[Improving prevention of sexual abuse by therapists during ongoing psychotherapeutic or psychiatric treatment].

OBJECTIVES: This interdisciplinary paper reports on the literature on sexual abuse in psychotherapy and on a case of unwanted sexual advances by a therapist toward his patient. Measures to help prevent such cases are discussed from a lawyer's (first author) and a medical psychotherapist's (second author) point of view. OVERVIEW OF THE LITERATURE: In psychotherapeutic practice, the borders of the therapeutic relationship are frequently not clear and sexual abuse of patients by psychotherapists also occurs in Germany. CASE REPORT: The reported case illustrates that under current German Criminal Code ( section sign section sign 174 c Abs.2, 181 f. Nr. 2 StGB) patients are protected by law against unwanted sexual advances by a therapist. However, physical examination by the therapist while the patient is undergoing psychotherapy may provide unscrupulous therapists with the opportunity to dismiss accusations of unwanted sexual advances as legitimate physical examinations. Thus they could further victimize patients in legal suits since due to the principle of innocent until proven guilty, it is difficult for prosecutors to prove a case. DISCUSSION: To improve patients' rights and the standards of practice, the first author suggests legal prohibition of simultaneous psychotherapeutic treatment and physical examinations/treatment by the same doctor. He suggests that a referral to a consulting physician for any physical examination deemed necessary should become the standard practice, thus also providing added protection to any doctor involved against false accusations of misconduct. The second author discusses critically whether such a prohibition would truly protect the patients. She concludes that simultaneous medical and psychotherapeutic treatment of a patient by the same physician should be thoroughly thought through by the physician, but comes to the conclusion that in some cases a combined medical and psychotherapeutic treatment seems appropriate. Instead of a general prohibition she suggests improved information and education for patients and psychotherapists as well as better use of the already existing legal possibilities.