doctor of more than 20 years, who has 4 other 'respected Doctors' speaking on his behalf?' The psychiatrist had also previously worked at an IOP clinic, where his behaviour became so alarming the nurses lodged a complaint, and rather than anything being done they just gave him a severance package and moved him onto another clinic. Like WTAF?!

The only reason I found out about the whole friendship and agreement set up with this group of Doctors was because one of the pill Doctors got high on his own supply and ran his mouth to me. That's when the psych getting off as light as the did made sense, because well of course he did when he's already got arrangements in place to have 4 other Doctors back him up in a hearing.

I'm not saying any of us who were abused by this Psychiatrist were innocent little angels, or that we weren't messed up and involved in some dodgy dealings ourselves, but we didn't deserve to be abused like that, we didn't deserve to have our trust in the mental healthy system completely shattered, and in some cases we didn't deserve to be driven to suicide (some former patients of his did either attempt of complete suicide kill out of sheer shame and guilt).

 

[ahnonemoose]

In his autobiography In and Out the Garbage Pail, Fritz Perls described having sex with patients and graduate students. He also thought it was okay to beat women. If you find anything good in Gestalt therapy, the good ideas might have really come from his wife, who later divorced him.