Charges

A Professional Conduct Committee (PCC) laid two charges against the Psychologist.  Those charges (as amended) were that the Psychologist:

1. Failed to observe sufficient professional and personal boundaries with, and/or fostered dependency by, the Patient, including by:
   1. treating, and continuing to treat, the Patient at his home, in circumstances where he had no support staff, so as, for example, to cause:
      1. him on occasion to present in his dressing gown when the Patient arrived for therapy sessions (whether or not the Patient was arriving on time or early for the sessions).
      2. him on occasion to eat his breakfast while the Patient waited for a therapy session (whether or not the Patient was arriving on time or early for the sessions).
      3. him to allow the Patient to accompany him on errands (whether during a therapy session or while waiting for the agreed time to attend a therapy session).
      4. avoidable issues relating to the Patient’s difficulty in leaving therapy sessions.
   2. conducting therapy sessions with the Patient of inappropriate frequency and duration.
   3. on one occasion, when the Patient had not presented for an arranged therapy session, going to her house, climbing into her house through a window and going in to see her in her bedroom.
   4. behaving in a way that led the Patient to become confused about the nature of his relationship with her and/or contributed to her feeling that his relationship with her was ‘special’.
   5. engaging in physical contact with the Patient that exceeded acceptable limits and/or was not in her best interests by using holding therapy of a particular nature.
2. Failed to obtain explicit informed consent from the Patient for the use of holding therapy, including failing to consider adequately the potential risks and benefits of that therapy and/or giving the Patient inadequate explanation of those potential risks and benefits.

Finding

The Psychologist pleaded guilty to the charges and the Tribunal found the Psychologist guilty of professional misconduct on both charges.

Background

The Patient had a history of sustained severe childhood sexual, physical and psychological abuse from her father.  After seeking psychological assistance in 1989, she was found to be exhibiting symptoms of post-traumatic stress disorder (“PTSD”).

The Patient’s first appointment with the Psychologist was in April 2000.  At the Patient’s request he agreed to become the primary therapist.

During therapy, the Patient had continued symptoms of PTSD in the form of intrusive memories, flashbacks and reliving of previous traumatic events.  She was further diagnosed by the Psychologist with dissociative identity disorder (“DID”).  In her case, the DID manifested itself as a splitting of her conscious awareness and emotional function into several parts, which were identified by their age.  There were infant, child and adolescent parts, as well as her adult self.  The Patient could switch between these states.  In her competent adult state, she was an intelligent and aware person.

In November 2003, Dr G, psychiatrist, was asked by the Sensitive Claims Unit of the Accident Compensation Corporation (“ACC”) to assess the Patient.  She confirmed a diagnosis of PTSD and DID.

The Patient’s last therapy session with the Psychologist took place in late April or early May 2006. 

Reasons for Finding

First Charge

Particular (a)

The Tribunal established that:

1. the Psychologist on at least six occasions presented himself in a dressing gown when the Patient arrived for therapy sessions, whether or not she was arriving on time or early.
2. on at least 12 occasions, the Psychologist was eating his breakfast while the Patient waited for a therapy session with the Patient being permitted to wait for him at the entrance to the kitchen.
3. the Psychologist allowed the Patient to accompany him on errands; this happened at least four times.
4. the Psychologist allowed the Patient to remain at his house for significant periods after therapy sessions, while she waited for Mr E (her partner) to collect her.  The Patient was able to go upstairs to the kitchen of the house to get more water if she chose; she was able to meet and talk with the Psychologist’s children.  She would remain at his house for anything from 20 minutes to a few hours after a session ended.  Sometimes she would have tea or coffee with the Psychologist and on one occasion stayed for dinner following a therapy session.

The Tribunal found Particular (a) was established.

Particular (b)

The Tribunal was satisfied the lengthy and/or frequent sessions should not be used on an extended basis; and should only be used for a specific purpose.  In the present case, the Psychologist provided the Patient with two to three therapy sessions per week, each of one and a half to 2 hours duration and sometimes longer, over a period of several years.  This particular was established, but the Tribunal considered it was less serious than the other particulars in this charge.

