Sexual boundary violations: victims, perpetrators and risk reduction

Abstract

SUMMARYSexual boundary violations by healthcare professionals is a subject that has largely been ignored in the UK. There has been little research into the field. It is rarely taught on professional training courses and practitioners appear to know very little about it. The history of sexual boundary violations is littered with failures to notice, failures to report and inadequate justice for victims and perpetrators alike. Perpetrators are commonly assumed to be predators. Given the many widely reported recent events in our media of both predatory and other sexual offenders, we believe it is timely for all healthcare and other professions working with vulnerable people to take the problem seriously, to provide appropriate services for victims, evaluation and assessment of perpetrators, and sanctions that fit the crime in order to regain public trust.LEARNING OBJECTIVES•Develop greater understanding of the problem of sexual boundary violations by professionals•Be able to manage the care of a patient who has been the victim of a sexual boundary violation•Understand factors in professionals that may lead to a sexual boundary violationDECLARATION OF INTERESTNone.

Complaint risk among mental health practitioners compared with physical health practitioners: a retrospective cohort study of complaints to health regulators in Australia

“…In our study, mental health practitioners had three times the risk of complaint regarding sexual boundary breaches compared with physical health practitioners. High rates of concern about sexual misconduct by psychiatrists and psychologists are a consistent finding in previous studies of complaints,11 regulatory actions6 10 12 and self-reported behaviour 7 37. Compared with comparator professions in this study, the day-to-day practice of mental health practitioners more often involves being alone with patients behind closed doors, discussing more personally-intimate information, for longer periods of time.…”

Boundary violations in therapy: the patient's experience of harm

“…We devote much of this article to adverse idealising transferences (AITs) – the adverse effects that may arise when a patient transfers idealising feelings onto the professional – because, although we have found it to be a significant factor in most cases of harm, it is rarely discussed in the literature on harm. Our second article (Hook 2018) will focus specifically on sexual boundary violations – the assessment and management of victims and perpetrators and proposals for reducing risk.…”

Explanatory paradigms for professional boundary violations

“…In relation to doctors as carers, Vaillant et al (1972) were possibly the first to suggest that behavioural problems in doctors might be related to their relationships with their fathers. In their second article Hook & Devereux (2018b) cite the study by MacDonald et al (2015) which found high levels of insecurity of attachment in doctors referred to a therapy programme for professional boundary violations. Insecure attachment might explain the adverse idealising transference described by Hook & Devereux (2018a), because idealisation is a key aspect of dismissing/avoidant attachment strategies.…”

“…I am grateful to both the Editor of BJPsych Advances and to the authors of these two stimulating articles (Hook 2018a,b) for an opportunity to reflect on this most important of topics. Reading these articles reminded me of a conversation about sexual boundary violations by therapists that I had in 1990 with a senior and highly respected professor of psychiatry who was a leader in mental health ethics.…”