title: Exploitation of patients: themes in the psychopathology of their therapists.
abstract: This clinical paper develops an interpersonal theory of the therapist-patient relationship when boundaries are violated. It describes a clinically useful way to define boundary transgressions. A variety of mutually created dialectical paradigms interact with the therapist's psychopathology when, for various reasons, the therapist who is fully ethically responsible cannot see what is happening. The role of burgeoning aggression, dominance/ submission interplay, envy, and erotized countertransference is explored as forces leading to sexual and nonsexual exploitation of patients. Numerous clinical vignettes are used to illustrate the theoretical issues. Two fundamental axioms of treatment are also described, which, if followed, can help avoid transgressions.
authors.affiliation: Topeka Institute for Psychoanalysis, Menninger Foundation, Wichita, KS, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Twemlow
mesh_terms: D003674:Defense Mechanisms; D004291:Dominance-Subordination; D004992:Ethics, Medical; D005201:Fantasy; D006801:Humans; D007389:Internal-External Control; D008149:Love; D010815:Physician Impairment / Q000523:psychology*; D010817:Physician-Patient Relations; D011575:Psychoanalytic Therapy; D012725:Sexual Behavior