Boundary Issues and Violations

SEXUAL BOUNDARY VIOLATIONS

All major professional organizations decry sexual activity with patients. Many also include past patients. Several states have laws making such behaviors specific causes of action for lawsuits, or even crimes. The prohibitions often seem clear, but may not define “sexual activity” very well. In addition, statutes and ethical guidelines may not differentiate 1) brief behaviors from lasting, calculated, and/or predatory ones; 2) recent behavior from that which occurred decades ago; or 3) intense therapeutic relationships from one-time consultations. Nevertheless, rigid requirements and interpretations are facts of life. Clinicians should be highly aware of the rules in their profession and locale, and how their behavior may appear to a sometimes accusing or suspicious public. An older clinician with an excellent reputation had a brief affair with a patient early in his career. He quickly felt remorse and took all the professional steps believed appropriate by his profession at the time of the transgression (e.g., took responsibility for his behavior,