Psych · Professional — ethics, boundaries and professionalism
Ethics, boundaries and professionalism
Also known as Professional boundaries · Boundary crossings and violations · Dual relationships · Sexual boundary violations · Confidentiality and duty to protect · E-professionalism · Impaired colleague · RANZCP Code of Ethics · Four principles of biomedical ethics
Exam-exhaustive fellowship reference on psychiatric ethics and professionalism — four principles, Gutheil–Gabbard boundary theory, dual relationships (including rural ANZ), sexual boundary violations, confidentiality limits and duty-to-protect principles, social media/e-professionalism, gifts and self-disclosure, impaired colleagues and mandatory reporting principles, and RANZCP Code of Ethics themes. Jurisdiction-specific law stated as principles only. FRANZCP-primary, globally tagged.
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Red flags
- Sexual contact with a current patient is always a boundary violation — never a 'therapeutic technique'
- Post-termination sexual relationships remain ethically high-risk and often prohibited by codes
- Progressive secrecy, specialness, extended sessions, and personal disclosure shift = slippery-slope warning
- Loyalty to a colleague never outranks patient safety when impairment or misconduct is present
- Social media privacy settings do not equal confidentiality; never post identifiable patient material
- Inventing Tarasoff or mandatory-reporting section numbers as if universal law
Meet the patient
Thursday, 5.40pm. Your long-term therapy patient hands you a wrapped box — "just something small" — and mentions she has sent you a friend request. Last week's session ran forty minutes over. She has started signing her texts with your first name.[1][5][14]
Not one of those things is misconduct. Every single one of them is on the slope.[1][20]
The examiner will not ask whether you take the gift. They will ask: "What is happening to the frame, and what do you do about it this week?" That question is this whole topic.[5][13]
References20ShowHide
- [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]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
- [6]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
- [7]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
- [8]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
- [9]Bloch S, Kenn F, Smith G Revising the Royal Australian and New Zealand College of Psychiatrists code of ethics Australas Psychiatry, 2018.PMID 30058364
- [10]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
- [11]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
- [12]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
- [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]Vukušić Rukavina T, Viskić J, Machala Poplašen L, et al. Dangers and Benefits of Social Media on E-Professionalism of Health Care Professionals: Scoping Review J Med Internet Res, 2021.PMID 34662284
- [15]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
- [16]Walcott DM, Cerundolo P, Beck JC Current analysis of the Tarasoff duty: an evolution towards the limitation of the duty to protect Behav Sci Law, 2001.PMID 11443695
- [17]Henretty JR, Levitt HM The role of therapist self-disclosure in psychotherapy: a qualitative review Clin Psychol Rev, 2010.PMID 19837497
- [18]Barnett JE Psychotherapist self-disclosure: ethical and clinical considerations Psychotherapy (Chic), 2011.PMID 22141415
- [19]Gulrajani C A Duty to Protect Our Patients from Physician Sexual Misconduct J Am Acad Psychiatry Law, 2020.PMID 32393516
- [20]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