Particular (c)

The particular concerned the Psychologist climbing into the Patient’s house via a window, and going to see her in a bedroom when she did not turn up for a scheduled appointment.   The Tribunal agreed with an expert witness that a crisis management plan should have been put into action.

The Tribunal considered this behaviour was an example of the blurring of professional boundaries and fostered dependency and prevented the Patient accessing appropriate treatment. The Tribunal found Particular (c) was established

Particular (d)

This Particular was established by the following facts:

1. the Psychologist referred to himself (to the Patient) as “the Patient’s stand-in Dad”.
2. the Psychologist told her that he:
   1. had learned a lot in working with her;
   2. cared for her;
   3. was committed to her healing; and
   4. would never abandon her younger parts
3. the Psychologist provided the Patient with a lot of “out of hours” contact, including by extensive emails (some sent late at night), text messages and home visits.
4. the Psychologist gave her a card and flowers for her birthday.
5. the Psychologist provided an audiotape about his commitment to her and her therapy, suggesting she listen to it whenever she thought it might help her.
6. the Psychologist provided the Patient with two to three therapy sessions per week, each of one and a half to two hours duration and sometimes longer, over a period of several years.
7. the Psychologist charged the Patient for only one hour of therapy per week.

The Tribunal was satisfied the evidence of these behaviours demonstrated the closeness and intensity of the relationship between the Patient and the Psychologist and it significantly transcended therapeutic boundaries. 

Particular (e)

The Tribunal accepted an expert’s evidence that the use of touch is excluded by mainstream psychotherapy in New Zealand and overseas.  There is no body of empirical research that supports its use as an effective therapeutic technique.  There are identified particular risks that may arise from the use of non-erotic touch in psychotherapy.

The particular highlighted the fact that a controversial “holding therapy” was provided in a manner which was extreme in its nature, intensity and frequency of use.  As such, it was clinically inappropriate, exceeded acceptable limits, and was therefore not in the Patient’s best interests. Accordingly, the Tribunal was satisfied that Particular (e) was established.

Overall Findind for the First Charge

Considered cumulatively, the Tribunal was satisfied the five particulars constituted negligence and malpractice, and were sufficiently serious as to warrant discipline, for the purposes of protecting the public, maintaining professional standards, and punishing the practitioner.

Second Charge

There was common ground that the Psychologist did not provide any specific advice about potential risks in using holding therapy at any stage.

The Psychologist appeared to have told the Patient about the benefits of holding therapy, but did not inform her of the risks – even although holding therapy is not a generally accepted or empirically proven treatment modality.  The Tribunal considered the Psychologist had an obligation to make himself familiar with the risks, and to advise the Patient of those risks before engaging in holding therapy with her - particularly as she was a sexual abuse survivor.

Accordingly, the Tribunal was satisfied this charge was established and it amounted to both negligence and malpractice and was sufficiently serious as to warrant discipline, for the purposes of protecting the public, maintaining professional standards, and punishing the practitioner.

Penalty

In this case the Tribunal was persuaded to take a generally rehabilitative approach on penalty, but one which also recognised the public health and safety factors.

The Tribunal ordered that the Psychologist’s registration be suspended for a period of 18 months.  The Tribunal imposed the following conditions for a period of three years following the end of the period of suspension:

• He must not provide supervision to others.
•  He must not teach on the topics of psychology, psychotherapy or counselling.
•  He must not practise from his home.
•  He must practise in a professional setting with other clinicians and support staff such as a group private practice or a mental health service.  He must only see clients in this setting (ie he must not see clients in their own homes).
• He must only see patients with mild adjustment or mental health difficulties.  He must not knowingly treat patients with personality disorders or serious mental health problems.  If it becomes apparent that a patient has such a disorder or health problem he will refer that patient to a suitable practitioner.
• He must not use holding therapy or other touch based approaches.
• He must participate in clinical supervision; the nature of this supervision must be determined by the Board including approval of the supervisor and the frequency and duration of supervision sessions.
• He must inform any employer with whom he obtains employment in the three year period, during which the conditions apply, of the outcome of this proceeding. 

The Tribunal further ordered that the Psychologist be censured and pay costs of $10,000.

The Tribunal recommended to the Board that it consider requiring the Psychologist to carry out a remedial programme when evaluating his competence.