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CLINICAL SYNTHESIS   |    
Ethics Commentary: Psychotherapy: Professionalism, Boundaries, and the Therapeutic Relationship
Laura Weiss Roberts, M.D., M.A.
FOCUS 2014;12:311-313. doi:10.1176/appi.focus.12.3.311
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Author Information and CME Disclosure

Laura Weiss Roberts, M.D., M.A., Professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.

Dr. Roberts reports: Owner, Investigator: Terra Nova Learning Systems.

Address correspondence to: Laura Weiss Roberts, M.D., Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA; e-mail: RobertsL@stanford.edu

Extract

Healing is the heart of medicine and, by definition, is the central commitment of the therapeutic relationship. In psychiatry, the therapeutic relationship can become deeper and richer in its meaning and influence. The special quality of the therapeutic relationship in psychiatry derives in part from the nature of mental illnesses that carry with them great anguish. The personal suffering associated with mental disorders, related conditions, and difficult life events that bring a patient into the care of a psychiatrist can be immense, cause a profound sense of vulnerability, and may be poorly understood by others—even among those closest to the patient. The therapeutic relationship in psychiatry, particularly but not exclusively in the context of psychotherapy, is also distinct in the House of Medicine because the psychiatrist uses not only special expertise but also the sequence of interactions between psychiatrist and patient—truly the dynamics that exist in the relationship itself—in the service of bringing about greater health in the patient. For these reasons, healing in psychiatry arises through trust in the psychiatrist and the aim of the therapeutic relationship is dedicated to the patient’s well-being.

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References

Gabbard  GO;  Roberts  LW;  Crisp-Han  H;  Ball  V;  Hobday  G;  Rachal  F:  Professionalism in Psychiatry .  Arlington, VA,  American Psychiatric Association, 2012
 
Gutheil  TG;  Gabbard  GO:  The concept of boundaries in clinical practice: theoretical and risk-management dimensions.  Am J Psychiatry 1993; 150:188–196
[PubMed]
 
Epstein  RS;  Simon  RI:  The exploitation index: an early warning indicator of boundary violations in psychotherapy.  Bull Menninger Clin 1990; 54:450–465
[PubMed]
 
Roberts  LW;  Dyer  AR:  Concise Guide to Ethics in Mental Health Care .  Washington, DC,  American Psychiatric Association, 2004
 
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