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The Slippery Slope

Doctors who serve as reviewers and consultants for the Minnesota Board of Medical Practice (BMP), which investigates such reports, note the slippery slope of how boundary crossings progress to boundary violations. Both physician and patient, knowingly or unknowingly, may allow a relationship to progress toward one that is inappropriate.

(2) A “grooming sequence” ensues when patient and physician begin addressing each other by first name. The professional persona of the examining room fades at the door, physician self-disclosure turns into doctor revelations of personal and sexual feelings, office visits may be extended while the length of other patients’ visits is disregarded, and physician record keeping deteriorates for the patient with which the physician is involved.

Physical contact begins with hugs and kisses on the cheek; the physician may discuss other patients with the special patient; they begin meeting at a restaurant outside the office; the physician stops charging the patient, and/or the patient’s bill mounts without discussion of it or attempts to collect on it; office visits for the special patient are moved to the end of the day; and dating begins.

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Treatment Boundary Violations:
Clinical, Ethical, and Legal
Considerations
Robert I. Simon, MD

The observance of treatment boundaries maintains the integrity of the therapistpatient relationship. It is the therapist's professional duty to establish appropriate
treatment boundaries. Basic boundary guidelines are reviewed. The principles
underlying these boundary guidelines are explored. A clinical vignette describing
the sexual exploitation of a patient by her therapist dramatically illustrates progressive boundary violations. Boundary violations involving money are particularly common. Double agent roles also are likely to lead to the establishment of dissonant
treatment boundaries with patients. The clinical, ethical, and legal issues surrounding the maintenance of treatment boundaries are discussed.