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Preventing Boundary Violations in Clinical Practice


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Table of Contents

IntroductionI. Foundations1. Definitions and Dilemmas 2. Therapy and Its Limits II. Explorations 3. Role, Time, Place 4. Money, Services, Gifts 5. Self-Disclosure6. Communication and Out-of-Office Contacts7. Clothing and Physical Contact8. Sexual MisconductIII. Implications9. What Harms Are Caused?10. Vulnerabilities11. Understandings and Misunderstandings 12. Liabilities13. Prevention Afterword

About the Author

Thomas G. Gutheil, MD, is Professor of Psychiatry at Beth Israel Deaconess Medical Center, Harvard Medical School, Massachusetts, USA, where he is Assistant Director of Medical Student Training and Co-Founder of the Program in Psychiatry and the Law. A leading forensic psychiatrist, Dr. Gutheil lectures worldwide and is regularly consulted on boundary questions, risk management, and malpractice prevention by attorneys, licensing boards, and institutions. His over 250 publications include the coauthored Clinical Handbook of Psychiatry and the Law, winner of the American Psychiatric Association's Manfred S. Guttmacher Award. Among Dr. Gutheil's many other honors and awards are the American Psychiatric Association's Isaac Ray Award for outstanding contributions to forensic psychiatry. He is currently President of the International Academy of Law and Mental Health. Archie Brodsky is a Research Associate in the Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Massachusetts, USA, and Co-Founder of the Program in Psychiatry and the Law. He has coauthored 15 books in the mental health field, including Sexual Dilemmas for the Helping Professional, a pioneering work on clinical and ethical boundaries in mental health treatment.


"At last, therapists have a clear, comprehensive, practical guide to the boundary decisions facing each of us throughout every course of therapy. Two foremost authorities discuss the full range of boundary issues-time, place, fee, gifts, self-disclosure, touch, documentation, causes and responses to false complaints, avoiding problems and misunderstandings, and so on-in light of the patient's condition and needs, benefits and risks, research, legal standards and liabilities, and varying theoretical orientations. No practicing therapist, training program, or expert witness should be without this essential resource." - Kenneth S. Pope, coauthor of Ethics in Psychotherapy and Counseling: A Practical Guide, Third Edition "This is an excellent volume. I'm pleased to see that it immediately addresses 'transference atheists,' psychotherapists whose theoretical models allow them to pretend that a therapist holds no special power or responsibility in the relationship. The authors' willingness to make clear that clinical practice of mental health occurs within boundaries-whether one practices CBT, prescribes medication, is covering for the treating provider, or does in-depth, transference-based work-is wonderful to encounter. The clarity of the writing makes this book accessible both for beginning therapists and for those of us who are more experienced and think we know better-but often don't." - Laura S. Brown, Director, Fremont Community Therapy Project, Seattle, USA

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