Psychiatrist-patient boundary issues following treatment termination

Ethics in psychotherapy: a focus on professional boundaries and confidentiality practices

The practice of psychotherapy gives rise to many ethical dilemmas. In this article we offered a "primer" on the most commonly cited ethical concerns in psychotherapy related to professionalism and therapeutic boundaries and confidentiality. There is no single answer to the varied and complex ethical issues that therapists may encounter in their treatment of patients. Such dilemmas are dynamic, nuanced, complex, and highly context dependent. Although professional codes offer guidance on optimal standards of conduct, they do not always offer clear answers; hence, therapists need to be able to critically evaluate and interpret such codes in relation to their daily practice. The contemporary therapist continues to face new dilemmas in an ever-evolving and dynamic twenty-first-century practice environment. Ethical therapists serve the well-being of their patients above all other interests or commitments. Therapists who are attentive to the professional obligations they possess can adopt several strategies to increase their ethical competence, including constantly evaluating their own attitudes and behaviors in addition to those of their patients, engaging in dialog and developing expertise in relation to ethics issues, having a solid grasp of relevant professional codes of conduct, and demonstrating an openness to consultation with peers and exposure of their work to peer review.

The cognitive-affective neuroscience of the unconscious

There is an ongoing debate about how best to conceptualize the unconscious. Early psychodynamic views employed theories influenced by physics to explain clinical material, while subsequent cognitivist views relied on computational models of the mind to explain laboratory data. More recently, advances in cognitive-affective neuroscience have provided new insights into the workings of unconscious cognition and affect. We briefly review some of this recent work and its clinical implications.

Transference and countertransference

TOPIC

The utility of transference and countertransference in professional nursing relationships.

PURPOSE

To provide an introductory text for nurses new to these concepts.

SOURCES

Literature specific to transference and countertransference illustrated by examples related to professional practice.

CONCLUSIONS

Transference and countertransference influence relationships in ways that under certain conditions may be unhelpful to all concerned. Understanding how transference and countertransference manifest themselves has implications for the safe structuring of professional relationships.

Post-termination sexual boundary violations

In this essay, the author has focused on the rationale for an absolute prohibition of sexual contact between psychiatrists and former patients. The role of an ethics code is to proscribe professional misconduct that may have the potential to harm the patient. Because we know that in many cases of psychiatrist-patient sex there is serious exploitation of the patient's vulnerability, we have clear prohibitions against sexual relations between a current patient and his or her psychiatrist. The same considerations apply to former patients. The transference (and countertransference) feelings established in the relationship persist well beyond termination. Even in the absence of a treatment that acknowledges the existence of transference, a power differential is unmistakable because of the fiduciary nature of the relationship. Moreover, the therapeutic relationship is effective because it will never be anything but a treatment relationship. The possibility of a future sexual affair between psychiatrist and patient erodes the conditions necessary for effective psychiatric therapy. Finally, most patients will feel the need to return to treatment at some point in the future, and the psychiatrist needs to preserve that potential as part of the duty to the patient. For all of these reasons, the current position of the APA on an absolute prohibition against sex with former patients is a sound and sensible one.