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For anyone interested in publications exploring therapeutic harm/boundaries/ professional ethics/misconduct, they can be found below (this is very much work in progress & will be added to over the coming months):

Papers from the AdEPT Study (understanding and preventing the Adverse Effects of Psychological Therapies) undertaken at the University of Sheffield UK (CI- Professor Glenys Parry) & work with links to that study 


Crawford, M., Thana, L., Farquharson, L., Palmer, L., Hancock, E., Bassett, P., . . . Parry, G. (2016). Patient experience of negative effects of psychological treatment: Results of a national survey. British Journal of Psychiatry, 208(3), 260-265. doi:10.1192/bjp.bp.114.162628


Curran, J., Parry, G. D., Hardy, G. E., Darling, J., Mason, A. M., & Chambers, E. (2019). How Does Therapy Harm? A Model of Adverse Process Using Task Analysis in the Meta-Synthesis of Service Users' Experience. Front Psychol, 10, 347.


Duggan, C., Parry, G., McMurran, M., Davidson, K., & Dennis, J. (2014). The recording of adverse events from psychological treatments in clinical trials: evidence from a review of NIHR-funded trials. Trials, 15, 335.

Hardy, G. E., Bishop-Edwards, L., Chambers, E., Connell, J., Dent-Brown, K., Kothari, G., O'Hara, R., & Parry, G. D. (2019). Risk factors for negative experiences during psychotherapy. Psychother Res, 29(3), 403-414.

McQuaid A, Sanatinia R, Farquharson L, Shah P, Quirk A, Baldwin DS, Crawford M. Patient experience of lasting negative effects of psychological interventions for anxiety and depression in secondary mental health care services: a national cross-sectional study. BMC Psychiatry. 2021 Nov 17;21(1):578. doi: 10.1186/s12888-021-03588-2. PMID: 34789182. 

Parry, G., Crawford, M., & Duggan, C. (2016). Iatrogenic harm from psychological therapies – time to move on. British Journal of Psychiatry, 208(3), 210-212. doi:10.1192/bjp.bp.115.163618


Publications by John Hook & Dawn Devereux (formerly affiliated to the Clinic for Boundaries Studies)

Hook, J., & Devereux, D. (2018). Sexual boundary violations: Victims, perpetrators and risk reduction. BJPsych Advances, 24(6), 374-383. doi:10.1192/bja.2018.27

Hook, J., & Devereux, D. (2018). Boundary violations in therapy: The patient's experience of harm. BJPsych Advances, 24(6), 366-373. doi:10.1192/bja.2018.26

Papers by American Psychologist & Ethicist Ken Pope (

Pope, K. S. (1991). Dual relationships in psychotherapy. Ethics Behav, 1(1), 21-34.

Pope, K. S. (2015). Steps to strengthen ethics in organisations: research findings, ethics placebos, and what works. J Trauma Dissociation, 16(2), 139-152.

Pope, K. S., & Keith-Spiegel, P. (2008). A practical approach to boundaries in psychotherapy: making decisions, bypassing blunders, and mending fences. J Clin Psychol, 64(5), 638-652.

Pope, K. S., Simpson, N. H., & Weiner, M. F. (1978). Malpractice in outpatient psychotherapy. Am J Psychother, 32(4), 593-602.

Pope, K. S., & Vetter, V. A. (1992). Ethical dilemmas encountered by members of the American Psychological Association: a national survey. Am Psychol, 47(3), 397-411.

Pope, K. S., Levenson, H., & Schover, L. R. (1979). Sexual intimacy in psychology training: Results and implications of a national survey. American Psychol, 34(8), 682-689.

Pope, K. S. (1990a). Therapist-patient sex as sex abuse: Six scientific, professional, and practical dilemmas in addressing victimization and rehabilitation. Professional Psychology: Research and Practice, 21(4), 227-239. 102

Pope, K. S. (1990b). Response to Williams's comment. Professional Psychology - Research & Practice, 21(6), 421-423.

