Houston

Monday and Tuesday I spent time with Cindy Boling, President of Advocateweb and an experienced and passionate advocate for victims and educator of professionals. She is dealing with huge pressure to support victims and survivors with almost no income and no other staff. Whilst driving around town and visiting the Rothko Chapel we talked extensively about programmes for boundary violating practitioners and how the victim empathy component can work. Cindy delivers this section at the PBI Inc courses and focuses on victim needs, impact and empathy. This will need to be a central part of any new course that we develop in the UK.  Cindy has seen good and bad approaches taken by regulatory councils, called 'boards' in the US. Some, like the Podiatry Board in Texas, have been excellent, bringing in Cindy to help write effective codes and genuinely listening to victims.  Others have needed, and still need, education about how to see the issue, moving away from treating victims as though they were jilted lovers.   The PBI programme consists of a structured approach, with clearly laid out workbooks for each person, and a follow up personal accountability plan.

Dinner with Glen Gabbard,  Brown Foundation Professor of Psychoanalysis & Professor Director, Baylor Psychiatry Clinic, on Monday - as well as being a charming host, he also has huge experience and knowledge, from his perspective as an evaluator of offending professionals. He and his team see around 75 to 80 professionals each year, providing an intensive three day evaluation, which includes full history, review of board papers and psych tests, by three diffeerent psychiatrists.  On his team are also social workers and psychologists who all have a role to play in the evaluation. This is then turned into a report with recommendations, with the split of safe and not safe to practice recommendations being about 50% each way.  The report, which is open to the individual, then goes to the board, or other referring agent. For those thought to be open to rehabilitation there is usually a recommendation for long-term supervision, with restrictions on practice, obligation to attend therapy and close monitoring by peers.  Over here some element of this would be overseen by a Physicians Health Programme, which exist in most states.

The majority of people he sees would have diagnosable psychiatric conditions, very commonly some variation of personality disorder.  'Treatment' often needs to consist of confronting denial, usually of the breach of trust and harmful effects - with many believing that, whilst this kind of thing would be of concern if it was one of thier juniors, it isn't for them as they can handle it, or are experienced enough to do so.

Both Cindy and Glen concur that many, but by no means all, practitioners are open to rehabiliation.