"Unavoidable Satisfactions": The Analyst's Pleasure

Analysts have often described their work as depriving, painful, and hard to endure, while its pleasures have been the subject of little commentary. The real history and ongoing temptations of boundary violation long ago made the gratifications of psychoanalytic work a matter of anxiety. Analysts' pleasure in their work was problematized. Some of this problematizing is necessary because of real risk, but much of it is not only unnecessary but misleading and destructive. Psychoanalysts pursue achievement of a unique form of human intimacy, yet acquired habits of professional modesty and humility have encouraged the illusion that analyzing can occur without desire or ambition on the analyst's part. These habits have made it difficult for analysts to openly discuss what they get from the intimacy of analyzing that yields its pleasures. Our field demands that analysts deny that the work provides much more than pain (at least until the conclusion of an analysis), but psychoanalysis both misunderstands and misrepresents itself if we cannot speak of the distinctly broad range of pleasures available in analyzing.

A personal commentary on J.W. Perry, M.D., and introduction to 'Reconstitutive process in the psychopathology of the Self'

John Weir Perry's influence on the understanding of the psychotic process through his research in San Francisco between 1950 and 1981 was groundbreaking, because it both verified and expanded upon C.G. Jung's research at the Burghölzli Hospital in Switzerland in the early 1900's. The author explores both the brilliance of Perry's contribution as a psychiatrist and Jungian analyst and also shows the flawed human, who, with his rare sensitivity to the psychotic process, devoted his life work to the schizophrenic population and their often ill-fated search for meaning. She tells how his creative engagement with the analytic processes of Self discovery eventually led to analytic boundary violations, which ultimately resulted in his indefinite suspension from membership in his local Jungian community. Further, this paper describes her reflections on the innovative work that influenced both the treatment of this population, as well as educating candidates in analytical training to be receptive to and cognizant of psychotic affects and imagery. The archetypal field of the psychotic process, its influence on the development of analytical psychology relative to the psychotic process, and one man's impact on the analytic community are considered.

Being a 'good' doctor: Understanding and managing professional boundaries is challenging and can lead to stress and burnout

OBJECTIVE

The aim is to increase the understanding of non-sexual boundary challenges and potential personal and professional impacts on doctors and medical students.

METHOD

We examined peer-reviewed and grey literature and published commentary and cases from Australian health practitioner boards and medico-legal insurance companies. Key ideas relating to the objective of our study were subsequently framed into a narrative.

RESULTS

Compared to 'sexual' boundary crossings, the literature examining 'non-sexual' boundaries is scanty, fragmented, and difficult to find. There are gaps in knowledge around the prevalence and consequences of non-sexual boundary challenges and crossings, although the safety and wellbeing of health professionals and patients are of concern. Non-sexual boundary crossings may represent a 'slippery slope' to boundary violations. Opportunities for doctors and medical students to access relevant training appear limited.

CONCLUSIONS

We identified several categories of boundary challenges based on context, the nature of the existing relationship, and the type of behaviour. Non-sexual boundary challenges may be related to stress, burnout, and risk for future boundary violations. Future research to investigate the impacts on doctors and medical students in maintaining professional boundaries in their relationships with patients and colleagues, their specific training needs, and the effectiveness of training in reducing work-related stress and burnout is needed.

Characterizing Referrals to Professional Health Monitoring Programs for Unprofessional Sexual Behavior

Concerns about sexual misconduct by health care professionals have been highlighted by recent high-profile cases. Professional health monitoring programs (PHPs) offer an additional layer of protection when health care professionals with a history of unprofessional sexual behavior (USB) return to practice; however, little is known about the characteristics or outcomes of clinicians referred to a PHP because of USB. Data were extracted from over 35 years of PHP records involving USB-related referrals (N = 570). The majority of cases were deemed ineligible for PHP monitoring and handled by other entities (e.g., licensing board, legal system). Of the 232 monitored cases (46.84 ± 9.42 years; 95.7% male), most were physicians (n = 156, 67.2%), with 75.9 percent of monitored cases involving USB with at least one patient. Most (74.9%) PHP monitoring outcomes were classified as "successful" or "very successful." Only three individuals (1.3%) who completed their monitoring were rereferred to the PHP. Monitored professionals exhibited less severe USB and were less likely to experience legal or disciplinary consequences (57.3% versus 69.8%, Cramer's V = .174, p < .0001) compared with unmonitored professionals. Findings enhance transparency of the PHP process and highlight its utility in safely returning clinicians to practice. Results may inform policies to prevent USB by health care professionals.