Post-termination sexual boundary violations.

Abstract

In this essay, the author has focused on the rationale for an absolute prohibition of sexual contact between psychiatrists and former patients. The role of an ethics code is to proscribe professional misconduct that may have the potential to harm the patient. Because we know that in many cases of psychiatrist-patient sex there is serious exploitation of the patient's vulnerability, we have clear prohibitions against sexual relations between a current patient and his or her psychiatrist. The same considerations apply to former patients. The transference (and countertransference) feelings established in the relationship persist well beyond termination. Even in the absence of a treatment that acknowledges the existence of transference, a power differential is unmistakable because of the fiduciary nature of the relationship. Moreover, the therapeutic relationship is effective because it will never be anything but a treatment relationship. The possibility of a future sexual affair between psychiatrist and patient erodes the conditions necessary for effective psychiatric therapy. Finally, most patients will feel the need to return to treatment at some point in the future, and the psychiatrist needs to preserve that potential as part of the duty to the patient. For all of these reasons, the current position of the APA on an absolute prohibition against sex with former patients is a sound and sensible one.