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Question
Posted by: Anonymous | 2010/09/20

Ethics in psychotherapy

Hi Professor Simpson

Feels a bit strange addressing a fellow professional on this forum. For what it is worth I would just like to comment on D''s issues from my perspective. I agree wholeheartedly with your opinion that quibbling over the extremities of a boundary violation (which I have no doubt D''s unfortunate experiences would amount to) tends to muddy the waters when it is already clear that the transgression is definitively a violation right out of the starting gate. What I find worrying is that a patient who so clearly possesses intelligence and is in the legal profession herself, finds herself in an untenable position as regards her rights!!!! It begs the question, what would the ordinary lay person have to resort to? Understandably she has also chosen not to pursue the issue any further but I must wonder whether the HPCSA would have been able deal with the matter with any real insight - personally I have very little faith in this organisation.

I think what also has to be understood is that SASOP have very little power or jurisdicion when it comes to dealing with misconduct effectively - indeed further supervision is one of the few discretionary powers they do have. The fate of Dr X''s license would lie solely at the door of the HPSCA.

I remain very troubled by this story and certainly wonder whether the time has not come to re-evaluate the intricacies of professional misconduct in a psychotherapy context such that the parameters are more apparent to professionals and patients alike. To be sure, had this doctor been a surgeon and performed the wrong procedure, the road open to the patient would have been that much clearer and the damage more self evident.

Regards

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Our expert says:
Expert ImageCyberShrink

Hello A, Thanks for your insightful comments.
Yes, one aspect that does deserve concern is that if someone with D's intelligence and personal power can have dificulty recognizing and exercising her rights, what hope have ordinary patients to do so ?
What troubles me within any psychotherapy situation, perhaps even more so within analytically oriented therapies, is where someone with great intelligence is enrolled in and trained in a set of language and concepts which in a sense supercedes her own perceptions, so that she can only see whatever happens within a certain range of models and terms, and unable to speak of the events except within the narrow terminology, they again lose autonomy and power.
And a cynical and/or unscrupulous therapist is able to USE the standard terms and theories to explain away what is happening, to convince the target either than nothing is wrong, or that if there is anything wrong, it must be HER fault.
As for the PHCSA dealing with ANY such matter with proper insight, I haven't noticed them managing that at any time in their history, and see no reason to expect them to be capable of it now. SASOP, too, has neither the mechanisms, the powers nor the capability ( maybe not even the will ) to deal with such matters either.
I agree that the system needs a radial overhaul. Even when dealing with surgeons, they concentrate, understandably, on cases where the error is physical, fairly gross, and easily emasured in an objective fashion. It needs to be recognized that such boundary violations and patient exploitation can occur even in surgery and general medicine, in ways that can be similarly damaging and wrongful, and just as hard to deal with, but important to recognize and protect patients from.
Its so easy for instiutions of all types to focus on measuring things because they are easy to measure, rather than because they are actually so important, and to neglect very important matters vecause they are harder to assess.
I also found it bothersome in D's case to kep hearing about how Eminent and brilliant the perpetrator was. All the more reason why he should have behaved properly - and if D is a lawyer, how would she know how famous and brilliant he was, except by what he told her ? Which suggests there may have been an element of bragging as part of his seduction techniques ?
Thanks for joining the discussion - I wish there was a broader professional and public debate about such issues.

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4
Our users say:
Posted by: loony tunes | 2010/09/22

All shrinks are perverts!!!!

Reply to loony tunes
Posted by: Denis | 2010/09/21

CS

As another fellow shrink - I join you in your concerns. I think it is time to revisit these issues on a more visible scale. We have enough on our hands trying to deal with mental health stigma - we don''t need unethical shrinks adding to the flavour!!

Reply to Denis
Posted by: cybershrink | 2010/09/21

Hello A, Thanks for your insightful comments.
Yes, one aspect that does deserve concern is that if someone with D's intelligence and personal power can have dificulty recognizing and exercising her rights, what hope have ordinary patients to do so ?
What troubles me within any psychotherapy situation, perhaps even more so within analytically oriented therapies, is where someone with great intelligence is enrolled in and trained in a set of language and concepts which in a sense supercedes her own perceptions, so that she can only see whatever happens within a certain range of models and terms, and unable to speak of the events except within the narrow terminology, they again lose autonomy and power.
And a cynical and/or unscrupulous therapist is able to USE the standard terms and theories to explain away what is happening, to convince the target either than nothing is wrong, or that if there is anything wrong, it must be HER fault.
As for the PHCSA dealing with ANY such matter with proper insight, I haven't noticed them managing that at any time in their history, and see no reason to expect them to be capable of it now. SASOP, too, has neither the mechanisms, the powers nor the capability ( maybe not even the will ) to deal with such matters either.
I agree that the system needs a radial overhaul. Even when dealing with surgeons, they concentrate, understandably, on cases where the error is physical, fairly gross, and easily emasured in an objective fashion. It needs to be recognized that such boundary violations and patient exploitation can occur even in surgery and general medicine, in ways that can be similarly damaging and wrongful, and just as hard to deal with, but important to recognize and protect patients from.
Its so easy for instiutions of all types to focus on measuring things because they are easy to measure, rather than because they are actually so important, and to neglect very important matters vecause they are harder to assess.
I also found it bothersome in D's case to kep hearing about how Eminent and brilliant the perpetrator was. All the more reason why he should have behaved properly - and if D is a lawyer, how would she know how famous and brilliant he was, except by what he told her ? Which suggests there may have been an element of bragging as part of his seduction techniques ?
Thanks for joining the discussion - I wish there was a broader professional and public debate about such issues.

Reply to cybershrink
Posted by: nightmare | 2010/09/20

what do you guys do with all the tapes of the psychotics you make in mental institutions?

Reply to nightmare

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