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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.

What are the sources of perceived occupational stress, and how troublesome are they to forensic psychiatrists? To examine these questions 1,800 90-item questionnaires were sent to the membership of AAPL. The questions explored what experiences forensic psychiatrists found most stressful and the degree of stress experienced. Three hundred seventy-two questionnaires were returned. On average, individuals rated the stress in their overall forensic practices as relatively low. Certain situations, however, were found to be highly stressful. Five of the most stressful aspects of forensic practice in this sample were: (1) fear of not being able to defend an opinion during cross-examination (63%); (2) fear of the prospect of disclosure of one's own content-related personal history (53%); (3) working with short deadlines (49%); (4) testifying while physically ill (43%); (5) stress from a retaining attorney's attempts to coerce an opinion (43%). An awareness of these matters may give guidance to people who are considering becoming forensic psychiatrists and may facilitate the management of stress.

The expert witness testifies under oath to tell "the whole truth," yet certain aspects of the legal system itself make this ideal difficult or impossible. The authors present both a philosophical and a practical discussion of the challenges for the expert in attaining this goal. After review of oaths in general and truth-telling in particular, real-life examples are provided to examine the vicissitudes of the whole truth in court. Recommendations are provided for experts, to preserve the truth in the adversary system.

Civil litigation often has profound psychological consequences for plaintiffs and defendants alike. For those individuals who are involved in ongoing psychotherapy, or those who enter psychotherapy during litigation, the stress of litigation often adds to whatever issues produced the lawsuit. This article reviews the effects of that stress, the mechanisms through which it arises, and its manifestations in psychotherapy and offers suggestions to increase psychotherapist awareness of the influence of litigation stress on treatment.

Objective: This article explores the clinical, legal, and ethical problems that typically occur when a psychotherapist serves as both a treating clinician and forensic evaluator (or expert witness) in the same case., Method: The professional literature, ethics codes, opinion surveys, and the changing economic and institutional contexts of psychotherapy are reviewed in order to identify obstacles to widespread recognition of this straightforward ethical issue. The processes of psychotherapy and forensic evaluation are then analyzed so as to reveal fundamental incompatibilities between the psychotherapist's clinical and legal functions., Results: Attempting to treat and evaluate the same person typically creates an irreconcilable role conflict. This role conflict manifests itself in different conceptions of truth and causation, different forms of alliance, different types of assessment, and different ethical guidelines., Conclusions: Although circumstances sometimes compel a practitioner to assume the dual role of treater and evaluator, the problems that surround this practice argue for its avoidance whenever possible.

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.

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.

This paper examines the issue of potential harmful effects on an individual who hears a description of his psychodynamics in the highly charged, adversarial context of a courtroom. Ethical considerations and strategies for minimizing such harm are discussed, accompanied by illustrative clinical case material.