Under section 196 of the Health Practitioner National Law (Victoria) Act 2009 the Tribunal finds that:

From mid-February 2012, IVX, while working as a psychologist, engaged in conduct constituting professional misconduct in that he engaged in an intimate personal relationship with Client A, a client he had been treating since August 2011 and whose final consultation was 6 February 2012, and whom he knew to be vulnerable to emotional and physical exploitation, in circumstances where:

1.1 At the time the relationship commenced, Client A was yet to be referred to an alternate psychologist;

1.2 At the time the relationship commenced, Client A had not been formally discharged back to the general practitioner who had referred her to IVX;

1.3 At the time the relationship commenced, IVX had taken no or insufficient steps to ensure Client A had received independent advice about entering into the intimate personal relationship; and

1.4 At the time the relationship commenced, IVX had not sought supervision from a peer regarding his decision to enter the intimate personal relationship.

1. IVX is reprimanded.
2. IVX's registration as a psychologist is suspended for 9 months from 10 March 2016.
3. During the period of suspension, IVX is to undertake a minimum of 10 hours of further mentoring and/or education to the satisfaction of the Psychology Board of Australia. Such mentoring and/or education is to be provided by a psychologist or mentor nominated by the Psychology Board of Australia and is to be at the expense of IVX. The mentoring and/or education is to include the areas of boundaries and multiple relationships, including how power imbalances may manifest in the dynamics of transference and counter-transference in therapeutic relationships.
4. IVX and the psychologist/mentor are each to report to the Psychology Board of Australia in writing on the mentoring and/or education undertaken and what has been learned, at three months and six months.
5. Following resumption of registration, IVX is to undertake professional supervision for a period of 12 months at fortnightly intervals. The supervision is to include the dynamics of transference and counter-transference in therapeutic relationships. IVX and the supervisor, who is to be approved by the Psychology Board of Australia and is not to be any previous supervisor of IVX, are each to report to the Psychology Board of Australia on the supervision undertaken and IVX's development of skills and further understanding, at six months and 12 months.

1. In November 2014, the Psychology Board of Australia referred allegations to the Tribunal about the conduct of the respondent psychologist. The allegations concern a relationship the psychologist formed with a vulnerable young woman, close to the time he terminated their professional relationship. She had been referred to IVX by her general practitioner with a history of abuse, depression and self-harm. She had 11 counselling sessions with him between August 2011 and 6 February 2012.
2. In brief summary, on a number of occasions in early to mid-February 2012, the psychologist visited her business, which was a tattoo parlour. She tattooed him and a friendship developed. She asked if he had room for a boarder as she had been asked to move out of her father's house. IVX agreed. She moved into his house. Very soon after, an intimate personal relationship developed and they have lived together since.
3. The Board originally alleged that the psychologist engaged in a sexual relationship with the client during the professional relationship and\or within two years of terminating the professional relationship. The psychologist had been adamant at all times that they did not intend to have sexual intercourse for at least two years and not before marriage.
4. On the first day of hearing, the parties advised us that they were close to reaching agreement about the facts, and the appropriate characterisation of the psychologist's conduct. We gave them time to conclude their discussions.
5. When the hearing resumed, the parties provided us with a statement of agreed facts, set out below, and their proposed agreed findings, which we were satisfied were appropriate and made in the terms proposed. The proposed agreed findings were in essence that the psychologist had engaged in conduct constituting professional misconduct in that he had engaged in an intimate personal relationship with the client from a time, mid-February 2012, shortly after his final consultation with her on 6 February 2012.
6. The parties did not agree to make a joint submission on the appropriate determination. Counsel for the Board submitted that as well as other orders, a suspension of 1 to 2 years was warranted. Counsel for the psychologist submitted that suspension should not be a starting point, and that any suspension should be only for a short period.
7. These reasons focus on what orders ought to now be made. We have taken into account the materials filed by both parties including affidavit evidence and character references. We heard evidence from the supervisor IVX engaged in 2012 and submissions on behalf of both parties.
8. Although we did not characterise the psychologist's conduct in this case as predatory, we consider that he showed an astonishing blindness to the risk of harm in allowing the dual relationship to occur. He also apparently failed to understand and apply the guidelines for ethical conduct, focussing instead on what he understood of the prohibition on sexual relationships - he clearly believed that provided they were not having sexual intercourse the relationship was within ethical guidelines. By his lack of attention to minor boundary crossings, described as the slippery slope phenomenon, he ended up committing a serious boundary violation with the potential to do great harm to a vulnerable young woman.
9. For the reasons which follow we have determined that the psychologist be reprimanded, that his registration be suspended for a period of 9 months, that he undergo a period of education and that when he returns to practice he be supervised for a period of 12 months.
10. As a result of orders made by the Tribunal in August 2015, the respondent's name is anonymized because identification of the psychologist would identify his former client with whom he now lives. The anonymisation orders in this case were made to avoid causing undue distress or embarrassment to his former client. We refer to him as IVX and his former client as Client A.

