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This article explores sexual boundary violations and their clinical implications in forensic settings. In particular, the authors consider whether female professional and male patient relationship transgressions have similar clinical meanings as the inverse, or whether there is an inherent or perceived difference between genders. Furthermore, attention is brought to the problematic aspects of reductive, dichotomous interpretations of victim-violator relationships.
Composite cases of such clinical “accidents” are presented. These are set within secure environments in the United Kingdom. The scope of these cases encompasses incidents between clinician and patient, as well as inter-professional boundary violations. By discussing these vignettes, the authors demonstrate the risk of a subtle, gradual, and insidious erosion of boundaries, alongside more overt incidents of a sexual nature and abuse of power. Contemporary societal factors that may influence conscious and unconscious biases will also be considered in the post #MeToo world.
Where clinical examples are given, they are composites of cases reported in the public domain known to the authors. They are clinically accurate but do not involve actual identifiable people and cases.