Objective: This paper illustrates certain recurrent themes occurring in the evaluation of sexual boundary violations that provide valuable lessons for all psychotherapists.
Method: By reviewing patterns found in nearly 80 cases of sexual misconduct by psychotherapists, I have been able to delineate common errors of clinical judgement that lead to serious boundary violations.
Results: Several issues deserve attention by all therapists: (i) the therapist's conscious and unconscious intent may be at odds with one another; (ii) feelings of love for a patient may defend against hostility and aggression; (iii) supportive psychotherapy requires careful attention to boundary issues; and (iv) therapists who withhold secrets from supervisors or consultants are at high risk for enacting boundary violations.
Conclusions: There is a confluence of clinical error and ethical misconduct in the development of sexual boundary violations during psychotherapy. The study of such cases reveals a number of important lessons to be learned by all psychotherapists. These lessons, as well as their implications for prevention in terms of training and supervision, are discussed.
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