Sexual Boundary Violations

In response to a growing interest in the provision of professional supervision to clergy and church workers in Australia, this study sought to examine reservations that current clergy and church workers might have towards the introduction of professional supervision as a regular supportive practice. This study was conducted in an evangelical Anglican metropolitan diocese, a factor which was expected to affect the results due to the dominant theology and ecclesiology of the diocese. Furthermore, professional supervision for clergy is not a current practice in this diocese. Following an initial pilot survey with 12 clergy who were currently accessing some form of supervision, a qualitative survey was conducted using a semi structured interview process with a judgment sample of 12 clergy to give a spread of age, ministry experience, and gender, Transcripts of interviews were subjected to thematic analysis, which delivered a complex and rich account of the data collected. After coding, 31 emergent themes were grouped into six dominant themes relating first to current knowledge, experience and helpfulness of any supervision received at the time of interview, and second to the desire for more structured professional supervision and barriers to accessing supervision. Despite an ecclesiology which eschews influence of diocesan structures, the majority of participants were engaging in some form of peer support or supervision, encouraged through diocesan networks. However, participants mentioned several drawbacks in current systems: lack of training of supervisors, fears over confidentiality, insufficient or irregular provision and lack of any support from parish that encouraged regular time and financial commitment to attend regular supervision. This study shows a surprising finding in the strength of support for professional supervision. Despite the reservations expressed about the provision of professional supervision: three quarters of the sample had an interest in receiving professional supervision or it being made available.  Enthusiasm was expressed variously such as being “invaluable for my long term survival”, or “really seeing the value in it”, and “I would jump at the opportunity”. This study demonstrates a consistent theme of clergy both needing and accessing some form of pastoral support for their ministry, a need which a large majority expressed as not being met while under the current system. This majority were keen for an encouraged, regulated system of accessing ‘proper’ supervision to be provided. It is noted that currently there has been limited research into the efficacy of professional supervision for clergy in promoting wellbeing, professional development through reflective practice and preventing burnout and boundary violations. As more denominations are providing or mandating professional supervision, it is imperative that further research is conducted into preferred models  and the efficacy of professional supervision for clergy.

This essay is split in content and intent. In the first part, I share my reflections from my long personal relationship with Muriel Dimen, who taught, supervised, and mentored me as a young candidate and beginning scholar. In this part, I try convey how staunch and thorough her commitment-and how extraordinary her generosity was in supporting the intellectual development of a new generation of emerging psychoanalytic thinkers and theorists.
The second part, written in an entirely different tone, takes on the body of
work Dimen produced in the last decade of her life, which focused on sexual boundary violations. This work highlights the hybridity of her thinking and the brilliance of her mind. I flesh out the genealogy of her reflections on this topic and discuss in some depth how her last, posthumously published paper changes the terms of the conversation in this very difficult matter. In this topic, as she had previously done in many others, Dimen’s contribution introduced an entirely novel way to think about the recalcitrant problem of sexual abuses in the consulting room.

I describe how memories of sexual abuse pushed into my consciousness after I was bombarded by a series of harrowing life events. I describe my symptoms of acute Post-Traumatic Stress Disorder and the path of my healing journey. As my healing evolved, it paralleled the stages of the hero’s journey. I moved from being a victim to a survivor to an empowered and thriving individual.  As a wounded healer, I use the discoveries from my own healing process to guide others on their paths.

Objective: To explore a number of issues related to boundary violations in psychiatry, including the relationship between the individual physician and his or her patient and broader issues related to various dilemmas arising in academic departments of psychiatry. Method: Several potentially troublesome scenarios are presented and discussed in the contexts of 1) the doctor–patient relationship, 2) sexual boundary violations, and 3) nonsexual forms of exploitation, such as finances, confidentiality, dual relationships, and relationships with industry. Conclusions: A number of examples of boundary problems involving psychiatrists have been explored, and although some of these behaviours are clearly forbidden and harmful, others are less clear and require careful consideration if the profession is to arrive at a thoughtful consensus.

In this paper I argue that sexual exploitation in the doctor-patient relationship would be dealt with more appropriately by the law in England and Wales on the basis of a breach of fiduciary duty. Three different types of sexual boundary breaches are discussed and the particular focus is on breaches where the patient’s consent is obtained through inducement. I contend that current avenues of redress do not clearly catch this behaviour and, moreover, they fail to capture the essence of the wrong committed by the doctor – the knowing breach of trust for self-gain - and the calculated way in which consent is induced. Finally, I demonstrate that the fiduciary approach is compatible with the contemporary pro-patient autonomy model of the doctor-patient relationship.