Professional Ethics: When Does Avant-Garde Psychiatry Become Sexual Harassment?

Reader’s Question

I saw a psychiatrist for the first time ever a few days ago and have become increasingly uncomfortable with what happened during the visit. It began in a manner I presumed to be normal. He asked various questions and I answered. Initially, the questions were about my medications, relationships, past abuse, etc. Then he began telling me what type of person he thought I was. He said I was depressed and would likely always be unhappy with myself. He then began asking more detailed questions about my past sexual relationships. He began telling me that I probably like to be submissive, and probably liked sex that would hurt. He asked if I liked to be dominated by a man in power and I admitted that I had fantasized about it once. He asked me increasingly vulgar questions and asked if he were making me aroused in the process.

Judging by this appointment, I don’t want to go back to this man, and I’m not sure that I ever want to see any psychiatrist ever again. Am I being too overly sensitive to his questions and suggestions? Does this sound like normal practice? Is it some kind of unusual but still appropriate psychiatry? Should I go back to him and see if the next appointment is just as awkward?

Psychologist’s Reply

Psychiatrists and Psychologists (as well as most other credentialed mental health professionals) are trained to observe certain ethical and professional standards that must be observed even when the most provocative or avant-garde techniques are employed. Those standards also include guidelines regarding behaviors that might easily be construed as sexual harassment or misconduct. The standards are published and are available to the general public so that any prospective patient can know what behaviors should not be considered standard operating procedure. The therapeutic relationship is a potentially powerful one that must be based on trust and confidence. Such trust cannot develop when your treatment provider engages in behaviors that make you feel extremely uncomfortable or violated.

Professionals who have problems behaving in a professional and ethical manner have generally evidenced those problems on other occasions and with other patients. It’s unfortunate, however, that instances of impropriety are often not reported to their licensing boards, professional organizations, or other oversight groups. However, sometimes the professional may have a history of complaints, often of a similar nature, and this can lead to eventual intervention or sanction on the part of those entities responsible for credentialing the professional.

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Practitioners who are impaired with sexual behavior disturbances and are ethically challenged are sometimes also very skilled manipulators who have the skills to make the victim of their misconduct feel like a fool for challenging their conduct or for thinking about reporting it to authorities. Such practitioners are also likely to persist in their unprofessional conduct if their behavior is not reported and they are not sanctioned.

Reason should prevail when you are attempting to determine whether you were simply apprehensive about being asked appropriate and necessary but somewhat unnerving questions — or whether the nature and content of the comments and questions from your psychiatrist were more than likely those of a person with insufficient regard and respect for your personal boundaries. If you were violated, then the chances are good that someone before you has also been, and it would be very important that such conduct be brought to the attention of authorities.