The respondent, a practising psychologist, engaged in multiple boundary violations with two patients. The respondent terminated his therapeutic relationships with both patients to pursue a personal, sexual and employment relationship with one patient and a personal, residential, employment and business relationship with another.
He also failed to make and keep adequate clinical records and was found to be impaired as a result of a personality disorder.
Background
The respondent had been a registered psychologist in Victoria since 1996 and carried on a limited part time practice since the late 2000s. The respondent established a private practice in New South Wales in 2013. The relevant complaints are in relation to two female patients who attended his practice during 2014 and 2015.
Patient B
For approximately two to three times a month between April 2014 and November 2014, Patient B sought help from the respondent in relation to distress and depression after separating from her husband. In November 2014, the therapeutic relationship was ended in order to pursue a business relationship. Until May 2016, there was a significant personal and business relationship between the respondent and Patient B involving a joint antiques business venture. There was also a period of 23 weeks where Patient B resided at the respondents home, as well as working unpaid at his practice and at his investment property. The personal and business relationship ended in April/May 2016.
When Patient B was hospitalised in April 2016 due to a deterioration of her mental health, the treating psychologist was made aware of the practitioner's actions, giving rise to a notification and ultimately these proceedings.
Patient A
Patient A sought help from the respondent on five occasions between August and September 2015. She was referred to the respondent for help with 'long standing' personal problems, marriage breakdown and financial problems. In September 2015, the therapeutic relationship was ended to pursue a personal relationship. Patient A and the practitioner began socialising together and the relationship progressed to a sexual relationship in April 2016 during a holiday together. Patient A then started paid work in his practice. The romantic relationship ended after 12 months however Patient A continued working at the practice until 2018. Patient A retains a high opinion of the respondent.
Complaints
The Health Care Complaints Commission ('HCCC') put forward six complaints. Complaints 1 and 3 were for unsatisfactory professional conduct concerning the multiple/dual relationships with two patients. Complaints 2 and 4 concerned associated failure of record keeping. Complaint 5 related to the seriousness of Complaints 1 and 3 individually and of Complaints 1 to 4 cumulatively. Complaint 6 related to the practitioner's impairment that affects or is likely to affect his ability to practice.
The Hearing
The applicant filed five volumes of evidentiary material. Patient A's notes from her treatment were in evidence however Patient B's were not. When Patient B's file was requested by HCCC in late 2016, the respondent identified it as missing.
The respondent was self-represented at the hearing and the Tribunal was mindful of the difficulties faced by underrepresented respondents.
The Issues
The practitioner acknowledged that a sexual relationship occurred with Patient A within two years of the therapeutic relationship. He also acknowledged that he had a social relationship with Patient A after their sexual relationship ended and that she worked for him in his private practice. The respondent also acknowledged the three business ventures with Patient B, introducing her to his friends, attending functions with her and hugging her on one occasion.
The respondent did not accept that his conduct amounted to unsatisfactory professional conduct or professional misconduct. He submitted to the Tribunal that he had terminated the therapeutic relationship as per the patient's wishes and acted in their best interests.
The following was in issue:
- Did the respondent fail to make reasonable arrangements for continuity of care of Patients A and B?
- Did the respondent fail to make and keep adequate records of Patients A and B?
- Did the respondent inappropriately speak to and touch Patient B?
- Does the admitted and proved conduct justify a finding of unsatisfactory professional conduct or professional misconduct?
- Does the respondent have an impairment under the National Law?
Findings
Patient A
The particulars of Complaints 1 and 2 were considered proven on the balance of probabilities with one exception. The respondent argued that he was not in fault for failing to provide a report to Patient A's referring general practitioner because Patient A requested that he not do so as she was changing General Practitioners. Additionally, Patient A had only attended five sessions under the Medicare Plan and reports are only provided after the sixth session. The Tribunal accepted this and made no adverse finding for this particular aspect.
The Tribunal did find however, that Complaints 1 and 2 were made out. The respondent's conduct was improper and unethical in that he precipitously terminated the therapeutic relationship with the patient so that he could pursue a personal relationship. A sexual and employment relationship is a boundary violation and the respondent placed his own needs and interests over the patients. This conduct was deemed to justify a finding of professional misconduct.
Patient B
The conduct of Complaint 3, including personal contact and gifts during the therapeutic relationship, various sexual remarks and touching thereafter, was found to amount to conduct that is below the standard expected and is improper and unethical. In tandem with the findings of other complaints, Complaint 5 of misconduct was 'very comfortably made out'.
Considering the conduct as a whole, the Tribunal was very concerned about the respondent's competence and fitness for practice.
Impairment
The Tribunal was satisfied that the practitioner's professional judgement was profoundly impaired by a personality disorder and detrimentally impacts upon his capacity to practice. Complaint 6 was made out. The Tribunal held that a Stage 2 hearing is required to consider the appropriate protective orders.
Orders
As a result of the Tribunal's findings of unsatisfactory professional conduct, professional misconduct and impairment, a second stage hearing on protective orders was directed.
