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Thomas G. Gutheil, MD

Thomas G. Gutheil, MD

Dr Gutheil is Professor of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School. He is an editorial board member of Psychiatric Times.



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The points summarized in this pocket guide—drawn from actual cases—recur repeatedly as problems for practitioners.

Cases that come to our attention as malpractice claims, ethics claims, or Board of Registration complaints raise the question: why did the treating clinician not terminate the treatment before things got so out of hand?

Psychotherapists have fiduciary power and—from a risk management perspective—the clinician must act in a manner in which misconduct cannot be inferred. In terms of boundary violations, some preventative measures (like psychodynamic education) can be taken.

Here we address some of these problems of meaningless phrasing, empty shells, and template-distorted recording in an attempt to improve clinical documentation for both clinical care and risk management.

In this podcast, Dr Thomas Gutheil talks about a key challenge facing psychiatrists. . . valid medical record keeping. Here: important tips from an expert based on an article he coathored with Dr Robert Simon.

Here is a “pocket guide” for clinicians drawn from actual cases. With some modification, the list could become a patient information sheet or office policy.

This letter constitutes my formal resignation from the American Psychiatric Association.

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.

I am writing to correct several inaccurate assertions in the essay, “The American Psychological Association and Detainee Interrogations: Unanswered Questions” (Psychiatric Times, July 2008, page 16), by Kenneth S. Pope, PhD, and Thomas G. Gutheil, MD.

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.


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