title: Dual agency, dual relationships, boundary crossings, and associated boundary violations: a survey of military and civilian psychiatrists.
abstract: We hypothesized that psychiatrists with high dual-agency potential (military and health maintenance organization [HMO] psychiatrists) were more likely than non-HMO civilian psychiatrists to engage in dual relationships, report pressures to do so, participate in other general boundary-crossing activities, and report associated counter-therapeutic outcomes (boundary violations). Ninety military and 191 demographically matched civilian psychiatrists reported the number of boundary-crossing activities (including dual relationships) and associated counter-therapeutic outcomes in the preceding year with adult patients. Military and HMO psychiatrists reported greater external pressures than non-HMO civilian psychiatrists to engage in dual relationships; however, all three groups were similar in their reported numbers of dual relationships. The reported boundary-crossing activities and dual relationships studied here are not necessarily associated with reported boundary violations. The relative risk of a particular boundary crossing associating with harm to a patient likely depends on the therapeutic context and should be determined on a case-by-case basis.
authors.affiliation: Department of Psychiatry, Walter Reed Army Medical Center, Washington, DC 20307, USA.
authors.forename: A H
authors.initials: AH
authors.lastname: Hines
authors.forename: D N
authors.initials: DN
authors.lastname: Ader
authors.forename: A S
authors.initials: AS
authors.lastname: Chang
authors.forename: J R
authors.initials: JR
authors.lastname: Rundell
mesh_terms: D000328:Adult; D003220:Conflict, Psychological; D004992:Ethics, Medical; D005260:Female; D006279:Health Maintenance Organizations; D006301:Health Services Needs and Demand; D006801:Humans; D007398:Interpersonal Relations; D007587:Job Description; D008297:Male; D008890:Military Psychiatry; D010344:Patient Advocacy; D010558:Personnel Loyalty; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States