Professor David Nutt (UK neuropsychopharmacologist) 

Nutt DJ, Sharpe M. Uncritical positive regard? Issues in the efficacy and safety of psychotherapy. J Psychopharmacol. 2008 Jan;22(1):3-6. doi: 10.1177/0269881107086283. PMID: 18187527.

Professional Standards Authority for Health and Social Care (formerly Council for Healthcare Regulatory Excellence)

Safer care for all: Solutions from professional regulation and beyond.


Sexual Boundary Violations by Health Professionals: An Overview of the Published Literature

This literature review exploring sexual boundary violations by health professionals has lots of useful references, including the following: 

Armsworth, M. W. (1990). A qualitative analysis of adult incest survivors' responses to sexual involvement with therapists. Child Abuse & Neglect,14(4), 541-554.

Averill, S. C., Beale, D., Benfer, B., Collins, D. T., Kennedy, L., & Myers, J. et al. (1989)

Preventing staff-patient sexual relationships. Bulletin of the Menninger Clinic, 53(5), 384-393

Bachmann, K. M., Bossi, J., Moggi, F., Stirnemann Lewis, F., Sommer, R.,& Brenner, H. D. (2000). Nurse-patient sexual contact in psychiatric hospitals. Archives of Sexual Behavior, 29(4), 335-347. 

BenAri, A., & Somer, E. (2004). The aftermath of therapist-client sex: Exploited women struggle with the consequences. Clinical Psychology & Psychotherapy, 11(2), 126-136.

Benowitz, M. (1994). Comparing the experiences of women clients sexually exploited by female versus male psychotherapists. Women & Therapy, 15(1), 69-83.

Berkman, C. S., Turner, S. G., Cooper, M., Polnerow, D., & Swartz, M. (2000). Sexual contact with clients: Assessment of social workers' attitudes and educational preparation. Social Work, 45(3), 223-235.

Berland, D. I., & Guskin, K. (1994). Patient allegations of sexual abuse against psychiatric hospital staff. General Hospital Psychiatry, 16(5), 335-339.

Brown, H. (1994). Lost in the system: Acknowledging the sexual abuse of adults with learning disabilities. Care in Place, 1(2), 145-157.

Celenza, A. (1998). Precursors to therapist sexual misconduct: Preliminary findings. Psychoanalytic Psychology, 15(3), 378-395.

Coverdale, J. H., & Turbott, S. H. (1997). Teaching medical students about the appropriateness of social and sexual contact between doctors and their patients: Evaluation of a programme. Medical Education, 31(5), 335-340.

Coverdale, J., Bayer, T., Chiang, E., & Moore, C. (1996). Medical students' attitudes on specialist physicians' social and sexual contact with patients. Academic Psychiatry, 20(1), 35-42.

Davies, C. (1995) Gender and the professional predicament in nursing. Philadelphia: Open University Press. 

Dawson, E. M. (1994). Professional misconduct in psychiatry: Sexual behaviour with patients. A report of recent New South Wales findings.Australian & New Zealand Journal of Psychiatry, 28(2), 197-204.

Dehlendorf, C. E., & Wolfe, S. M. (1998). Physicians disciplined for sex related offenses. JAMA, 279(23), 1883-1888.

DeLozier, P. P. (1994). Therapist sexual misconduct. Women & Therapy,15(1), 55-67.

Disch, E., & Avery, N. (2001). Sex in the consulting room, the examining room, and the sacristy: Survivors of sexual abuse by professionals. American Journal of Orthopsychiatry, 71(2), 204-217.

Enbom, J. A., Parshley, P., & Kollath, J. (2004). A follow-up evaluation of sexual misconduct complaints: The Oregon board of medical examiners, 1998 through 2002. American Journal of Obstetrics & Gynecology, 190(6), 1642-1650.

Epstein, R. S., Simon, R. I., & Kay, G. G. (1992). Assessing boundary violations in psychotherapy: Survey results with the exploitation index. Bulletin of the Menninger Clinic, 56(2), 150-166.

