Rehabilitating Analytic Communities after Ethics Violations

The COPE Study Group on Boundary Violations and Rehabilitation is now in its eighth year of existence. Our scope has been inclusive as serious boundary violations affect both the analyst and patient as well as the entire analytic community. When the boundary violation is sexual and the analyst is a respected senior colleague, the damage is exponential and will affect the psychoanalytic community for years to come.

APsaA has been dealing with the problem of boundary violations for several decades prior to the establishment of this COPE study group. In 1975, the Ethics Code was established and has been periodically revised. APsaA mandated the establishment of Ethics and Colleague and Patient Assistance Committees, in all our societies and institutes, and required teaching ethics courses to candidates. We were no longer in denial as we moved ethics to the forefront of our attention. In 2001, APsaA published the Ethics Casebook, edited by Rita Clark and Paul Dewald. No other psychoanalytic organization in the world has done more to address this problem. These institutional and educational measures are important beginnings. They may reduce boundary violations, however, they do not completely eliminate them.

In this article, I will focus on short- and long-term community-wide strategies that address the continuing problem of what to do after an ethics violation has come to our attention.

Models for rehabilitation do not formally exist in APsaA; our ethics code is silent about this possibility. Fortunately, five of our APsaA communities have embarked on extensive ad hoc programs and we have been able to study these efforts, some of which now extend 12 to 15 years following the original ethical breach. The following has been gleaned from these nascent efforts.

The first task of the shocked community has been to conduct an ethics committee investigation. Once the case has been adjudicated, the sanctions are usually made public to both faculty and candidates who hear the troubling information and make an initial attempt to deal with their painful feelings. The community at this point has been traumatically fractured. There is a widespread feeling of betrayal, anger and profound demoralization within the analytic community and the broader mental health community. Unattended this community reaction constitutes an existential danger to psychoanalysis itself. We need to find opportunities to clarify to our members and to mental health professionals that we welcome their concerns and complaints and the integrity of the analytic process is our highest concern.

The analyst and patient also need support, as it is a time of considerable humiliation and even suicidal potential. Either party may require emergency care; support from family and friends can be critical. If the patient is a candidate or attending our extension courses, it often is necessary to set aside class time for discussions and support. If there has been a recent history of several such unethical events, it may be desirable to establish a committee to study this problem and, if indicated, seek institutional remedies.

Long-Term Remedial Experiences

The issue of what to do about a long-term approach to the colleagues and patients who were caught up in unethical involvements, so far, has proved to be a vexing situation that is far from being consensual. While some believe we should adopt an approach built around punitive sanctions, including temporary and/or permanent loss of membership, most favor a case-by-case approach, taking into consideration the potential for rehabilitation of each colleague. There is now an equal concern about dealing with the profound damage to patients directly involved in boundary violations. More recently, there is also a belated recognition of collateral damage to all patients of the unethical analyst and to the members of the analysts' and patients' families.

A several year period ensues, in which there will be other institute-wide meetings, sometimes with colleagues from out of town, selected to continue the healing process. This may be facilitated by a site visit of the Committee on Institutes. The analyst and his former patient may each benefit significantly from a second analysis. There have been patients who have had a second analysis, continued their development as candidates, and eventually became leading members of their analytic communities. Some analysts with a good enough re-analysis may be able to return to some of their former institute/society activities. It is painfully true that some of these patients and analysts turn their backs on a second analysis and on analysis itself. There is obviously a wide range of outcomes. Most colleagues and patients can be significantly helped and deserve our support and encouragement.

Unless an institute was on a verge of collapse before the boundary violation, there is clearly a pathway back to institutional health. Fundamentally, it relies on a strong core of ethical, committed analysts from the institute, who are dedicated to restoring a sound educational environment, together with a sustained rehabilitation program.

Our study group is currently attempting to develop a rehabilitation plan based on these experiences, which can be modified and adapted for use in any of our APsaA communities. We wish to acknowledge the contributions of many colleagues who have participated in our group discussions. We will welcome your interest as we move to the final phase of our study.