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Joel Dvoskin's legendary wit is at its lambent and penetrating peak when he pretends that my didactic article on boundaries¹ is some sort of forensic report requiring objectivity and a comprehensive database; an artist at the top of his form is always a treat to read.²

For those who missed the irony, in my article, I described and analyzed six vignettes of patients with boundary issues. The material was presented in the service of dynamic understanding and risk management instruction.

In his commentary, Dr. Dvoskin correctly pointed out that, when presenting the clinical material, I omitted the individual sources of the data. Because the article is clearly risk management advice and a form of warning for the practitioner—and equally clearly not a forensic opinion—I omitted individual sources in the interests of space and efficiency and the wish to avoid diluting the central points of focus.

However, to heighten the satire, Dr. Dvoskin ignored the fact that—since the cases in question went to actual trials and hearings—due to my function as expert, I did have access to a large database in each case, which I employed to validate my opinions. I had to summarize or even ignore most of that vast data to save space, and highlight only the material relevant to my core risk management point. Dr. Dvoskin also pretended that I did not know that one cannot take the unilateral claims of a litigant as factual.

In reality, Dr. Dvoskin expresses some doubt about the rule, in the foreign country I mentioned, that a consultant had a duty to report a consultee who disclosed a boundary issue, including sitting in an office while the patient masturbated. I did not merely accept the litigant's claim that a consultant in the foreign country would have to report him. Instead, I checked the regulations and interviewed some native practitioners. The defendant was right. Of course, this represents a terrible solution to the misconduct problem, in my opinion, since it deprives the practitioner of the benefits of consultation.

Finally, since my aim was not to persuade (which would fail) but to teach, I am left with the hope that that aspect of the piece succeeded. I offer my renewed thanks to Dr. Dvoskin for his brilliant satire.

Thomas G. Gutheil, MD

Harvard Medical School
Boston, MA

References

1. Gutheil TG: Boundaries, blackmail, and double binds: a pattern observed in malpractice consultation. J Am Acad Psychiatry Law 33:476–81, 2005[Abstract/Free Full Text]
2. Dvoskin JA: Commentary: two sides to every story—the need for objectivity and evidence. J Am Acad Psychiatry Law 33:482–3, 2005[Abstract/Free Full Text]

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