Frueh, B. C., Knapp, R. G., Cusack, K. J., Grubaugh, A. L., Sauvageot, J. A., & Cousins, V. C. et al. (2005). Patients' reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services, 56(9), 1123-1133.

Gabbard, G. O. (1997). Lessons to be learned from the study of sexual boundary violations. Australian and New Zealand Journal of Psychiatry, 31(3), 321-327.

Garfinkel, P. E., Bagby, R. M., Waring, E. M., & Dorian, B. (1997). Boundary violations and personality traits among psychiatrists. Canadian Journal of Psychiatry - Revue Canadienne De Psychiatrie, 42(7), 758-763.

Garrett, T. (1998). Sexual contact between patients and psychologists. The Psychologist, 11(5), 227-230. 

Gartrell, N., Herman, J., Olarte, S., Feldstein, M., & Localio, R. (1987). Reporting practices of psychiatrists who knew of sexual misconduct by colleagues. American Journal of Ortho- psychiatry, 57(2), 287-295.

Gartrell, N., Herman, J., Olarte, S., Feldstein, M., & Localio, R. (1986). Psychiatrist-patient sexual contact: Results of a national survey. I: Prevalence. American Journal of Psychiatry, 143(9), 1126-1131.

Gartrell, N., Herman, J., Olarte, S., Localio, R., & Feldstein, M. (1988). Psychiatric residents' sexual contact with educators and patients: Results of a national survey. American Journal of Psychiatry, 145(6), 690-694.

Gartrell, N. K., Milliken, N., Goodson, W. H.,3rd, Thiemann, S., & Lo, B. (1992). Physician-patient sexual contact. prevalence and problems. Western Journal of Medicine, 157(2), 139-143.

Gartrell, N. K., & Sanderson, B. E. (1994). Sexual abuse of women by women in psychotherapy: Counseling and advocacy. Women & Therapy, 15(1), 39-54.

Gorton, G. E., Samuel, S. E., & Zebrowski, S. M. (1996). A pilot course for residents on sexual feelings and boundary maintenance in treatment. Academic Psychiatry, 20(1), 43-55.

Goodyear, R. K., & Shumate, J. L. (1996). Perceived effects of therapist self-disclosure of attraction to clients. Professional Psychology: Research and Practice, 27(6), 613-616.

Grunebaum, H. (1986). Harmful psychotherapy experience. American Journal of Psychotherapy, 40(2), 165-176.

Haas, L. J., Malouf, J. L., & Mayerson, N. H. (1986). Ethical dilemmas in psychological practice: Results of a national survey. Professional Psychology - Research & Practice, 17(4), 316-321.

Harper, K., & Steadman, J. (2003a/b). Therapeutic boundary issues in working with childhood sexual-abuse survivors. American Journal of Psychotherapy, 57(1), 64-79.

Harris, A. H. (2001). Incidence of critical events in professional practice: A statewide survey of psychotherapy providers. Psychological Reports, 88(2), 387-397.

Herman, J. L., Gartrell, N., Olarte, S., Feldstein, M., & Localio, R. (1987). Psychiatrist-patient sexual contact: Results of a national survey, II: Psychiatrists' attitudes. American Journal of Psychiatry, 144(2), 164-169.

Hetherington, A. (2000). A psycho-dynamic profile of therapists who sexually exploit their clients. British Journal of Psychotherapy, 16(3), 274-286.

Hoencamp, E. (1990). Sexual abuse and the abuse of hypnosis in the therapeutic relationship. International Journal of Clinical & Experimental Hypnosis, 38(4), 283-297.

Holroyd, J. C., & Brodsky, A. M. (1977). Psychologists' attitudes and practices regarding erotic and nonerotic physical contact with patients. American Psychologist, 32(10), 843-849.

Housman, L. M., & Stake, J. E. (1999). The current state of sexual ethics training in clinical psychology: Issues of quantity, quality, and effectiveness.Professional Psychology - Research & Practice, 30(3), 302-311. 

Jackson, H., & Nuttall, R. L. (2001). A relationship between childhood sexual abuse and professional sexual misconduct. Professional Psychology: Research and Practice, 32(2), 200-204.

