Boundary Crossings | Violations

Abstract

Principles of beneficence, autonomy, and nonmaleficence, compassion along with fiduciary partnership are the core concepts in the doctor-patient relationship in therapeutic settings. There are varieties of reasons for boundary problems. Physicians ignorance, exploitative character, emotional vulnerability moral weakness and similar factors may pave the way for boundary issues resulting in nonsexual or sexual boundary crossings and violations.

INTRODUCTION

Physicians are held in great esteem and respect by the society. It is the duty of the medical personnel to discharge their duties toward the billions of suffering from physical or psychological disorders, with a sense of commitment and without damaging the values of ethics. The behavior of the physicians toward their clients must be consistent in all aspects with the norms of the society and culture they live. Physicians are bound to abide by Hippocratic Oath. The Hippocratic Oath is an oath historically taken by doctors swearing to practice medicine ethically.[1]...

Abstract

A scenario common to several boundary violation/sexual misconduct cases is reviewed and discussed. Common features include an articulate patient whose high functionality concealed more primitive dynamics that arose in the therapy; boundary problems, often on an “attempted rescue” basis; and eventual litigation in some form. The patient's high functioning appeared to cause the therapists to underestimate the severity of the patients' disturbances. Drawing on forensic experience, the author analyses the cases and suggests risk management approaches.

In malpractice prevention and risk management consultation, boundary questions are a very common concern among consultees. Such questions account for a considerable portion of legal and ethics-related difficulties for clinicians. The subject has been extensively discussed in the professional literature (see, for example, Refs. 1–10).

Over time, a particular pattern has emerged that seems to pose repeated problems and create familiar pitfalls for the therapists involved. This review lays out the pattern and indicates...