Ethics Column

Patients Who Experienced a Boundary Violation with their Prior Therapist

Debra Borys, Ph.D., FABPS


Psychologists must be mindful of several ethical considerations when treating a patient who has experienced a boundary violation by a previous therapist (e.g., sexual intimacy or a joint business venture).

Competence:  To treat this specific patient population, the psychologist should have a familiarity with the literature regarding the common clinical presentation and the impact of boundary violations on patients. The psychologist should also, optimally, have experience treating individuals who have experienced victimization or exploitation. Consultation with an experienced psychologist can serve to meet the competence requirement.

Boundary issues in the new treatment: A patient reporting inappropriate behavior by a prior therapist may evoke a range of conflicted feelings in the subsequent psychologist as well as the patient.  The psychologist should engage in self-reflection and consultation regarding any  impulses toward less objective or dual therapeutic roles, such as advocate or “rescuer,” or feelings of sexual arousal, disbelief, or blame toward the patient.  Additionally, if the psychologist is acquainted with the previous therapist, a conflict of interest may be present in treating the patient.

Special legal duties:  If the previous therapist engaged in any sexually inappropriate conduct, the subsequent psychologist is required by California law to provide the patient with a copy of the Board of Psychology pamphlet “Professional Therapy Never Includes Sex.”

Confidentiality:  Unless the patient was a minor or dependent adult at the time the boundary violation occurred, prompting review of mandated reporting laws, the subsequent psychologist may not report the behavior to any third party without the patient’s written authorization.  Additionally, since many such patients do pursue litigation or a professional complaint against the prior therapist, the subsequent psychologist should inform the patient at that time that release of his or her records and testimony of the new psychologist may be compelled by the Court or the Board of Psychology.  Further, a written release must be obtained before the new psychologist may even acknowledge to a third party, for example, the patient’s attorney, that the patient is in treatment.

Informed Consent:  The patient should be informed of any additional charges that would be incurred for litigation or related complaint, including the preparation of reports, phone calls with their attorneys, or subpoenaed testimony.  Also, the distinction between the role of treating therapist and expert witness should be made clear to the patient.

Documentation:  Since release of therapy records might be required in subsequent litigation or a professional complaint initiated by the patient, avoidance of the use of jargon, pejorative or pathologizing terminology, or use of third party names  is advisable because the patient, prior therapist, attorneys, and a jury may all have access to the notes in the future.  Failure to keep progress notes is below the standard of care and an ethical violation in itself for psychologists.  Charting any decision-making regarding ethical or legal issues arising in a case is also recommended.