Jacobson, A., & Richardson, B. (1987). Assault experiences of 100 psychiatric inpatients: Evidence of the need for routine inquiry. American Journal of Psychiatry, 144(7), 908-913.

Kardener, S. H., Fuller, M., & Mensh, I. N. (1973). A survey of physicians' attitudes and practices regarding erotic and nonerotic contact with patients. American Journal of Psychiatry, 130(10), 1077-1081.

Kluft, R. P. (1990). Dissociation and subsequent vulnerability: A preliminary study. Dissociation: Progress in the Dissociative Disorders, 3(3), 167-173.

Kullgren, G., Jacobsson, L., Lynoe, N., Kohn, R., & Levav, I. (1996). Practices and attitudes among Swedish psychiatrists regarding the ethics of compulsory treatment. Acta Psychiatrica Scandinavica, 93(5), 389-396.

Ladany, N., O'Brien, K. M., Hill, C. E., Melincoff, D. S., Knox, S., & Petersen, D. A. (1997). Sexual attraction toward clients, use of supervision, and prior training: A qualitative study of predoctoral psychology interns. Journal of Counseling Psychology, 44(4), 413-424. 

Lamb, D. H., & Catanzaro, S. J. (1998). Sexual and nonsexual boundary violations involving psychologists, clients, supervisees, and students: Implications for professional practice. Professional Psychology: Research and Practice, 29(5), 498-503.

Lamb, D. H., Catanzaro, S. J., & Moorman, A. S. (2003). Psychologists reflect on their sexual relationships with clients, supervisees, and students: Occurrence, impact, rationales and collegial intervention. Professional Psychology: Research and Practice, 34(1), 102-107.

Lamb, D. H., Strand, K. K., Woodburn, J. R., & Buchko, K. J. (1994). Sexual and business relationships between therapists and former clients. Psychotherapy: Theory, Research, Practice, Training, 31(2), 270-278.

 Langevin, R., Glancy, G. D., Curnoe, S., & Bain, J. (1999). Physicians who commit sexual offenses: Are they different from other sex offenders? Canadian Journal of Psychiatry, 44(8), 775-786.
Leggett, A. (1994). A survey of Australian psychiatrists' attitudes and practices regarding physical contact with patients. Australian & New Zealand Journal of Psychiatry, 28(3), 488-497.


Luepker, E. T. (1999). Effects of practitioners' sexual misconduct: A followup study. Journal of the American Academy of Psychiatry & the Law, 27(1),51-63. 

Matthias, R., & Benjamin, A. (2003). Abuse and neglect of clients in agency based and consumer-directed home care. Health Social Work, 28, 174-184.

Mattison, D., Jayaratne, S., & Croxton, T. (2002). Client or former client? implications of ex-client definition on social work practice. Social Work, 47(1), 55-64.

Meek, K. R., McMinn, M. R., Burnett, T., Mazzarella, C., & Voytenko, V. (2004). Sexual ethics training in seminary: Preparing students to manage feelings of sexual attraction. Pastoral Psychology, 53(1), 63-79.

Nickell, N. J., Hecker, L. L., Ray, R. E., & Bercik, J. (1995). Marriage and family therapists' sexual attraction to clients: An exploratory study. American Journal of Family Therapy, 23(4), 315-327.

Norris, D. M., Gutheil, T. G., & Strasburger, L. H. (2003). This couldn't happen to me: Boundary problems and sexual misconduct in the psychotherapy relationship. Psychiatric Services, 54(4), 517-522. 

Parsons, J. P., & Wincze, J. P. (1995). A survey of client-therapist sexual involvement in Rhode Island as reported by subsequent treating therapists. Professional Psychology - Research & Practice, 26(2), 171-175.

Powers, L., Curry, M., Oschwald, M., & Maley, S. (2002). Barriers and strategies in addressing abuse: A survey of disabled women's experiences. Journal of Rehabilitation, 68, 4-13.

