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Dear Editor
Bob Hinshelwood is right to say (BJP 19(4): 541) that my suggestion, which was that we should inform the patients of a practitioner who is ‘struck off’ of his/her change of professional status, would not address the problem of the patients' transference in some cases (actually the ones that need most help). Nevertheless, I thought that it would serve better than no attempt at all to protect such patients. At the same time, our present non-interventionist policy leaves our professional bodies open to accusations of negligence with respect to a ‘duty of care’, with the consequent undermining of public confidence in our professional worth. My experience of a patient who remained with a therapist who was known to be abusive was that the intrusion of some reality disturbed the abusive symbiotic bubble and gave her emerging doubts some credence on which she built, and she was eventually able to break free. The process took quite some time. We are at the interface of internal and external realities and can only talk to that part of the patient's mind that is available at the time: but we are not in a position to know what that is. Of course, how one imparts the information needs to be very carefully thought out; and that might require a range of solutions depending on circumstances.
I welcome Bob's suggestion of contracts as an alternative but wonder if the profession has the will and the resources or even the ability to make it effective? Such a contract might have been signed in good faith, but when an embattled situation emerges resulting in expulsion, there is nothing to stop the practitioner changing his title slightly and joining some accommodating alternative treatment register, or no register at all and just continuing to practise. The onus would then be on the Registering/Training Body to enforce the contract by checking if that the person was practising and, if so, suing the practitioner. With the attendant difficulties, time and financial commitment th