Ethics physicians dating patients

07-Mar-2015 07:51

The literature tends to focus on patient-therapist sexual misconduct (3) as an extreme violation and not on the wide variety of lesser and more complex boundary crossings, many of which are, at first glance, less obvious but pose difficulties of their own for clinicians.Clinicians tend to feel that they understand the concept of boundaries instinctively, but using it in practice or explaining it to others is often challenging. They selectively review the literature on the subject and identify critical areas that require explication in terms of harmful versus nonharmful boundary issues short of sexual misconduct. Gabbard Abstract: The authors systematically examine the concept of boundaries and boundary violations in clinical practice, particularly as they relate to recent sexual misconduct litigation.However, modern clinicians should be aware of three principles that govern the relationship among boundaries, boundary crossings, boundary violations, and sexual misconduct.First, sexual misconduct usually begins with relatively minor boundary violations, which often show a crescendo pattern of increasing intrusion into the patient's space that culminates in sexual contact.This latter problem is rendered more difficult by the tendency of the legal system, particularly plaintiffs' attorneys, to apply it mechanistically: any boundary crossing is bad, wrong, and harmful.Empirical evidence suggests that boundary violations frequently accompany or precede sexual misconduct (2, 4, 5), but the violations themselves do not always constitute malpractice or misconduct or even bad technique.

Heightened awareness of the concepts of The concept of boundaries, particularly in the sense of boundary crossings and boundary violations, has come under increased scrutiny in relation to the wave of sexual misconduct cases (2) arising in litigation, ethics committee hearings, and complaints to boards of licensure.

Like many concepts in psychotherapy, such as "therapy," "transference," and "alliance," the term proves slippery on closer observation.

These areas include role; time; place and space; money; gifts, services, and related matters; clothing; language; self-disclosure and related matters; and physical contact.

While broad guidelines are helpful, the specific impact of a particular boundary crossing can only be assessed by careful attention to the clinical context.

A direct shift from talking to intercourse is quite rare; the "slippery slope" is the characteristic scenario.

Heightened awareness of the concepts of The concept of boundaries, particularly in the sense of boundary crossings and boundary violations, has come under increased scrutiny in relation to the wave of sexual misconduct cases (2) arising in litigation, ethics committee hearings, and complaints to boards of licensure.

Like many concepts in psychotherapy, such as "therapy," "transference," and "alliance," the term proves slippery on closer observation.

These areas include role; time; place and space; money; gifts, services, and related matters; clothing; language; self-disclosure and related matters; and physical contact.

While broad guidelines are helpful, the specific impact of a particular boundary crossing can only be assessed by careful attention to the clinical context.

A direct shift from talking to intercourse is quite rare; the "slippery slope" is the characteristic scenario.

As Gabbard (4) and Simon (6) have pointed out, a common sequence involves a transition from last-name to first-name basis; then personal conversation intruding on the clinical work; then some body contact (e.g., pats on the shoulder, massages, progressing to hugs); then trips outside the office; then sessions during lunch, sometimes with alcoholic beverages; then dinner; then movies or other social events; and finally sexual intercourse.