Ethics and Patient-Therapist Sexual Contact

acting from an apriori position rather than responding to the present need of the patient. Those who throw the stones which Masson [ 1 I ] has provided against the psychoanalytic establishment should beware of his friend Breggin, whose To,uic Psychiatry is an indictment of psychiatric practice in general. Of interest for this discussion is Breggin’s description of the Harvard-Radcliffe Mental Hospital Volunteer Program, in which untrained but supervised college students sustained great success over a number of years in helping backward patients achieve discharge. “Make him feel that he is important to you, the worker” [ 121. This is the most general of noble precepts but one which requires sensitive specific application and sincerity more than technical training. The mischief at the end of Andrews’ address is that he recommends reducing the emphasis on dynamic psychotherapy in the training of psychiatrists. The implication is that psychotherapy supervision, a hallmark of Australian training, might be dropped. This is perplexing in that he has just acknowledged of the dynamic psychotherapies that “perhaps one of their greatest strengths is that they train doctors to have the patience and the theoretical interest in working with a disturbed patient year after years, using the factors common to all successful therapies (crisis resolution, empathy, support, non-possessive warmth and kindly advice) to encourage healthy behaviours and minimise damage.” Incidentally, this is an impressive list of placebos to encounter “while waiting for natural remission to occur”. I suspect that the methodology has not yet been developed to discriminate all these factors, though I would not doubt somk protocols aim in that direction. Likewise those on waiting lists for treatment do not live in a vacuum. A refined methodology would scan for such contaminants as fortunate marriages, caring homosexual partners, tolerant prison warders and motherly sergeant-majors. Despite the irony, I take my hat off to the industry of colleagues labouring to devise scientific methods appropriate to this uniquely complex subject matter. For some years yet, however, I think it will remain the way of realism to view psychotherapy as a difficult art whose practitioners have had some training in science.