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J Am Acad Psychiatry Law 33:4:476-481 (2005)
Copyright © 2005 by the American Academy of Psychiatry and the Law.
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REGULAR ARTICLE

Boundaries, Blackmail, and Double Binds: A Pattern Observed in Malpractice Consultation

Thomas G. Gutheil, MD

Dr. Gutheil is Professor of Psychiatry, and Co-Director, Program in Psychiatry and the Law, Massachusetts Mental Health Center, Harvard Medical School, Boston, MA. Address correspondence to: Thomas G. Gutheil, MD, 6 Wellman Street, Brookline, MA 02446. E-mail: gutheiltg{at}cs.com

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.




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T. G. Gutheil
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J Am Acad Psychiatry Law, January 1, 2006; 34(1): 131 - 131.
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Commentary: Two Sides to Every Story--the Need for Objectivity and Evidence
J Am Acad Psychiatry Law, December 1, 2005; 33(4): 482 - 483.
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Copyright © 2005 by the American Academy of Psychiatry and the Law.