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Professional Boundary Violations and Mentalizing in the Clergy

Professional Boundary Violations and Mentalizing in the Clergy. Holly Crisp-Han, MD Glen O. Gabbard , MD. Background.

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Professional Boundary Violations and Mentalizing in the Clergy

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  1. Professional Boundary Violations and Mentalizing in the Clergy Holly Crisp-Han, MDGlen O. Gabbard, MD

  2. Background • “Professional Boundary Violations and Mentalizing Problems in the Clergy”; Holly Crisp-Han, Glen O. Gabbard, Melissa Martinez. Journal of Pastoral Care and Counseling, 2011 • Types of problems referred for evaluation • 70 Episcopal Priests • Universality of problems in clergy—similar to other denominations and religions

  3. History • The Menninger Clinic 1988-2001 • Baylor Psychiatry Clinic 2001-2011 • The Gabbard Center 2011--

  4. Introduction • Clergy face many stressors • 24 hour availability • Function in many roles: pastor, counselor, mediator, preacher, accountant, CEO, friend, surrogate parent • “Impossible job”

  5. Introduction • Technology increases the pressure on clergy to be available 24 hours a day • Difficulty taking vacations • Clergy and church responsibilities on the weekends

  6. Introduction • Burnout, health problems, stress • Similar to other helping professions • Automatic pilot, despair • Decreased sense of calling

  7. Introduction • Depression, anxiety, substance use, marital or relationship problems • Can sometimes lead to boundary crossings and violations • Systemic issues in the congregation—challenges of managing multiple expectations and conflicts

  8. Boundary Violations • Too facile to view them as “bad pastors” • Often mulitfactorial interplay among personality characteristics, psychiatric disorders, disinhibiting influence of substances, systemic problems of congregation, overwork, adult developmental crises, stressors with spouse/partner, incomplete education re: power differential, boundaries, and the role of idealization

  9. Boundary Violations • Qualities of those who transgress boundaries • Like other helping professionals—physicians, therapists • Some are true predators with antisocial features and little remorse • The majority are complex and defy simple categorization—narcissism can co-exist with highly moral, perfectionistic, conscientious, altruistic and self-sacrificing traits

  10. Unique Features of Priests • Idealization in priest/parishioner relationships, Godlike transference • Parental expectations transferred to the minister • Overlap of personal and professional • Life under constant scrutiny

  11. Gender • Ministers predominantly male in the past, now increasingly more female; priests/ministers in some faith traditions, but not in others • Gender dynamics in the church • Gender issues in boundary violations

  12. Mentalizing • Concept out of attachment theory • Jon Allen, Anthony Bateman, Peter Fonagy • Capacity to place one’s mind in the mind of another and imagine his or her perspective • To understand one’s own and other’s thinking and behavior is motivated by internal states, feelings, and assumptions

  13. Mentalizing • Our team has observed how problems in mentalizing—certain difficulties in thinking about self and other—are part of the picture in professional boundary violations • Not confined to one psychiatric condition or type of personality

  14. Mentalizing • Problems in mentalizing may affect one’s ability to relate smoothly in interpersonal situations • Have difficulty understanding how they come across to others • Necessity in the clergy to be constantly aware of self and other • Intent vs. impact

  15. Evaluations: Method • 3 day multidisciplinary evaluations: professionals, others with complex treatment problems • Psychiatrists, social worker, psychologist, collateral information

  16. Evaluations: Method • Began at Menninger Clinic late 80s • 2001 Baylor Psychiatry Clinic • 2011 The Gabbard Center • Many clergy evaluated from different traditions • Paper reviewed 70 Episcopal Priests

  17. Evaluations: Method • Checklist of gender, age, marital/partner status, ethnicity, position, work, referral source • Psychiatric diagnosis: Axis I and II (disorders and traits) • Substance abuse • Boundary violations • Mentalizing problems

  18. Results: Demographics • 81% male • 19% female • Mean age 51.39 • 80% married or partnered • Ethnicity: • 91.4% Caucasian • 7.1% Black • 1.4%% Hispanic • Referral source • Diocese 42.9% • Pension fund 37.1% • Psychiatrist/therapist 2.9% • Self 1.4% • Seminary 1.4% • Work status • Working 31% • Disability 26% • Not working 43%

  19. Results: Psychiatric Diagnosis • Substance Abuse? Yes 17.1%, No 82.9% • Axis I Diagnosis? Yes 82.9%, No 17.1% • Mood disorders: 55.7% • Anxiety disorders: 11.4% • Cognitive disorders: 11.4% • Sexual disorders: 2.9%

  20. Results: Psychiatric Diagnosis • Axis II Personality Disorders? • Yes 42.9% • No 10% • Personality traits that fall short of true disorder 47.1% • Specific Personality disorders (% of total sample) • Personality disorder NOS (mixed) 31.4% • Narcissistic personality disorder 10% • Obsessive-compulsive personality disorder 1.4%

  21. Results: Boundary Violations • Boundary Violations • Yes 44.3% • No 55.7% Includes both sexual and nonsexual violations Nonsexual violations highly varied: inappropriate physical or emotional relationships with parishioners, intimate emails, hugging, kissing, violations of confidentiality, financial violations including personal use of church funds

  22. Results: Mentalizing Problems • Mentalizing Problems • Yes 72.9% • No 27.1% Difficulty understanding how their behavior or comments affected others Examples of conflicts with parishioners or coworkers in which comments were perceived as demeaning, arrogant, aggressive or threatening Lack of awareness of the power differential and transference issues

  23. Discussion

  24. Discussion: Education, Prevention • Education about clergy stressors and mental health, boundary violations • Seminary education: concept of professional boundaries, power differential, the path from nonsexual to sexual boundary violations • Continuing Education • Decreasing isolation: colleague consultation, small groups

  25. Discussion: Response • After a boundary violation, church response to address needs of those victimized, the priest, and broader congregation • Can be devastating • Scapegoating of victim or priest vs. doing nothing • Support from diocese or broader religious authority

  26. Discussion: Response • When necessary, psychiatric evaluation with expert in this area • Recommendations may emerge: • psychotherapy, specific focus or type • couples’ therapy • treatment of any primary psychiatric condition such as depression or anxiety • substance treatment • structural changes in the work setting • education re: boundaries and mentalizing • insight into traits that cause difficulty • consultant with organizational expertise for the priest and other religious leaders • disability issues • Legal consequences or ecclesiastical discipline in some cases

  27. Contact information • Glen Gabbard glengabbard@thegabbardcenter.com • Holly Crisp-Han hollycrisphan@thegabbardcenter.com

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