Rehabilitation of Sexual Boundary Transgressors

The evaluation usually takes about 20 hours, with 5 to 6 hours of personal interviewing, psychological testing (especially personality testing), and gathering of collateral information. All documentation is reviewed, the nature and scope of the transgressor's practice is determined, and the transgressor's family situation is explored. Each evaluation is individually tailored. The victim/survivor may also be interviewed because the degree of consistency between the transgressor's and the patient's narrative is an important factor in assessing the transgressor's credibility. In all cases, a thorough exploration of the transgressor's point of view is emphasized, including his attitudes, beliefs, and understanding of how and why the transgression occurred. The emphasis on the transgressor's experience is designed to thoroughly evaluate his functioning at the time of the transgression, the rationalizations that were used, the limitations of his understanding of the nuances of boundary maintenance, and the specific limitations in his ability to handle the treatment at the time. All of these issues bear directly on the foci of the rehabilitation plan should it be recommended.

The first question to address is whether the transgressor has the crucial character traits and attitudes that indicate a good prognosis.¹ I have constructed a 20-item checklist to use in the interview that delineates these characteristics. In addition, the Boundary Violations Vulnerability Index is designed to assess the presence or absence of several precursors of vulnerability to sexual boundary violations.⁸ This tool may also be used by practitioners for self-monitoring to identify risk factors before any steps on the slippery slope are taken.

Rehabilitation programs
Rehabilitation programs should be individually tailored, because not all transgressors have the same needs, and not all components will be necessary to each circumstance. It is important that only relevant safeguards are applied. Most rehabilitation programs last 2 to 3 years and involve some or all of the following:

• Assignment of an independent rehabilitation coordinator to monitor the overall program and communicate among all the participants.
• Individual psychotherapy or psychoanalysis to address the specific problems identified in the evaluation.
• Couples therapy is almost always indicated to address neglected marital problems, as well as the trauma of the complaint process itself.
• Supervision performed by independent practitioners who have expertise in boundary issues; the supervisor must be thoroughly informed of the details of the misconduct and must be willing to report to the overseeing agency regarding progress.
• Practice limitations for the rehabilitation period, the most common of which is a limitation on independent practice.
• Psychoeducation on ethics and boundary management.
• Mediation may be indicated to address lingering injuries from the transgression itself and to give the transgressor the opportunity to acknowledge wrongdoing.

Efficacy of rehabilitation
Outcome research is just beginning to address the adequacy and efficacy of rehabilitation programs for therapists who transgress. I have conducted an informal survey on 32 cases involving therapists and clergy for whom rehabilitation had been recommended. In each of these cases, the rehabilitation program was either under way or had been completed. At the time of the study, most cases were more than 4 years postrehabilitation (n = 20) with a range of 1 to 10 years for all of the cases.

Whenever possible, the follow-up data were gathered from the original overseeing professional agency rather than from the transgressor. For example, in the cases of clergy transgressors, the presiding Bishop in the transgressor's diocese reported on outcome and recidivism. In the cases of therapist transgressors, the licensing board, supervisor, and/or the transgressor were contacted. In a total of 32 cases, 3 transgressors had retired, one was deceased, and 5 were not included because of incomplete data. In the remaining viable cases (n = 23), no reports of recidivism were received nor were there any reports of concern for the professional's conduct in general. In 11 cases where I was directly involved in the rehabilitation program in an ongoing way (as therapist or supervisor), the rehabilitations were assessed by an outside evaluator as successful. In addition, by virtue of their involvement with the rehabilitation program, I gained a greater trust in these therapists than I have for the average therapist.

Conclusion
There is no problem that better underscores our need for self-care throughout our professional lifespan than the problem of sexual boundary transgressions. Mental health practitioners of all disciplines tend toward ministering to others as a character trait and way of life. It is incumbent upon us to monitor our own needs in a way that takes into account the developmen- tal challenges we are likely to face throughout our professional careers.