Preventing Boundary Violations in Clinical Practice

Thomas G. Gutheil, MD, is Professor of Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, where he is Assistant Director of Medical Student Training and Co-Founder of the Program in Psychiatry and the Law. One of the world's leading forensic psychiatrists, he is a past president of the American Academy of Psychiatry and the Law and current president of the International Academy of Law and Mental Health. Dr. Gutheil is coauthor of the widely used Clinical Handbook of Psychiatry and the Law, which won the American Psychiatric Association's Manfred S. Guttmacher Award (an award Dr. Gutheil has shared three times). His numerous other awards and honors include the American Psychiatric Association's 2000 Isaac Ray Award for outstanding contributions to forensic psychiatry. The author of more than 250 scholarly journal articles and book chapters, Dr. Gutheil lectures worldwide and is regularly consulted by attorneys, licensing boards, and institutions on boundary questions, risk management, and malpractice prevention.Archie Brodsky is Research Associate in the Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, where he is Co-Founder of the Program in Psychiatry and the Law. He is coauthor of Sexual Dilemmas for the Helping Professional, a pioneering work on clinical and ethical boundaries in mental health treatment. Among the 15 trade and professional books he has coauthored in the mental health field are Love and Addiction; The Truth about Addiction and Recovery; Medical Choices, Medical Chances; and Clinical Supervision in Alcohol and Drug Abuse Counseling. A co-winner (with Dr. Gutheil) of the Guttmacher Award, Mr. Brodsky is a member and former chair of the Human Rights Committee at Massachusetts Mental Health Center.

• 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

"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, PhD, ABPP, coauthor of Ethics in Psychotherapy and Counseling: A Practical Guide, Third Edition"Gutheil and Brodsky have provided mental health professionals of all persuasions with a marvelous guide to navigating the minefield of professional boundaries. What is refreshing and exemplary about this superb book is that the authors appreciate the pervasive ambiguity and uncertainty that are inherent in clinical decisions involving boundaries. A gesture that saves the therapy in one context can destroy the therapy in another context. Each chapter of this rich volume is filled with clinical wisdom and thoughtful risk management strategies that will be of great assistance to both mental health trainees and experienced psychotherapists."--Glen O. Gabbard, MD, Brown Foundation Chair of Psychoanalysis and Professor of Psychiatry, Baylor College of Medicine "Gutheil and Brodsky have done an outstanding job. Reading this book is like taking a course with the authors, who demonstrate great wisdom and perspicacity as they build the reader's awareness, elucidate what constitutes a boundary violation, and provide strategies for prevention. In today's litigious climate, in which clinical practitioners need to remain so mindful of their professional role, this book is a welcome contribution. I highly recommend this resource to everyone from students to seasoned professionals."--Frank M. Dattilio, PhD, ABPP, Department of Psychiatry, Harvard Medical School and University of Pennsylvania School of Medicine"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, PhD, ABPP, past president, Division of Trauma Psychology, American Psychological Association; private practice, Seattle, Washington-