Boundary violations and departments of psychiatry
Garfinkel, P.E.; Dorian, B.; Sadavoy, J.; Bagby, R.M.
Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 42(7): 764-770
1997
ISSN/ISBN: 0706-7437 PMID: 9307838 DOI: 10.1177/070674379704200710Document Number: 281668
Trust, integrity, and a commitment to the patient's needs and well-being are essential to effective psychotherapy. Psychiatrists with poor impulse control, exaggerated views of their own specialness, excessive needs for affirmation, or unacknowledged longings for care and nurturance are at risk of succumbing to the intimate enticements of the psychotherapeutic relationship. Academic departments have a responsibility both to prevent and respond to transgressions of professional boundaries and to develop a consensus regarding the parameters of professional conduct. The capability of psychiatrists to serve as effective role models for their trainees may be nullified by the failure to address boundary issues. This article presents examples of boundary problems potentially encountered by psychiatrists. Although sexual contact represents the most extreme and publicized form of boundary violation, nonsexual forms of exploitation involving finances, confidentiality, dual relationships, and relationships with the pharmaceutical industry also are salient. A significant factor in the occurrence of boundary violations is the view that one is "above the rules" and entitled to broaden the parameters of physician privilege and professional conduct.