Nonsexual Exploitation of Patients—An Ethical Perspective

Abstract

These are some instances of nonsexual exploitation that I have become aware of over the past several years. Some of them have resulted in complaints to various ethics committees, but most have not. Many colleagues are unaware that such behavior is in any way unethical. As far as analytic principles are concerned, many of these problems can be rationalized or the psychoanalytic theory can be modified to fit the Procrustean bed of the analyst's desire. Yet when you get down to it, the bulk of the Principle of Medical Ethics with Annotations Especially for Psychiatrists is derived from a few elements of the Hippocratic principles and a large chunk of psychoanalysis. Understanding what the nature of the therapeutic relationship is and applying some basic psychoanalytic principles will result in one's own code of conduct that will not be appreciably different from that suggested by the Principles of Medical Ethics. If we as psychoanalysts will attend to these psychoanalytic points of view, there will be little need to consult the book.

The analyst's professional self as a “third”; influence on the dyad when the analyst writes about the treatment

“…Is the patient being "used" in the negative, colloquial sense-being objectified or otherwise depersonalized by the analyst (see Stoller, 1988;Gruenberg, 1995)? Does he or she feel this?…”

Narcissistic Temptations to Cross Boundaries and How to Manage Them

“…The few articles available tend to be anecdotal and impressionistic (e.g., Wahl 1974;Warner 1991;Knafo 1991;Gruenberg 1995). The few articles available tend to be anecdotal and impressionistic (e.g., Wahl 1974;Warner 1991;Knafo 1991;Gruenberg 1995).…”

“…Remarkably little has been written in the psychoanalytic literature about the analyst's narcissistic temptations in treating impressive patients. The few articles available tend to be anecdotal and impressionistic (e.g., Wahl 1974;Warner 1991;Knafo 1991;Gruenberg 1995). Of course, analysts have had to be wary of trying to write about recognizable patients.…”