Would you accept: (a) a handshake, (b) a lift, (c) a drink from a patient? Perhaps in a multiple-choice ethics examination you might avoid giving the impression that you were embarking on the famous ‘slippery slope’. In real life, you might be somewhat puzzled at these situations having become apparently ‘problematised’. Yet this is apparently the case for psychiatrists in the USA, following the extensive focus on boundary violations, with sexual misconduct being the most serious. In the view of the authors, the concept of the slippery slope has given rise to extensive constraints and fear of legal action or professional complaints, deriving more from overzealous risk management than the good of the patient.

Gutheil & Brodsky derive their thinking and material from hours of discussion over many years at the Program in Psychiatry and the Law at Harvard Medical School. Their expertise is evident. The chapter on self-disclosure is particularly helpful in inducing reflection and considering wider options than in Britain, where they tend to range only from ‘disclose nothing personal under any circumstances’ to non-discussion and personal idiosyncrasy. Psychiatrists, used to asking the questions, may be taken aback by a more ‘equal’ approach and being asked ‘Tell me, doctor, are you gay?’ or ‘Do you find me sexually attractive?’, though ‘Do you have children?’ is not uncommon. Sometimes, honesty and straightforwardness is best, sometimes asserting that the question is ‘not part of therapy’, sometimes reversing the question by replying, for instance, ‘What would it mean to you if I did find you sexually attractive, or if I did not?’ The ethical standard recommended is that the response should be for the benefit of the patient.

Encounters in the community may be tricky. Therapists are advised that attending a patient's funeral is usually all right, as it may be appreciated by the bereaved family. On the other hand, attending a wedding has potential pitfalls – one might be asked to dance with one's patient or be perceived as trying to drum up custom on the basis of success.

Gutheil & Brodsky are clearly most used to transference-based analytic work in private office practice and their references to community and hospital psychiatry or other forms of therapy are brief and artificial, though an attempt is made. In the UK we have been slow to realise the extent of professional abuse of patients and give serious consideration to boundary issues, yet it is evident that remedies will depend so much on context that books such as this one almost require translation.