Nonsexual boundary violations: sauce for the gander

Numerous articles in the mental health literature concern sexual contact between therapists and patients, which is explicitly prohibited by all four mental health professions' ethical codes. There is relatively little about nonsexual boundary violations, which are often covert and much more difficult to recognize (particularly in their early stages) than sexual violations; what little there is assumes that the clinician has the power in the relationship and uses that power for personal advantage. In this article the authors discuss the situation, rare in civil mental health facilities but common in correctional and forensic mental health facilities, in which personality-disordered patients manipulate and coerce clinicians to cross appropriate professional nonsexual boundaries for the patients' benefit; this reversal of the usual power dynamics between treaters and patients requires recognition of the role reversals present and requires different strategies for preventing such violations (hence "sauce for the gander").