Behavioral Medicine Institute, Professional Sexual Misconduct, 27-30 October

The Behavioral Medicine Institute (BMI) of 1401 Peachtree St Atlanta was established by Dr Gene Abel MD, it's Medical Director.

BMI specializes in the treatment of sexual problems, disruptive behaviors, and medical and psychological problems. The key areas of work are Professional Sexual Misconduct (PSM), Disruptive Professionals, Sexual Addictions, Sex Offenders, Behavioral Medicine, Sexual Dysfunction and Sexual Harassment.

BMI provides three core services related to PSM - evaluation, treatment and monitoring. The clinic is staffed by a registered nurse, and licensed professional counsellor and two doctors.

Over three days I was able to experience a range of elements of the Professional Sexual Misconduct work, including individual evaluations, a range of groups and staff meetings, and meetings with individual staff members. The oft repeated motto of the programme is 'Secrets Keep You Sick'.

The programme centres on groups covering:

• Sexual Boundaries - law and rules
• Anger Management - a spectrum of behaviours considered, from irritation through to homicidal feelings
• Assertiveness - as opposed to agreession or passivity
• Cognitive Restructuring
• Victim Empathy
• Aversion Therapy
• Sex Addiction
• Relapse Prevention
• Intimacy - Successful relationships
• Personality

In addition there are one to one sessions and use of polygraphy (lie detector). Four core books are provided for participants 'Why Marriages Succees or Fail by John Gottman; 'The 9-5 Guide to Combating Sexual Harassment' by Ellen Bravo, Ellen Cassedy; 'Anger & Men - Understanding and managing Your Anger by Murray Cullen, Robert E. Freeman; the Sex Addiction Workbook, by Sbraga, Ph.D. and O'Donohue, Ph.D.

Below I summarise sessions that I sat in on , but the write up should not be taken as a comprehensive description of the whole programme.

Throughout the session the notion that the power differential between practitioner and patient is central and never disappears. Participants need to show that they have had an attitude change, a learning improvement and to show the evidence for this.

Psychologist Markus Wiegel Phd described the programme as covering three areas:

1. Thoughts - worked with through Cognitive Re-structuring
2. Feelings/Urges - through Aversion Therapy
3. Behaviours - through Relapse Prevention
   

Sitting in on an evaluation by Dr Abel I noted some key issues. At one point he said "I want you to return to practice but I won't jeopardise the safety of patients" which in my mind summarised the overall approach and aim of BMI's work. Another comment I noted, in talking about the truthfulness of people on the course, "The polygraph never sleeps"".

The victim empathy component to the PSM programme includes viewing a film (My Doctor, My Lover) and writing up a report on the feelings of the patient, the doctor and the treating psychiatrist. Patients also have to write letters to themselves as though from their patient, or their wife, or anyone who has been affected. Donna Valentine LPC who directs the session defines victim as "anyone for whom there were consequences as a result of [the perpetrators] actions".  Report and letters are then read out in a group and there is feedback from Donna and from the other patients. Donna is especially looking for evidence that participants can put themselves in the shoes of others and over time to develop a good understanding of the harm that they have caused.  The group I sat in on identified staff, other patients, family members of clinician and patient, the community at large and even the regulatory board itself as being victims of their behaviour under this definition. Interestingly, those who objected to the word 'victim' easily accepted the discussion once Donna had provided the definition.

The aversion therapy component involves first going through ten sessions where they dictate into a tape recorder their thoughts and feelings when they contemplate approaching a patient for flirting, then breaking an ammonia capsule and breathing in the fumes. They then describe how this makes them feel, and the tape is critiqued in the next group session and the client is given feedback. After this ten they do a further twenty which replace ammonia with a 'switch' technique whereby they turn their thoughts to the dire consequences of following through on their desires eg 'my wife has left me', 'I cannot practice any longer'.  Towards the end of this strand of work they learn to put affirming thoughts in place 'I am still married, I have a thriving practice' and so forth.

Cognitive restructuring includes looking at Cognitive Distortions which Dr Wigel simplifies by defining it as 'excuses', as a 'thought process that makes it acceptable [to the individual] to move lines [boundaries]' and as 'an innacurate thought'. Distortions may be made before, during and after a particular action and typically take many forms, three of which are:

• Minimisation - it wasn't that bad
  
• Rationalisatioin - an after the fact justification
  
• Denial - I didn't do it
  

The process for changing inaccurate thoughts has four stages:

1. Hypothesis - what is the thought
   
2. Examine the evidence
3. Decide of it is accurate
4. Replace with a more accurate and more helpful thought

Dr Abel has completed extensive outcome  studies and reports a success rate, measured against recidivism, of 99%.

 Waiting room BMI