Boundary violations and sexual misconduct

Also known as Sexual boundary violations · Physician sexual misconduct · Professional boundary violations · Post-termination sexual relationships · Slippery-slope boundary erosion · Therapist–patient sexual contact · Gutheil Gabbard boundaries

Exam-exhaustive fellowship reference on professional boundary violations and sexual misconduct in psychiatry — Gutheil–Gabbard crossing vs violation, slippery-slope mechanisms, epidemiology caveats from PHP series, sexual boundary violations (current, former, trainee), response algorithms, prevention and supervision, patient harm and professional consequences, dual-relationship risk, and RANZCP/GMC/AMA principle-level codes without invented statute numbers. FRANZCP-primary, globally tagged.

high16 referencesUpdated 26 July 202614 min readVerification in progress

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10 MCQs

Meet the patient

A 27-year-old woman, two years into weekly therapy for complex trauma, tells your registrar something she has never told anyone. Her previous psychiatrist used to see her last on Fridays, kept no notes of those sessions, and eventually began driving her home. She stopped attending. She has not sought care since — until today.^[5]^[6]

She asks your registrar not to tell anyone. She says she does not want to ruin his career, and that some of it was her fault.^[5]^[6]

Neither of those statements is true, and neither of them changes what happens next. This topic is the answer to what happens next.^[5]^[6]

References16Show

[1]Gutheil TG, Gabbard GO The concept of boundaries in clinical practice: theoretical and risk-management dimensions Am J Psychiatry, 1993.PMID 8422069
[2]Gutheil TG, Gabbard GO Misuses and misunderstandings of boundary theory in clinical and regulatory settings Am J Psychiatry, 1998.PMID 9501754
[3]Gabbard GO Post-termination sexual boundary violations Psychiatr Clin North Am, 2002.PMID 12232973
[4]Celenza A, Gabbard GO Analysts who commit sexual boundary violations: a lost cause? J Am Psychoanal Assoc, 2003.PMID 12866759
[5]Norris DM, Gutheil TG, Strasburger LH This couldn't happen to me: boundary problems and sexual misconduct in the psychotherapy relationship Psychiatr Serv, 2003.PMID 12663839
[6]Gulrajani C A Duty to Protect Our Patients from Physician Sexual Misconduct J Am Acad Psychiatry Law, 2020.PMID 32393516
[7]Brooks E, Gendel MH, Early SR, et al. Physician boundary violations in a physician's health program: a 19-year review J Am Acad Psychiatry Law, 2012.PMID 22396343
[8]Pope KS, Keith-Spiegel P A practical approach to boundaries in psychotherapy: making decisions, bypassing blunders, and mending fences J Clin Psychol, 2008.PMID 18386835
[9]Scopelliti J, Judd F, Grigg M, et al. Dual relationships in mental health practice: issues for clinicians in rural settings Aust N Z J Psychiatry, 2004.PMID 15555031
[10]Endacott R, Wood A, Judd F, et al. Impact and management of dual relationships in metropolitan, regional and rural mental health practice Aust N Z J Psychiatry, 2006.PMID 17054567
[11]Bloch S, Kenn F, Smith G Revising the Royal Australian and New Zealand College of Psychiatrists code of ethics Australas Psychiatry, 2018.PMID 30058364
[12]Lim I, Kenn F, Bloch S The 30th anniversary of the code of ethics of the Royal Australian and New Zealand College of Psychiatrists-a worthy milestone Australas Psychiatry, 2022.PMID 35077253
[13]Lampe L, Hitching R, Hammond TE, et al. Being a 'good' doctor: Understanding and managing professional boundaries is challenging and can lead to stress and burnout Australas Psychiatry, 2023.PMID 37563780
[14]Reyes Nieva H, Ruan E, Schiff GD Professional-Patient Boundaries: a National Survey of Primary Care Physicians' Attitudes and Practices J Gen Intern Med, 2020.PMID 31755012
[15]Bismark MM, Mathews B, Morris JM, et al. Views on mandatory reporting of impaired health practitioners by their treating practitioners: a qualitative study from Australia BMJ Open, 2016.PMID 27993902
[16]Robertson M, Kerridge I, Walter G Ethnomethodological study of the values of Australian psychiatrists: towards an empirically derived RANZCP Code of Ethics Aust N Z J Psychiatry, 2009.PMID 19373701