Professional Boundary Violations and Mentalizing in the Clergy

Holly Crisp-Han, MD Glen O. Gabbard, MD

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

History

Introduction

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

Introduction

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

Introduction

• • Burnout, health problems, stress Similar to other helping professions

Introduction

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

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

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

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

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

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

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

Evaluations: Method

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

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

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

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%

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%

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%

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

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

Discussion

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

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

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

Contact information

• • Glen Gabbard [email protected]

Holly Crisp-Han [email protected]