The Exploitation Index: an early warning indicator of boundary violations in psychotherapy

Bull Menninger Clin. 1990 Fall;54(4):450-65.


Exploitive behavior by therapists is highly disruptive in psychotherapy because it violates the sense of trust derived from a coherent treatment boundary. Such behavior may be difficult to detect because it is often associated with self-deception. The compensatory need to feel "special," a state of mind often associated with exploitiveness, suggests that narcissistic mechanisms play a significant role. The authors present an "Exploitation Index" (EI), a self-assessment questionnaire for therapists that is designed to serve as an early warning indicator of boundary violations.

MeSH terms

  • Ethics, Medical*
  • Humans
  • Narcissism
  • Personality Tests
  • Physician-Patient Relations*
  • Psychotherapy / methods*