Continuing Challenge of Rehabilitating Boundary Violators

In 2007, the Committee on Psychoanalytic Education (COPE) established a Study Group on Boundary Violations and Rehabilitation to consider the rehabilitation of unethical colleagues. The members of our study group are indebted to the many courageous colleagues and patients who have shared their experiences of boundary violations and rehabilitation with us. We are also deeply appreciative of the representatives of institutes and societies who have joined our meetings to describe their creative efforts to establish innovative structures to deal with these issues.

After six years, we still feel that we are a long way from the conclusion of our work. The following is a brief interim overview. Most of our institutes, societies, and centers do not as yet have rehabilitation programs. We have been studying the efforts of the minority who do have such programs. They have initially been established to help deal with colleagues who have been sanctioned for major sexual boundary violations, but they are structured to deal with a wider range of boundary violations. These psychoanalytic communities wish to devise programs to provide a path back to full membership, if at all possible, since many of these colleagues have the potential to deal successfully with their ethical problems.

Analytic Community's Response: Sanctions and Rehabilitation

Sexual boundary violations have been particularly shocking to the entire analytic community, especially when committed by prominent analysts in leadership positions. Their unethical behavior has been a betrayal of our analytic ideals, an undermining of our effectiveness in the community, and, first and foremost, very damaging to patients who had turned to our colleagues for help but were betrayed. All recognize our responsibility to help these patients find a new analyst and continue our support as long as it is needed.

Understandably, colleagues' shock soon turns to anger. While this is not the appropriate time for a decision about permanent membership status, there is an immediate need to discipline the colleague usually by restriction of privileges and often by a suspension of membership.

A rehabilitation program is next considered if agreeable to both the analyst and the institute. A special subcommittee of the Ethics Committee may be appointed to oversee the rehabilitation program, which primarily consists of a return to analysis and supervision. These subcommittees must report regularly to the Ethics Committee, which in turn reports to the elected officers of the institute. If the colleague demonstrates growth, insight, and a deep sense of remorse, privileges may be gradually restored; for some, full restoration may not happen, i.e., the return to functioning as a training and supervising analyst. The support of colleagues and family is often critical for the sanctioned analyst's survival, for suicide is not rare among such colleagues. They are often profoundly humiliated by their unethical behavior.

Rehabilitation is broader than prescribing more treatment and supervision, for this is not just a clinical and educational matter. Most would agree that unethical colleagues have to make formal amends to both their former patients and to the analytic community. This often includes an apology to the patient, restitution of fees paid for the flawed treatment, and a deep recognition of the harm caused to the patient and the analytic community and to psychoanalysis itself.

Psychoanalytic communities require years to fully recover from these tragic events. While it must be primarily an internally driven healing process, outside consultants may help in sharing the experience gained in other communities who have faced similar problems. Many find that they have over-idealized colleagues in an effort to avoid dealing with early signs of unethical slippage. Perhaps such colleagues were beginning analytic sessions late on a consistent basis or disclosing excessive amounts of personal information to their patients. The cultural climate of the institute may have been too permissive and forgiving of these lapses. De-idealization is a necessary step in all analyses, but it is a priority in these situations.

To this end, some suggest that attention be given to the history of unethical behavior, both local and national, in candidate education to further the process of de-idealization. Increasingly, colleagues are concluding that early detection and correction of minor boundary violations are necessary, since if unattended over time, they often balloon into major ethical breaches. It is granted that the major problem lies in the analyst's grandiosity, seductiveness, and unresolved core problems that require further treatment.

Communities Lacking Rehabilitation Programs

Some psychoanalytic communities do not provide rehabilitation programs for sanctioned colleagues. They are expelled for a given number of years and can then request reinstatement. There are many problems with this approach. The colleague usually feels abandoned and has to create a do-it-yourself rehabilitation program. Usually, this separation leads to a permanent alienation on both sides. The colleague needs support and advice. The Ethics Committee can provide guidance and monitoring of progress through a special subcommittee. The oversight and restrictions provided help the analyst regain the confidence of his colleagues. Some psychoanalytic communities export the rehabilitation to the Ethics Committee of the colleague's primary professional affiliation, e.g., the local medical society or psychology board. These efforts usually lack the rigor and analytic focus of our Ethics Committees. Outside analysts can help if they work very closely with the governing bodies of the institute and/or society since the analyst is living and working in that community and is well known to his colleagues.

Rehabilitation in the Wider Community

Rehabilitation extends to both the analytic and wider mental health community. The psychoanalytic community may need to demonstrate to the larger mental health community that we do not protect such colleagues, that we welcome their complaints of boundary violations so we can take appropriate remedial action. This goes a long way toward restoring trust.

Some analytic communities have established special study groups to deepen their understanding and find ways to improve the ethical climate. Colleagues and candidates need to have institutional pathways to safely bring forward their complaints and ethical concerns. Candidates are often positioned to be the first to detect an analyst's growing difficulty in maintaining an analytic frame. Help should also be provided to colleagues who were not directly involved but may have been the analysands of an unethical colleague, or classmates of an affected candidate, and have experienced considerable collateral damage.

Rehabilitation seems to work best when an ethics breach is self-reported early on in its development by an analyst who is in psychic distress over the breach, particularly when this is a singular occurrence that is due to situational traumatic events such as illness, divorce, or even death of a loved one. Ideally the degree of remorse has already led to efforts at reparation and restitution both to the patient and the analytic community. There are always exceptions—even colleagues who were involved in unethical conduct for many months, even years, have made substantial recovery. Rehabilitation should be available to all and we should reserve judgment about outcome, which in any case may not be known for several years.

The pain to our analytic community and to the individuals more directly involved has had some beneficial side effects. We are now more mindful of this ever-present risk in analytic work; we have deepened our understanding of our institutional, clinical, and theoretical responsibilities. As we all know, trauma can lead to enhanced strength both with individuals and groups. This can only occur if we are open, resilient, and scientifically modest before the daunting challenge of rehabilitation. It is in that spirit that we offer these initial observations. We hope they stimulate others to join in our conversation.