Preventing Boundary Violations in Clinical Practice

What do you do when you run into a patient in a public place? How do you respond when a patient suddenly hugs you at the end of a session? Do you accept a gift that a patient brings to make up for causing you some inconvenience? Questions like these which virtually all clinicians face at one time or another have serious clinical, ethical, and legal implications. This authoritative, practical book uses compelling case vignettes to show how a wide range of boundary questions arise and can be responsibly resolved as part of the process of therapy. Coverage includes role reversal, gifts, self-disclosure, out-of-office encounters, physical contact, and sexual misconduct. Strategies for preventing boundary violations and managing associated legal risks are highlighted.

Thomas G. Gutheil, MD, is Professor of Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, where he is Assistant Director of Medical Student Training and Co-Founder of the Program in Psychiatry and the Law. One of the world's leading forensic psychiatrists, he is a past president of the American Academy of Psychiatry and the Law and current president of the International Academy of Law and Mental Health. Dr. Gutheil is coauthor of the widely used Clinical Handbook of Psychiatry and the Law, which won the American Psychiatric Association's Manfred S. Guttmacher Award (an award Dr. Gutheil has shared three times). His numerous other awards and honors include the American Psychiatric Association's 2000 Isaac Ray Award for outstanding contributions to forensic psychiatry. The author of more than 250 scholarly journal articles and book chapters, Dr. Gutheil lectures worldwide and is regularly consulted by attorneys, licensing boards, and institutions on boundary questions, risk management, and malpractice prevention. Archie Brodsky is Research Associate in the Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, where he is Co-Founder of the Program in Psychiatry and the Law. He is coauthor of Sexual Dilemmas for the Helping Professional, a pioneering work on clinical and ethical boundaries in mental health treatment. Among the 15 trade and professional books he has coauthored in the mental health field are Love and Addiction; The Truth about Addiction and Recovery; Medical Choices, Medical Chances; and Clinical Supervision in Alcohol and Drug Abuse Counseling. A co-winner (with Dr. Gutheil) of the Guttmacher Award, Mr. Brodsky is a member and former chair of the Human Rights Committee at Massachusetts Mental Health Center.

Introduction I. Foundations 1. Definitions and Dilemmas 2. Therapy and Its Limits II. Explorations 3. Role, Time, Place 4. Money, Services, Gifts 5. Self-Disclosure 6. Communication and Out-of-Office Contacts 7. Clothing and Physical Contact 8. Sexual Misconduct III. Implications 9. What Harms Are Caused? 10. Vulnerabilities 11. Understandings and Misunderstandings 12. Liabilities 13. Prevention Afterword