Psychiatrist-patient sexual contact: results of a national survey, II: Psychiatrists' attitudes

Sexual Misconduct: What Does a 20-Year Review of Cases in Quebec Reveal about the Characteristics of Professionals, Victims, and the Disciplinary Process?

While there is a considerable body of literature on sexual aggression, we know much less about the violation of sexual boundaries within professional relationships. To address this knowledge gap, the characteristics of cases of sexual misconduct in the province of Quebec were extracted, based on a search of published disciplinary decisions between 1998 and 2020, using the legal databases CANLII and SOQUIJ. The search yielded 296 decisions including 249 male and 47 female members from 22 professional orders, and involving 470 victims. Results indicate that male professionals approaching mid-career accounted for a greater proportion of cases of sexual misconduct. Moreover, physical and mental health professionals were overrepresented in cases, as were female adult victims. Acts of sexual misconduct concerned mostly sexual touching and intercourse and occurred during consultations. Female professionals were more inclined to establish romantic and sexual relationships with clients than their male counterparts. Of the 92.0% of professionals found guilty of at least one count of sexual misconduct, two thirds eventually returned to practice. Following the guilty verdict, few faced rehabilitative measures. Recommendations are provided for the prevention of sexual recidivism and the accompaniment of victims of sexual misconduct throughout the disciplinary process.

Fifty Years of Change: A Shared Journey

The author shares a personal account of 50 years of experience practicing psychodynamic psychiatry and psychoanalysis after migrating from Argentina to the United States. Her career developed in parallel as a clinician and as an academic psychiatrist, with leadership roles in the American Psychiatric Association, the Association of Women Psychiatrists, and the American Academy of Psychodynamic Psychiatry and Psychoanalysis. After describing what constitutes the essence, substance, and form of psychoanalysis, she reviews the historic shift within psychoanalysis in the United States from intrapsychic dyadic practice with selected patients to the application of psychodynamic concepts to everyday psychiatric care of patients with complex morbidities in multiple clinical settings.

Shoestring science

ABSTRACT Nanette K. Gartrell, MD, is a psychiatrist, teacher and researcher who has served on the faculties of Harvard Medical School and the University of California, San Francisco. For the past thirty years, without relying on major grants, she has been gathering data to depathologize lesbianism. Her earliest investigations contributed to the effort to remove "homosexuality" from the list of mental disorders. More recently, Dr. Gartrell has been conducting a national, longitudinal study of lesbian families. In this overview of her research career, Dr. Gartrell discusses the strategies that she has used successfully for pursuing scientific investigations on a shoestring budget.

Sex, lies and training programs: the ethics of consensual sexual relationships between psychiatrists and trainee psychiatrists

OBJECTIVE

The aim of this paper is to chart the ethical territory surrounding the issue of consensual sexual relationships between psychiatrists and doctors training in psychiatry.

METHOD

The arguments for and against the prohibition of such relationships are critically examined both in general and in a number of specific circumstances.

RESULTS

There should not be a general prohibition against such relationships, but a prohibition should apply in certain special circumstances. Such circumstances include occasions when the psychiatrist is currently supervising the trainee, when a particular psychiatrist has repeated sexual relationships with trainees and when a group of psychiatrists voluntarily pledge to abstain from such relationships.

CONCLUSIONS

Institutions involved in psychiatric training should develop guidelines for dealing with such relationships, adopting a generally permissive attitude toward them with clear exceptions in special cases.

Practices and attitudes among Swedish psychiatrists regarding the ethics of compulsory treatment

Few empirical studies have examined the attitudes and ethical beliefs of psychiatrists. In this study, 328 members of the Swedish Psychiatric Association were randomly selected to respond to a questionnaire containing three clinical vignettes examining involuntary hospitalization, other compulsory interventions, and restraint. The questionnaire also contained 16 controversial statements and items on the abuse of psychiatry. A 60% response rate was obtained. Psychiatrists' responses were influenced not only by the severity of and risks associated with the patient's disorder, but also by family pressure which affected the decision-making process. Female psychiatrists less often suggested the use of physical restraints and the compulsory use of ECT. Sexual misconduct, and also the inadequate treatment of refugees, were the most frequently reported forms of abuse of psychiatry.

Sleeping with the past: the ethics of post-termination patient-therapist sexual contact

OBJECTIVE

The aim of the paper is to devise an ethical argument to support the contention that post-termination patient-therapist sexual contact (PTSC) is always unethical.

METHOD

Arguments both defending and condemning post-termination PTSC are reviewed and their strengths and weaknesses explored.

RESULTS

Analysis of these arguments reveals a strong case for the universal condemnation of post-termination PTSC.

CONCLUSIONS

Ethical codes, including that of the Royal Australian and New Zealand College of Psychiatrists, should be amended to explicitly prohibit post-termination PTSC.

A survey of Australian psychiatrists' attitudes and practices regarding physical contact with patients

A brief review of the ethics of psychiatrists' and psychotherapists' physical contact with patients is followed by a more detailed review of the major North American studies using self report surveys to measure attitudes and behaviour regarding physical contact with patients. The methodology and results of a recent sample survey of Australian psychiatrists' attitudes and behaviour regarding such physical contact are presented and discussed by comparison with the North American literature. Issues pertaining to both "erotic" and "non-erotic" contact are explored.

Sex and gender and the impaired therapist

A brief review of the problem of impaired therapists is followed by a more comprehensive review of sexual relationships arising in and following psychotherapy. The prevalence of this latter problem is approximately 10%. Offenders are predominantly male, one half are said to be "ruthless" and "exploitative", whilst the remainder are often "lovesick". The author relates these phenomena to processes of repudiation of the relational/feminine self of the highly masculinised clinician. Characteristics of offenders and consequences for patients are presented and issues of detection, sanctions, legislation, and prevention are addressed. Studies suggest that the vast majority of patients are harmed by the experience and that neither improved training, licensing, personal therapy, nor supervision of therapists will guarantee against its occurrence.

The prevention of sexual exploitation of patients: educational issues

The following guidelines were approved by the Board of Directors of the Canadian Psychiatric Association on April 12, 1992.

Fatal attraction: the ethical and clinical dilemma of patient-therapist sex

This article reviews the existing literature on the subject of patient-therapist sexual contact. Seven point one percent to 10.9% of male therapists and 1.9% to 3.5% of female therapists admit to engaging in intimate contact with patients. Offenders tend to justify their behaviour as being at least innocuous if not beneficial for the patients. The consequences to the patients include increased psychological and psychosomatic complaints, greater mistrust and anger towards men, hospitalization and suicide. Transference and countertransference issues which account for this behaviour are explored as is the issue of post-termination involvement. Education of physicians and residents concerning the temptations and dangers of this type of contact is strongly recommended.