Thomas G. Gutheil, MD

Thomas G. Gutheil, MD

Dr Gutheil is a professor of psychiatry and cofounder of the Program in Psychiatry and Law, Beth Israel Deaconess Medical Center Department of Psychiatry at Harvard Medical School in Boston, Massachusetts. He is the first professor of psychiatry in the history of Harvard Medical School to be board certified in both clinical and forensic psychiatry. An internationally known forensic psychiatrist and author of over 300 publications in the national and international clinical and forensic literature, Gutheil has served as a consulting or expert witness in more than 40 states.

The recipient of every major award in the forensic field and multiple teaching and writing awards, he is also the recipient of the 2000 A. Clifford Barger Lifetime Achievement in Mentoring Award, Harvard Medical School. Gutheil lives and works in the Boston area.

Articles by Thomas G. Gutheil, MD

The issue of self-disclosure in psychotherapy is one of complexity and some evolution.1-16 Most discussions about the practice refer to boundary questions because self-disclosure by the therapist to the patient is a boundary issue. Self-disclosure has, of course, a number of dimensions, including clinical, therapeutic, technical and-in some cases-legal or regulatory. Despite the rich and interesting clinical issues relating to self-disclosure (outlined in Gutheil and Brodsky1), the focus of this article is on the ethical aspects of self-disclosure.1,15,16 Of necessity, the discussion centers on the more exploratory forms of psychotherapy, such as dynamic therapy, rather than on behavioral therapies, co-counseling, substance abuse treatment, or pharmacological treatment.

News accounts and court records of detainee interrogations in such settings as the Guantnamo Bay detainment camp and the Abu Ghraib prison have sparked controversy over involvement of mental health professionals and behavioral scientists. Authors of articles in medical, psychological, legal, and scientific journals have struggled with complex ethical questions about psychiatrists and psychologists who participate in planning or implementing detainee interrogations.

In the historical context of American psychiatry, the concept of boundaries is a relatively recent development.1 Freud reportedly analyzed some patients while walking along the river Danube, gave patients gifts, and was known to share a meal with a patient.

What are the qualities of forensic psychiatry? In reviewing the basis on which forensic psychiatry is defined as a specialty or, more accurately, a subspecialty of psychiatry, the author discusses the altered relation between physician and "subject," the consultative role in relation to the legal system, and the areas of specialized knowledge and skills that attend the field.

It is relatively recent that boundary issues in clinical practice have attained professional awareness, although some early concepts portended the issue. Several decades ago, for example, the term boundary violations referred almost exclusively to what we now term sexual misconduct.

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