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Drawing on their own consultative experience illustrated by case vignettes and with support from the professional literature, the authors discuss the perennial problematic issue of boundary violations and sexual misconduct, aiming at an audience of both experienced and novice clinicians. The authors review the difference between boundary crossings and boundary violations and stress the therapist's responsibility to maintain boundaries. Therapist risk factors for violations include the therapist's own life crises, a tendency to idealize a "special" patient or an inability to set limits, and denial about the possibility of boundary problems. Factors exacerbating patient vulnerability, such as overdependence on the therapist, seeking therapy to find an intense relationship or even "true love," and the acceptance by childhood abuse victims of an abusive therapy relationship, are discussed. Consultation and education-for students and for clinicians at all levels of experience-and effective supervision are reviewed as approaches to boundary problems.

Legislative enactment of criminal penalties for psychotherapists' sexual contact with their patients is pending in several states. The arguments in favor of criminalization are that it serves as a deterrent, offers retribution, provides redress when other avenues are blocked, deals with unlicensed psychotherapists, makes victims' assistance funds available, and provides due process protection against false accusations. In opposition to criminalization are the arguments that civil and administrative measures already exist to deal with the problem, it may have a chilling effect on the reporting of misconduct, it may void malpractice insurance, it makes guilty psychotherapists place themselves in jeopardy if they acknowledge their wrongdoing in attempting to make amends, it removes control of the legal process from the victim, it fails to offer rehabilitation, and it singles out psychotherapists from other fiduciaries for more stringent treatment. APA district branches inevitably will be called on to take positions with regard to legislation criminalizing sexual exploitation of patients. The current public outrage over patient victimization, however appropriate it may be, appears to make it difficult to publicly justify anything other than support for criminalization.

Although there is unanimity among mental health professionals as to the unethical aspect of psychotherapist-patient sexual contact, there is disagreement as to whether subsequent treating psychotherapists should be required to report the abuse of a former therapist to a licensing agency. Such reporting may have negative effects upon the patient and upon the patient's relationship with the therapist. It may also, however, prevent further exploitation by the original abusing therapist. Three states have adopted reporting statutes designed to protect patients from this type of abuse. The current statutory enactments of California, Wisconsin, and Minnesota are compared in terms of their differing approaches to the problem.