Professional Boundary Violations
and Mentalizing in the Clergy
Holly Crisp-Han, MD
Glen O. Gabbard, MD
• “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
• Clergy face many stressors
• 24 hour availability
• Function in many roles: pastor, counselor,
mediator, preacher, accountant, CEO, friend,
surrogate parent
• “Impossible job”
• Technology increases the pressure on clergy to
be available 24 hours a day
• Difficulty taking vacations
• Clergy and church responsibilities on the
• Burnout, health problems, stress
• Similar to other helping professions
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,
• 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
• Overlap of personal and professional
• Life under constant scrutiny
• 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
• 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
• 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
• Problems in mentalizing may affect one’s
ability to relate smoothly in interpersonal
• 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
• 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
• Paper reviewed 70 Episcopal Priests
Evaluations: Method
• Checklist of gender, age, marital/partner
status, ethnicity, position, work, referral
• 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: 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
• Support from diocese or broader religious
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
– 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]

psychot x and faith 2011final Gabbard - ISH-TMC