Boundaries, blackmail, and double binds: a pattern observed in malpractice consultation.
A scenario common to several boundary violation/sexual misconduct cases is reviewed and discussed. Common features include an articulate patient whose high functionality concealed more primitive dynamics that arose in the therapy; boundary problems, often on an "attempted rescue" basis; and eventual litigation in some form. The patient's high functioning appeared to cause the therapists to underestimate the severity of the patients' disturbances. Drawing on forensic experience, the author analyses the cases and suggests risk management approaches.
Gutheil
Thomas G
TG
Program in Psychiatry and the Law, Massachusetts Mental Helath Center, Harvard Medical School, Boston, USA. gutheiltg@cs.com
D000328:Adult; D001883:Borderline Personality Disorder / Q000523:psychology / Q000628:therapy; D005201:Fantasy; D005260:Female; D006801:Humans; D008257:Machiavellianism; D008318:Malpractice / Q000331:legislation & jurisprudence*; D011369:Professional-Patient Relations; D011570:Psychiatry / Q000941:ethics* / Q000331:legislation & jurisprudence*; D013811:Psychotherapeutic Processes; D011613:Psychotherapy / Q000941:ethics; D013406:Suicide, Attempted / Q000517:prevention & control; D014167:Transference, Psychology