Robinson, G. E., & Stewart, D. E. (1996). A curriculum on physician-patient sexual misconduct and teacher-learner mistreatment. part 2: Teaching method. CMAJ Canadian Medical Association Journal, 154(7), 1021-1025.

Rodolfa, E., Hall, T., Holms, V., & Davena, A. (1994). The management of sexual feelings in therapy. Professional Psychology: Research and Practice, 25(2), 168-172.

Russell, J. (2003). Issues of sexual abuse and violation within the counselling relationship. Chapter in rape crisis/ MACSAS (2003) A breach of trust: Sexual abuse of adults by professionals and the clergy. Galway, Ireland: Rape Crisis Network. 

Salisbury, W. A., & Kinnier, R. T. (1996). Post-termination friendship between counselors and clients. Journal of Counseling & Development, 74(5), 495-500.


Samuel, S. E., & Gorton, G. E. (1998). National survey of psychology internship directors regarding education for prevention of psychologist patient sexual exploitation. Professional Psychology: Research and Practice, 29(1), 86-90.

Seto, M. C. (1995). Sex with therapy clients: Its prevalence, potential consequences, and implications for psychology training. Canadian Psychology, 36(1), 70-86.

Shavit, N., & Bucky, S. (2004). Sexual contact between psychologists and their former therapy patients: Psychoanalytic perspectives and professional implications. American Journal of Psychoanalysis, 64(3), 229-248.

Sobsey, R. (1994). Violence and abuse in the lives of people with disabilities. Baltimore: Paul H. Brookes. 
Somer, E., & Nachmanil, I. (2005). Constructions of therapist-client sex: A comparative analysis of retrospective victim reports. Sexual Abuse: Journal of Research & Treatment, 17(1), 47-62.


Somer, E., & Saadon, M. (1999). Therapist-client sex: Clients' retrospective reports. Professional Psychology: Research and Practice, 30(5), 504-509.

Spickard, A., Swiggart, W. H., Manley, G., & Dodd, D. (2002). A continuing education course for physicians who cross sexual boundaries. Sexual Addiction & Compulsivity, 9(1), 33-42.

St. Germaine, J. (1996). Dual relationships and certified alcohol and drug counselors: A national study of ethical beliefs and behaviors. Alcoholism Treatment Quarterly, 14(2), 29-44.

Thoreson, R. W., Shaughnessy, P., & Frazier, P. A. (1995). Sexual contact during and after professional relationships: Practices and attitudes of female counselors. Journal of Counseling & Development, 74(1), 84-89.

Thorn, B. E., Shealy, R. C., & Briggs, S. D. (1993). Sexual misconduct in psychotherapy: Reactions to a consumer-oriented brochure. Professional Psychology - Research & Practice, 24(1), 75-82.

Tomita, S. K. (1990). The denial of elder mistreatment by victims and abusers: The application of neutralization theory. Violence and Victims, 5(3), 171-184. 

Twemlow, S. W. (1997). Exploitation of patients: Themes in the psychopathology of their therapists. American Journal of Psychotherapy, 51(3), 357-375.

Walfish, S. (1983). Crisis telephone counselors' views of clinical interaction situations. Community Mental Health Journal, 19(3), 219-226.

White, G. E. (2004). Setting and maintaining professional role boundaries: An educational strategy. Medical Education, 38(8), 903-910.

White, G. E. (2003). Medical students' learning needs about setting and maintaining social and sexual boundaries: A report. Medical Education, 37(11), 1017-1019.

Wilbers, D., Veenstra, G., van de Wiel, H. B., & Weijmar Schultz, W. C. (1992). Sexual contact in the doctor-patient relationship in the Netherlands. BMJ, 304(6841), 1531-1534.

Williams, M. (1990). Comment on Pope (1990). Professional Psychology -Research & Practice, 21, 420-421. 

Wincze, J. P., Richards, J., Parsons, J., & Bailey, S. (1996). A comparative survey of therapist sexual misconduct between an American state and an Australian state. Professional Psychology - Research & Practice, 27(3), 289-294

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