I am a retired, married, male psychiatrist. A divorced, female former patient of mine contacted me recently, 45 years after her treatment ended. Would it be OK to correspond with her by email? Or is this a case of “once a patient, always a patient?” — Name Withheld
From the Ethicist:
The relevant professional associations tend to have strictures that are specifically about sexual relationships with former patients. The American Psychiatric Association has a crisp, narrow rule: “Sexual activity with a current or former patient is unethical.” The American Psychological Association forbids sexual intimacies until at least two years after the termination of therapy, and says that, even then, it’s acceptable only “in the most unusual circumstances.” In light of the potential for exploitation within the therapist-patient relationship, these rules are meant to maintain clear boundaries, protect patient welfare, uphold the integrity of the profession and eliminate any gray areas that could lead to ethical breaches.
But though you do mention her marital status, and yours, you’re just asking about emailing her — about establishing friendly relations. The question for you is whether she might be harmed by this, whether whatever knowledge or trust gained from your professional relationship would shadow a personal one. Yes, almost half a century has elapsed since your professional relationship, but you still have to be confident that a correspondence with her clears this bar. If it does, you may email with a clear conscience.
Readers Respond
The previous question was from a reader who was holding onto a devastating secret. He wrote: “When I was a child, I was sexually abused by my father. I never told anyone about it when it was happening. To this day, nobody in my family is aware that the abuse occurred. My mother is still married to him, and he has a good relationship with most of our immediate and extended family. In adulthood, I’ve chosen to continue keeping his transgressions to myself. I’ve followed this path not only to avoid familial conflict but also for the sake of containing the damage he has done. … After many years of therapy, I finally followed the advice of therapists and friends and cut ties with him. I let my family know that I couldn’t be around him anymore. … A few trusted friends have told me that I should consider telling the family about all of this. They say that if they had an abuser in the family, they would want to know. What is the ethical thing to do here? Should I continue my silence to protect the rest of my family from emotional harm? Or do I owe it to them to tell them the truth?”
In his response, the Ethicist noted: “I’m so sorry about what you’ve gone through. There’s something particularly dreadful about being harmed by someone who was supposed to take care of you. You’re to be commended for addressing so thoughtfully the issues you face. Now, an immediate issue is whether your father could be in a position to repeat his crimes with other children — that there aren’t others suffering in silence. If that’s the case, staying silent isn’t an option. You don’t raise this as a concern, but you need to be confident that it isn’t one. … Whatever you decide, though, you shouldn’t be motivated by the thought that you owe this truth to anyone. … Taking measures to protect your well-being isn’t selfish when you are, objectively, the wronged and wounded party. Will your well-being be best protected by your admittedly painful policy of steering clear of both your father and the tumult of disclosure? That’s the sense I get from your letter, but it’s a forecast you’re better positioned than anyone else to make.” (Reread the full question and answer here.)
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I’m glad to see such a trauma-informed approach to conflict resolution and disclosure from the Ethicist. Very often I have seen people push victims to disclose traumatic incidents not from a desire to protect others but from a misguided sense of justice. I think we all want the world to be just and fair, and for perpetrators of abuse to suffer publicly for their actions. If we lived in that world, we would have a sense of certainty and safety in the connections we share with others. But the world we live and act in is far murkier, less kind and not often fair, so self-preservation is by far the more important objective. — Julian
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There’s a saying in Alcoholics Anonymous: “You’re only as sick as your secrets.” I don’t think the letter writer should protect his father; the father certainly failed to protect him. Only when his shameful secret is out in the open will he, his son and the entire family begin to fully heal. — Andrew
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I admire the thoughtfulness of both the Ethicist and the letter writer. I am a psychotherapist, and I have worked with incest survivors, perpetrators and other family members for over 30 years. In my clinical experience it is very rare that a perpetrator has had only one victim, especially if he has never been busted. I would guess that other people in the letter writer’s generation have also been molested — such that if he reveals his experience he might be supported by others with similar experiences. And in my humble, though clinical, experience, I feel that he has a responsibility to share his father’s misdeeds so as to protect the next generations. For, just as his father seems to be acting out based on his own victimization, other potential victims are surely at risk of perpetuating this cycle of abuse. — Sarah
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I am a felon convicted of having sex with a 15-year-old. The letter writer’s father needs to be forced to own up to his egregious behavior the same as I had to. I have to say, I am a far better man now, but that’s cold comfort for those around me whose lives I destroyed. Living a lie is not living at all; I strongly recommend that the person who was abused disclose that event so that everyone lives an honest life going forward. — Mark
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I would like to thank the author of this letter for his courage in sharing his story. We cannot control what other people say, think and believe, and so it is important that he do what makes the most sense for him. Abusers are very skilled at controlling victims and their surrounding communities. It can help to take back that control and make decisions for your own best interest. Abuse thrives in silence and maybe bringing it into the open will help the letter writer find a path to further healing. The choice is a personal one and there is no right or wrong path to take. — Ethel