Defensive psychiatry and the disruption of treatment boundaries

Defensive psychiatry refers to any act or omission that is performed not for the benefit of the patient but to avoid malpractice liability or to provide a legal defense against a malpractice claim. Defensive practices that produce deviant treatment boundaries usually take the form of clinically unnecessary prohibitions that disturb the therapist's position of neutrality. A distinction is drawn between boundary violations, boundary crossings and boundary issues. Typical clinical issues that provoke defensive treatment boundaries include managing patients with sexual transferences and potentially violent patients that may require the therapist to warn and protect endangered third parties. Defensive boundaries are usually created by unrecognized or uncorrected therapists' countertransferences.