Therapist sexual misconduct has its genesis in the therapeutic relationship. The mental health professions have long recognized the delicacy with which the therapist must handle the therapeutic relationship, with its power imbalance, inherent vulnerability of the patient, and transference and countertransference reactions. The prevention of sexual contact starts with the careful attention to boundary violations, which, though themselves perhaps not harmful, may escalate into sexualized behavior. Methods of preventing this behavior include the establishment of clear guidelines for practitioners and the expansion of the educational process for therapists, therapists' employers, patients, and other professionals. Last resorts lie in the legal and quasi-legal proceedings available to victims, such as civil suits for damages, criminal complaints, board of licensing complaints, and actions before professional associations. The best method of preventing sexual contact with patients involves respecting the boundaries of the professional relationship and avoidance of the slippery slope.

Understanding the genetic influence on ECG time intervals and heart rate (HR) is important for identifying the genes underlying susceptibility to cardiac arrhythmias. The objective of this study was to determine the genetic influence on ECG parameters and their age-related changes in mice. ECGs were recorded in lead I on 8 males and 8 females from each of 28 inbred strains at the ages of 6, 12, and 18 mo. Significant interstrain differences in the P-R interval, QRS complex duration, and HR were found. Age-related changes in the P-R interval, QRS complex duration, and HR differed among strains. The P-R interval increased with age in 129S1/SvlmJ females. The QRS complex duration decreased with age in C57BR/J males and DBA2/J females but increased in NON/ShiLtJ females. HR decreased in C57L/J females and SM/J and P/J males but increased in BALB/cByJ males. Differences between males and females were found for HR in SJL/J mice and in the P-R interval in 129S1/SvlmJ mice. Broad-sense heritability estimates of ECG time intervals and HR ranged from 0.31 for the QRS complex duration to 0.52 for the P-R interval. Heritability estimates decreased with age for the P-R interval. Our study revealed that genetic factors play a significant role on cardiac conduction activity and age-related changes in ECG time intervals and HR.

Despite prohibitions by the ethical codes of all major mental health professions, therapist sexual misconduct remains a serious problem. Over the past 13 years, individual states have enacted laws regarding therapist sexual misconduct with the hope of more successfully curbing this behavior. The laws fall into four categories: civil, criminal, reporting, and injunctive relief statutes. This article discusses the theoretical underpinnings of the laws, examines the provisions of the existing statutes, and provides an overview of the advantages and disadvantages of each category of statute. Preliminary evaluative data are also presented.The issue of sexual misconduct by therapists (and other professionals ) has gradually emerged from the shadows of public consciousness and into the spotlight. All major mental health organizations recognize the unethical nature of sexual involvement with patients (American Psychiatric Association, 1993; American Psychological Association, 1992; National Association of Social Workers, 1994). Organizations such as the Walk-In Counseling Center of Minneapolis, Minnesota, and self-help groups such as Therapist Exploitation Link Line (TELL) and Boston Association to Stop Therapist Abuse (BASTA) provide much-needed assistance to victims. Members of these groups raise the level of public awareness and understanding of the problem and lobby state legislatures, licensing boards, and pro-KATHERINE C. HASPEL received her PhD in clinical psychology from the University of Rhode Island in 1981. She is an adjunct assistant professor of psychology at the University of Rhode Island and is in private practice in Providence. She is also the Chair of the Legislative Committee of the Rhode Island Task Force on Therapist Sexual Misconduct. LINDA MABUS JORGENSON of Spero & Jorgenson, P.C., Cambridge, Mas-• sachusetts, is an attorney experienced in cases involving sexual misconduct by therapists, physicians, attorneys, clergy, and other professionals and has seen over 300 clients who have been sexually exploited. She has also published widely in this area.

The task of defining boundaries and boundary violations in the therapeutic relationship is examined from several perspectives. This paper reviews the ethical rules of the major mental health associations and the American Medical Association to determine the professions' ethical positions with regard to boundary maintenance and boundary violations. It also analyzes judicially sanctioned causes of action for recovery by clients for damages suffered as a result of boundary violations. The authors examine the ways in which fiduciary theory is used in the formulation of the ethical rules and to support the imposition of civil liability for boundary violations. The authors conclude that fiduciary theory provides a useful paradigm for setting and evaluating boundaries that acknowledge and address the fiduciary nature of the therapist–client relationship. The authors point out that measuring boundary violations with the yardstick of fiduciary duty serves the interests of both the client and the therapist. © 1997 John Wiley & Sons, Ltd.

In the face of evidence suggesting that there is a substantial incidence of sexual contact between physicians of all specialties and their patients, the medical profession and the courts have not yet reached a consensus regarding appropriate responses. Some commentators, including the American Medical Association, have urged bans on sexual contact during treatment and extensive restriction of posttreatment sexual relationships. Others favor looser restrictions, particularly after termination of the physician-patient relationship. These differences in approach stem from the varying importance given the two conflicting values involved: (1) protecting patients from being harmed by unfair manipulation by physicians and (2) insulating choices about intimate relationships from intrusion by society. We propose a model for balancing these interests that would bar sexual contact during the physician-patient relationship and for a fixed period after termination; thereafter, in most cases, sexual relationships would not be proscribed. A waiting-period approach of this sort is likely to diminish most of the harms that might result from physician-patient sexual contact and may constitute a template for the resolution of similar issues elsewhere in society.