Professional misconduct in psychiatry: sexual behaviour with patients. A report of recent New South Wales findings

The status of ethics education in Australasian psychiatry

OBJECTIVE

To determine to what extent ethics is taught and how it is taught to psychiatrists-in-training across Australasia.

METHOD

Anonymous mail-out survey of training directors.

RESULTS

The questionnaire was completed by 23 of 25 training directors (response rate = 92%) who reported on 625 trainee psychiatrists. Individual one-to-one case supervision was adopted by 96% of the programs for teaching ethics; formal teaching in seminars or lectures was chosen as the second most common method in 70% of programs. Topics most commonly taught in formal seminars were so taught in only 70% of programs or less.

CONCLUSION

A uniform curriculum in psychiatric ethics is needed. The results are discussed in relation to identified needs for improvement.

Sexual abuse in therapy: gender issues

OBJECTIVE

That sexual abuse in therapy occurs predominantly with male perpetrators and female patients is a phenomenon that requires analysis in terms of gender relations. Such an analysis is undertaken here from the perspective of feminist psychoanalytic and psychosocial theories.

METHOD

Data informing the analysis are derived from assessments of 40 women who experienced sexual abuse in therapy. These women had mostly presented depression, 68% had a history of childhood abuse, and one half were themselves helping professionals.

RESULTS

The majority were seriously damaged by the abusive therapy. Offenders were chiefly male (90%) and most were senior, well-qualified therapists of high status: some were charismatic leaders or teachers. Such a group cannot be dismissed as marginal, deviant, or ill-informed; a more systemic analysis is necessary to understand how the professions spawn and sometimes protect offenders.

CONCLUSION

It is concluded that the professional culture mirrors fundamental problems of gender relations that inhere in the larger socio-cultural context where they are expressed in various forms of sexual abuse and violence. A cultural change requires better education on issues of power and sexual politics.