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Sexual boundary violations: victims, perpetrators and risk reduction

  • John Hook (a1) and Dawn Devereux (a2)


Sexual boundary violations by healthcare professionals is a subject that has largely been ignored in the UK. There has been little research into the field. It is rarely taught on professional training courses and practitioners appear to know very little about it. The history of sexual boundary violations is littered with failures to notice, failures to report and inadequate justice for victims and perpetrators alike. Perpetrators are commonly assumed to be predators. Given the many widely reported recent events in our media of both predatory and other sexual offenders, we believe it is timely for all healthcare and other professions working with vulnerable people to take the problem seriously, to provide appropriate services for victims, evaluation and assessment of perpetrators, and sanctions that fit the crime in order to regain public trust.


  • Develop greater understanding of the problem of sexual boundary violations by professionals
  • Be able to manage the care of a patient who has been the victim of a sexual boundary violation
  • Understand factors in professionals that may lead to a sexual boundary violation




Corresponding author

Correspondence John Hook, 5 Kemishford, Woking GU22 0RL, UK. Email:


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Celenza, A (1998) Precursors to therapist misconduct: preliminary findings. Psychoanalytic Psychology, 15: 378–95.
Celenza, A, Gabbard, GO (2003) Analysts who commit boundary violations: a lost cause? Journal of the American Psychoanalytic Association, 51: 617–36.
Celenza, A (2007) Sexual Boundary Violations: Therapeutic, Supervisory, and Academic Contexts. Jason Aronson.
Council for Healthcare Regulatory Excellence (2008) Learning about Sexual Boundaries between Healthcare Professionals and Patients: A Report on Education and Training. CHRE.
Gabbard, GO, Lester, EP (1995) Boundaries and Boundary Violations in Psychoanalysis. Basic Books.
Gabbard, GO (2016) Boundaries and Boundary Violations in Psychoanalysis (2nd edn). American Psychiatric Association Publishing.
Garrett, T, Davis, JD (1998) The prevalence of sexual contact between British clinical psychologists and their patients. Clinical Psychology and Psychotherapy, 5: 253–63.
General Medical Council (2013) Maintaining a Professional Boundary Between You and Your Patient. GMC.
Gutheil, TG, Brodsky, A (2008) Preventing Boundary Violations in Clinical Practice. Guilford Press.
Hook, J, Devereux, D (2018) Sexual boundary violations: the patient's experience of harm. BJPsych Advances, 24: XXX–XXX.
Lee, V, Charles, C (2008) Research into CPS Decision-Making in Cases Involving Victims and Key Witnesses with Mental Health Problems and/or Learning Disabilities. Crown Prosecution Service.
MacDonald, K, Sciolla, A, Folsom, D, et al. (2014) Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs. General Hospital Psychiatry, 37: 489–96.
Margerison, N, Bewley, S (2016) Boundary Violations and Sexual Exploitation: Recognition, Avoidance and Management (CPD Online module). Royal College of Psychiatrists.
MPTS, GMC Sanctions Guidance (2018) (;
Nutt, D, Sharp, M (2008) Uncritical positive regard? Issues in the efficacy and safety of psychotherapy. Journal of Psychopharmacology, 22: 36.
Parry, G, Crawford, M, Duggan, C (2016) Iatrogenic harm from psychological therapies – time to move on. British Journal of Psychiatry, 208: 210–2.
Peltz, ML, Gabbard, GO (2001) Speaking the unspeakable: institutional reactions to boundary violations by training analysts. Journal of the American Psychoanalytic Association, 49: 659–73.
Pope, K, Levenson, H, Schover, L (1979) Sexual intimacy in psychology training: results and implications of a national survey. American Psychologist, 34: 682–9.
Pope, KS, Vetter, VA (1991) Prior therapist–patient sexual involvement among patients seen by psychologists. Psychotherapy, 28: 429–38.
Pope, KS (1994) Sexual Involvement with Therapists: Patient Assessment, Subsequent Therapy, Forensics. American Psychological Association.
Royal College of Psychiatrists (2009) Good Psychiatric Practice (3rd edn) (College Report CR154). Royal College of Psychiatrists.
Royal College of Psychiatrists (2013) Vulnerable Patients, Safe Doctors: Good Practice in our Clinical Relationships (2nd edn) (College Report CR180). Royal College of Psychiatrists.
Sarkar, SP (2004) Boundary violation and sexual exploitation in psychiatry and psychotherapy: a review. Advances in Psychiatric Treatment, 10: 312–20.
Schoener, G, Gonsiorek, J (1989) Assessment and development of rehabilitation plans for the therapist. In Psychotherapists’ Sexual Involvement with Clients: Intervention and Prevention (eds Schoener, G, Milgrom, J, Gonsiorek, J, et al. ). Walk-in Counseling Center.
Scott, J, Young, AH (2016) Psychotherapies should be assessed for both benefit and harm. British Journal of Psychiatry, 208: 208–9.
Subotsky, F, Bewley, S, Crowe, M (eds) (2010) Abuse of the Doctor–Patient Relationship. RCPsych Publications.
Swiggart, W, Starr, K, Finlayson, R, et al (2002) Sexual boundaries and physicians: overview and educational approach to the problem. Sexual Addiction & Compulsivity, 9: 139–48.



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Sexual boundary violations: victims, perpetrators and risk reduction

  • John Hook (a1) and Dawn Devereux (a2)
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