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Dear Sirs,
I read Gabbard (2003) with great interest, on a subject which the author so appropriately described as being ‘at the frontiers of our work’. The author's observations resonated so well with my own practice of patients in similar predicaments: suicidal ideas following sexual acting out with patients. I will mention two aspects, which I believe may add to your detailed description of such clinical situations. I will use disguises not affecting the essential points.
Some years ago, I had in analysis a mental health professional who had been severely reprimanded by his professional Order and had lost his licence of practice for several years following a sexual acting out with one of his female patients. He became very disturbed, alternating between suicidal ideas and temptations of murderous revenge against members of his Order, which by depriving him of the exercise of his professional identity increased the fragility of his sexual and self-identity. But he mostly felt pained for having been ‘betrayed’ by his patient who, after ‘seducing him’, reported the event to his Order. He really ‘had done it for love’ towards this woman, convinced by her history that she had never experienced a ‘real orgasm’ which he could provide because of his love. He therefore would be her saviour.
An important circumstance of my patient's childhood eventually emerged during the analysis. His father wanted only to have sons in order to assure the perennial existence of his name. The mother, however, wished very much to have a daughter and was disappointed and depressed when he, the third boy of the family, was born. The patient resisted for a long time the idea that his acting out was related to his enduring wish to convince his female patient (as a proxy of the disappointed mother) that his (manic) penis would cure her, as well as redeeming him for being a male. The sexual act under the cover of giving the sexual happiness to his female patient would also magically restore the very