Boundary violations and sexual misconduct — structured clinical viva

This viva tests whether the candidate can hold a firm frame under erotic pressure, recognise their own slippery-slope behaviours, respond ethically to historical sexual misconduct disclosure, and describe professional consequences without inventing law.^[1][3][5]

Boundary theory. Coffee after sessions with a current patient is dual-relationship risk and a step toward violation. Extending sessions and personal after-hours texting already mark crossings needing immediate correction, supervision, and documentation. Sexual contact would be an unambiguous violation; patient "consent" does not erase power asymmetry.^[1][3]

Self-management. Name countertransference; stop personal texting; reinstate time boundaries; take the case to supervision urgently; consider transfer of care if the frame cannot be restored. Do not shame the patient for the disclosure of love; explore it as clinical material while holding the limit.^[1][3]

Prior psychiatrist sexual advances. Believe and support; do not investigate alone; discuss reporting options and support pathways; assist with trauma-informed care and board/complaint pathways as the patient chooses and as mandatory duties require; document; protect against retaliation.^[3][4]

Post-termination. Residual dependency and power make post-termination sexual relationships ethically high-risk and often prohibited or tightly constrained by codes; termination engineered for sex is misconduct.^[2]

Consequences. Board sanctions, conditions, suspension or deregistration, civil and possible criminal liability; patient trauma sequelae require alternative care planning. PHP series show sexual violations are a substantial share of referred boundary cases — with under-reporting caveats.^[4][6]

Professionalism themes. Patient welfare, integrity, non-exploitation, collegial responsibility, and self-awareness align with RANZCP Code of Ethics themes.^[5]