Rehabilitation of Sexual Boundary Transgressors

One objection involves the unwillingness to forgive such an egregious violation of trust. Whether the transgressor is capable of being rehabilitated is not the central point to this argument; the underlying assumption is that mental health practitioners are a privileged group (officially privileged by virtue of licensure and other types of certification) and thereby must be held to a higher standard. The argument is that if a practitioner behaves in a way that demonstrates an inability to uphold the highest values of the profession, these privileges should be permanently revoked.

But what if the problem is more complex and rests on a universal vulnerability to which we all have the potential to succumb? Is it fair or even reasonable to hold such standards in a way that professes an illusory fortification against transgressing boundaries? I think not, given that we now have many examples of highly trusted and talented colleagues (not of the psychopathic ilk, it is important to stress) who have been unable to maintain their highest ethical standards at a certain time in their life, with a certain patient, and under certain circumstances.

To hold that one is and always will be immune to sexual boundary transgression when ours is a most intimate, emotional, and involving form of work is imprudent at best and at worst, cavalier. How do any of us know what stresses, needs, or tragedies might await us in the coming decades? One transgressor with whom I worked had a recurrence of a potentially fatal illness during a time of marital discord. His transgression followed an illustrious career as a highly trusted teacher and senior therapist with years of experience. Sadly, his case is not uncommon.

A more difficult objection points out that many (if not most) transgressors have already had psychotherapeutic treatment. In the cases of psychodynamic or psychoanalytically trained therapists, treatments have been both intensive and long-term. Studies do show a lower prevalence of sexual boundary trangression among clinicians representing these orientations; however, the rate is by no means low. Is the vulnerability to sexual boundary transgressions impervious to change and does this not argue for the lack of rehabilitation potential in us all? On the contrary, the persistence of sexual boundary transgressions, even among the previously treated, underscores our universal vulnerability.⁸

The most compelling explanation invokes a developmental understanding of our ethical responsibilities in which the life-stage circumstances and mental state of the practitioner are taken into account across the span of his professional life (Behnke S, personal communication; 2007). Ethical standards and our ability to practice within them are capacities that exist in a timeframe and within a mental state.

The universal vulnerability to sexual boundary transgressions is difficult to imagine only if we view it from within a current, stable frame of mind. A spouse may not be able to imagine infidelity in the early years of marriage nor a priest a loss of faith at ordination. As life deals its blows, we grow and change with it. Midlife pre-sents challenges that those before it or beyond it may not appreciate.

At the same time, it is not sufficient to refer to the midlife crisis as the total explanation for these unethical acts because most of us make it through this life stage without professional self-destruction.

Assessing rehabilitation potential
Through my professional involvement with more than 75 cases of sexual boundary transgressions, I have come to believe in the viability of and the ethical obligation for the rehabilitation of one-time transgressors. While there were a minority of cases in which rehabilitation was not viable and was not undertaken, in the majority of cases, my involvement represented some aspect of a comprehensive rehabilitation plan. In most of the cases in which rehabilitation was recommended and carried out, my role was to perform the initial and follow-up evaluations. Primarily, the initial question revolved around whether rehabilitation was indicated and, if so, how to construct a comprehensive treatment program. The main question at follow-up was to assess the adequacy and thoroughness of the rehabilitation with attendant questions of readiness to return to practice.

I would venture to say, as well, that with many, if not most of the rehabilitated transgressors, I have come to trust their judgment and ability to maintain the highest ethical standards more than I do average practitioners because of the experience and transformation in the rehabilitation program. It is compelling to perceive the extent to which these therapists have reflected on the complexities of boundary maintenance, have been introspective, have worked through their vulnerabilities (to a greater extent than most of us), and have enhanced their familiarity with the nuances of boundary management and self-care.

Independent assessments aimed at evaluating rehabilitation potential of transgressors have been carried out for decades by a small group of practitioners specializing in the area of sexual boundary transgression.^1,3,4 Usually, the evaluation is requested after the case has been adjudicated by an overseeing professional agency, such as a licensing board, a professional organization, or even after civil litigation. In most cases, the evaluator will be hired by the overseeing agency. It is crucial that the evaluation be performed in an independent manner, ie, the evaluator is not partial to the outcome and does not have conflicts of interest or a previous relationship with the transgressor.