Responding to Sexual Boundary Notifications: The Evolving Regulatory Approach in Australia

ABSTRACT A sexual boundary violation by a health practitioner has an immense impact on a patient, and the trust and confidence in the health care system and the health care regulator are negatively affected. The Australian Health Practitioner Regulation Agency (Ahpra) and the Medical Board of Australia (MBA) in 2017 commissioned an independent review in response to a specific high-profile case of multiple physician-patient* sexual boundary violations. In response to recommendations for process improvement, Ahpra and the MBA worked to transform the regulatory management of sexual boundary notifications.The purpose of this paper is to explore the structural and cultural changes that have been made to manage sexual boundary violation notifications and lessons learned through the process. Three factors — specialized decision-making, training for investigators and policy and cultural changes — were identified as key elements of the change process. Since the changes in 2017, the rate of immediate regulatory action taken in response to sexual boundary notifications has increased substantially, with a higher proportion of decisions resulting in suspension of a physician’s registration. Further work on the experience of those who are part of the notification process and supporting people to share their stories and experiences through the notification and tribunal process is ongoing.

“The revolution will not be supervised”: Consent and open secrets in data science

The social impacts of computer technology are often glorified in public discourse, but there is growing concern about its actual effects on society. In this article, we ask: how does “consent” as an analytical framework make visible the social dynamics and power relations in the capture, extraction, and labor of data science knowledge production? We hypothesize that a form of boundary violation in data science workplaces—gender harassment—may correlate with the ways humans’ lived experiences are extracted to produce Big Data. The concept of consent offers a useful way to draw comparisons between gender relations in data science and the means by which machines are trained to learn and reason. Inspired by how Big Tech leaders describe unsupervised machine learning, and the co-optation of “revolutionary” rhetoric they use to do so, we introduce a concept we call “techniques of invisibility.” Techniques of invisibility are the ways in which an extreme imbalance between exposure and opacity, demarcated along fault lines of power, are fabricated and maintained, closing down the possibility for bidirectional transparency in the production and applications of algorithms. Further, techniques of invisibility, which we group into two categories—epistemic injustice and the Brotherhood—include acts of subjection by powerful actors in data science designed to quell resistance to exploitative relations. These techniques may be useful in making further connections between epistemic violence, sexism, and surveillance, sussing out persistent boundary violations in data science to render the social in data science visible, and open to scrutiny and debate.

The Spectrum of Analytic Interaction: A Contemporary Freudian Perspective

The authors set forth a contemporary Freudian perspective proposing that enacted interaction be viewed as a spectrum of distinct yet overlapping clinical phenomena: acting in/acting out, transference actualization, enactment, countertransference actualization, and boundary violation. At the center of this spectrum are enactments proper, interactions in which both parties construct and sustain a process that embodies a crucial aspect of their affective relationship. By conceptualizing these interactions as a continuum that is patient-focused at one end and analyst-focused at the other, the authors delineate a range of modalities for analytic intervention. They contend that an oscillation between monadic and dyadic perspectives is integral to grappling with the interactive dimension of the analytic process.

Professional Conduct and Handling Misconduct in Psychotherapy: Ethical Practice between Boundaries, Relationships, and Reality

The special nature of the professional relationship in psychotherapy requires a code of conduct that protects the patient, but also allows therapeutic flexibility. However, the limits of professional conduct are transgressed when a psychotherapist goes beyond his or her professional boundaries to satisfy his or her own needs. The implications of misconduct are considered to be particularly severe in psychotherapy. Misconduct has various faces and facets. Sexual misconduct is the most drastic form of boundary violation; however, this should not detract attention from other forms of misconduct, especially because they often precede the more severe boundary violations. Any form of misconduct is profoundly connected with the person of the therapist. Nevertheless, research often addresses the question of what professional misconduct is, rather than how ethical professional conduct can be facilitated. This chapter aims to give an overview of the current literature to (1) define professional conduct and outline ethical reasoning, (2) describe different forms of misconduct, (3) discuss options for prevention and intervention, and (4) discuss options for improving training of future psychotherapists.