Boundary violations and departments of psychiatry

Differences and similarities in cross-cultural perceptions of boundaries: a comparison of results from two studies

There has been substantial literature on boundary excursions in clinician-patient relationships; however, very little empirical research exists. Even less information exists on how perceptions of this issue might differ across cultures. Prior to this study, empirical data on various kinds of boundary excursions were collected in different cultural contexts. First, clinicians from the U.S. and Brazil were asked to rate 173 boundary excursions for both their perceived harmfulness and their professional unacceptability (Miller et al., 2006). In a second study, colleagues from Qatar administered a slightly modified version to mental health care professional staff of a hospital in Doha, Qatar (Ghuloum et al., 2011). In this paper, the results of these two separate studies are compared. The results showed some similarities and some differences in perceptions of the boundary behaviors. For example, both sets of cultures seem to agree that certain behaviors are seriously harmful and/or professionally unacceptable. These behaviors include some frankly sexual behavior, such as having sexual intercourse with a patient, as well as behavior related to doing business with the patient, and some disclosing behavior. There are also significant cultural differences in perceptions of how harmful some of the behaviors are. Qatari practitioners seemed to rate certain behaviors that within therapy mix disclosing or personal behavior with therapy as more harmful, but behaviors that involved interacting with patients outside of therapy as less serious. A factor analysis suggested that participants in U.S./Brazil saw a much larger number of behaviors as making up a set of Core Boundary Violations, whereas Qatari respondents separated sexual behaviors from others. Finally, a Rasch analysis showed that both cultures perceived a continuum of boundary behaviors, from those that are least harmful or unprofessional to those that are highly harmful or unprofessional. One interpretation is that cultural factors may be most influential on those kinds of behaviors that are perceived as relatively less serious. Implications for training and supervision are also discussed.

Sexual boundaries between physiotherapists and patients are not perceived clearly: an observational study

QUESTION

What are the sexual boundaries between physiotherapists and their patients? and do they differ between males and females?

DESIGN

Observational study using a postal questionnaire.

PARTICIPANTS

2248 physiotherapists registered with the Physiotherapist's Registration Board of Western Australia.

OUTCOME MEASURES

Respondents were asked to state: i) their perception of the behaviour of a hypothetical physiotherapist in six vignettes highlighting professional sexual boundaries; ii) the incidence of sexual attraction between themselves and their patients, and iii) the course(s) of action they would take in a situation of alleged sexual misconduct between a physiotherapist colleague and a patient.

RESULTS

A response rate of 42% (939 responses, 706 females) was achieved. The majority of respondents (= 80%) thought the physiotherapist's behaviour to be wrong in four of the six vignettes; 65% of respondents thought it acceptable for a physiotherapist who provides physiotherapy services to a rugby team to go on a date with a team member; 74% of males and 41% females (p > 0.001) reported having felt sexually attracted to a patient; respondents were aware of a colleague who had dated a patient (33%) or ex-patient (60%). When presented with a vignette describing alleged sexual misconduct, 83% of respondents stated they would advise the patient to make a written complaint to the appropriate disciplinary body. Less than 20% stated that they would personally report their colleague to the Physiotherapists' Registration Board (19%) or the Australian Physiotherapy Association National Professional Standards Panel (15%).

CONCLUSION

The variation in responses to the vignettes, the reported incidence of sexual attraction and dating of patients, and apparent confusion with regard to the complaints process identifies the need for education of the physiotherapy profession in Australia.

Forbidden Love: Sexual Exploitation in the Forensic Milieu

Strategies must be developed within forensic psychiatric nursing practice that deal with issues surrounding forbidden love before, during, and after they arise. Unfortunately, nurses are generally ill prepared to deal with the sexual dilemmas that can occur in clinical practice. Sexual dilemmas must be recognized as an occupational hazard and not a professional taboo. Open acknowledgement that the potential for abuse exists in all nurse-client relationships is the key to avoiding the pitfalls that lead to sexual impropriety.