When colleagues go astray...

One of the saddest aspects of a long career as a psychiatric psychotherapist is the experience of working with colleagues who have seriously betrayed the ethical code of our profession. Mostly sexual violations, these are inevitably distressing situations that gravely harm patients, ruin careers, and bring about personal tragedy to the wayward colleague and his or her family. When we encounter these situations, either through doing damage control with the victims or by trying to help the colleague deal with what he or she has done, we ourselves must come to grips with a sea of conflicting feelings in order to offer the best we can do as professionals. Each situation presents its own unique set of circumstances and challenges. Dealing with our own feelings about what has happened Understandably, our first reaction to hearing about the situation is a feeling of shock and revulsion. We have been intensively indoctrinated with the dictum of primum non nocere or “first, do no harm.” A patient has been hurt by the boundary violation, and so has the ethical tradition of our profession. Our colleague has betrayed what we stand for and undermined the fundamental trust that is essential to the patient’s full engagement in treatment, especially psychotherapy. Ethical violations also damage the public image of psychiatry, medicine, and other mental health professions. As we learn more about what has happened, our feelings may progress to indignation and anger. If we learn that the perpetrator is a habitual offender, we want to condemn and ostracize him or her. But we are also likely to be aware of the truth uttered by early colonist John Bradford, as he watched prisoners marched to their execution, that “But for the grace of God, there goes John Bradford.” We are well aware that prominent, experienced leaders in psychiatry and other mental health professions, even professional association presidents or chairs of ethics committees, have fallen to disgrace in the wake of ethical violations. The private setting of psychotherapy and the encounter of deep-seated, intense emotional forces place a heavy burden on our adherence to ethical constraints. Thus we approach our task with some measure of humility, along with anxiety about our own vulnerability. We also wonder about the role the patient has played in the dismal events. I resist using the word “blame” in regard to the patient’s part, because no matter what the patient has done, it was the therapist’s responsibility to maintain ethical boundaries. Patients bring powerful forces with them into therapy, and sometimes they act them out. It is our task to assist the patient in containing them and mastering them through understanding and managing them in a healthier manner, but a boundary violation is a failure on the part of the therapist. These negative feelings are countered by compassion. We feel for the patient whose opportunity for the benefits of therapy has turned into a traumatic situation that will make future therapy much more difficult. There is much work to do, if the patient has not been too hurt to accept it. We also may feel for the colleague, especially if the colleague is a friend or respected member of our professional community. We wonder how this could have happened. We suspect that shame, anguish, and despair rule the day. We know that the colleague’s family relations and livelihood are in grave peril. We