Professional Boundary Violations and Mentalizing in the Clergy

Holly Crisp-Han, MDGlen 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

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

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• Automatic pilot, despair• Decreased sense of calling

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

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 violationsNonsexual 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 othersExamples 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 Gabbardglengabbard@thegabbardcenter.com

• Holly Crisp-Hanhollycrisphan@thegabbardcenter.com