As a regular reader of Acupuncture Today, I was shocked and angered by Dr. Felice Dunas' July 2008 column, "When Sex Infiltrates the Treatment Room." Although I appreciate the fact that AT and Dr. Dunas are attempting to address clinical boundary issues between providers and patients, the July article is outrageous for condoning the actions of a male patient who ejaculated during an acupuncture session.
Dr. Dunas' response to this incident was to turn it into an educational moment for the patient by describing the energetics of TCM and confirming that she will not date the patient. This is outrageous and irresponsible.
Yes, patients will present in clinical practice with pathological behaviors. This does not mean the behaviors are to be condoned, tolerated or brushed off. For practitioners, these behaviors are psychologically difficult to experience. In addition, promoting an atmosphere of tolerance with a grossly inappropriate client only places providers at further physical risk when a client's behaviors continue to escalate.
Furthermore, the tone of Dunas' article comes dangerously close to suggesting that her own boundaries are not clear-cut. Specifically, a patient who behaves in a sexually inappropriate manner does not constitute an opportunity for patient education. It is imperative for a provider to have expressly clear and uncompromising boundaries when a patient is demonstrating poor boundaries and inappropriate behavior. This includes immediate discharge from care.
In addition, Dunas' failure to delineate a clear and appropriate response places her at risk in regulatory and legal venues should such a patient choose to legally act against her. A provider who continues a therapeutic relationship with a sexually inappropriate client is not following professional standards of care. Providers can best protect themselves by proactively discharging a patient after experiencing threats from the patient, including sexual misconduct.
I believe the July article does a disservice to AOM professionals and does not describe appropriate standards of professional conduct. I would encourage Dr. Dunas to either seek training in professional ethics so she can write about a well-established standard of practice when it comes to clients who are actively inappropriate or, short of this, immediately cease and desist with her current level of "advice."
Terry Courtney, MPH, LAc Dean, School of Acupuncture and Oriental Medicine, Bastyr University
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