1. The following are the facts as agreed by the parties, with the numbering used by them:
   1. At all relevant times IVX was a registered psychologist and worked as a psychologist in [name of town deleted].
   2. At all relevant times IVX was bound by the Code of Ethics and Ethical Guidelines prepared and distributed by the Australian Psychological Society, including:

2.1 The Guidelines for managing professional boundaries and multiple relationships;

2.2 The Guidelines on the prohibition of sexual relationships with clients; and

2.3 The Guidelines for psychological practice with women and girls.

1. Client A was referred to IVX by her general practitioner Dr N on a Mental Health Plan for treatment for anxiety. The referral referred to a history of abuse, depression and self-harm.
2. In the course of the professional relationship Client A disclosed a history of long term sexual, emotional and physical abuse and a current practice of self-harming.
3. On 9 September 2011 IVX wrote to Dr N informing him that treatment would focus both on anxiety but also on developing a better self-image and coping with emotions and images associated with her past history of physical and sexual abuse.
4. On 8 December 2011 Dr N reviewed Client A's Mental Health Plan and noted that Client A was getting a lot of benefit from her sessions with IVX and that he felt further sessions would be beneficial.
5. Client A had a total of 11 sessions with IVX between August 2011 and February 2012.
6. On 3 February 2012 IVX attended a meeting of psychologists, the Mitchell Psychology Network and discussed the topic "Living in the Non-Physical World or a Psychotic Episode."
7. On 6 February 2012 IVX discussed the results of psychological testing with Client A, referring to the fact that he believed Client A might need psychiatric intervention and or medication. They also discussed the possibility of her attending upon another psychologist who operated from a spiritual perspective.
8. On 6 February 2012 IVX told Dr N in writing that he believed Client A might be experiencing a long standing psychotic episode and that she might benefit from a trial of psychiatric medication. The letter also referred to Client A self-harming and stated that IVX was concerned about Client A's state and that she had been going through a very difficult time. He did not mention in that letter that Client A should see another psychologist, but did state "I have requested that she came [sic] to visit you in order to take appropriate action and to be reviewed for ongoing treatment."
9. There were no further consultation sessions between IVX and Client A after 6 February 2012.
10. On 8 February 2012, after a discussion with Client A about the benefits and detriments of antipsychotic and anti-depressant medications, Dr N prescribed an anti-depressant to Client A and wrote to IVX informing him of that course of action.
11. During the course of the counselling sessions with IVX, Client A had told him that she worked as a tattooist in [name of town deleted]. In early to mid-February 2012 IVX visited the tattoo parlour where Client A worked. He asked her to do some corrective work on a tattoo he had previously obtained from another tattoo artist.
12. Client A agreed and thereafter IVX attended the tattoo parlour on multiple occasions in early to mid-February for the purposes of her tattooing him. A friendship developed. Client A told IVX that she had been asked to move out of her father's house and had nowhere suitable to live, and asked IVX whether he had room for a boarder. He agreed and she moved into his house.
13. The intimate personal relationship between IVX and Client A commenced in mid February 2012.
14. IVX and Client A have lived together since February or March 2012.
15. On or about 17 February 2012 IVX and Client A attended a music concert together.
16. On 19 February 2012 IVX and Client A visited Client A's father and his wife and informed them they were in a personal relationship together.
17. On 14 March 2012 Client A was referred by another general practitioner (in the same clinic as her regular general practitioner) to an alternate psychologist, Ms D, whom she had previously consulted in 2010.
18. On 15 March 2012 IVX wrote to Dr N informing him of "some developments regarding management of her condition." He said that he had attended upon Client A as a client for tattooing services in mid February 2012 and that she felt "a lot more comfortable to discuss aspects of herself and spirituality in that setting than she had during her sessions." IVX said Client A had decided that she would maintain a friendship with him and seek psychological services from another practitioner.
19. On 5 April 2012 Client A had her first session with the alternate psychologist Ms D, whom she continued to see for some years thereafter. During that first session Client A told Ms D that IVX was her new partner, that the relationship was unexpected, and that he was "very spiritual" and she "needed the spiritual side to be okay."
20. On or about 7 and 8 April 2012 IVX socialised with Client A's family, including boating and dinner. During the diner IVX and Client A sat beside each other at the table and IVX was physically affectionate to Client A.
21. On 10 April 2012, IVX sent a text message to Client A's parents in which he referred to his love for Client A and to the fact Client A calmed him down and made him feel at ease. He also referred to an intention to buy a ring for Client A.
22. On 10 May 2012 in her second session with Ms D Client A told Ms D that she and IVX had dreamt of each other the first night after she tattooed him. She also said it was a very different kind of relationship; that they had a spiritual connection beyond anything physical, that they had decided not to have sex before marriage, and that she felt respected and accepted beyond 'the shell.' She reported her self-harming had stopped.
23. In June and / or July 2012 IVX and Client A travelled overseas together to attend a wedding of a member of IVX's family.
24. IVX and Client A remain in an intimate personal relationship.

1. In accordance with the Statement of Agreed Facts we were invited to, and we made, the following findings pursuant to section 196(1) of the National Law:
   1. From mid-February 2012 IVX, while working as a psychologist, engaged in conduct constituting professional misconduct in that he engaged in an intimate personal relationship with Client A, a client he had been treating since August 2011 and whose final consultation was 6 February 2012, and whom he knew to be vulnerable to emotional and physical exploitation, in circumstances where:

1.1 At the time the relationship commenced Client A was yet to be referred to an alternate psychologist;

1.2 At the time the relationship commenced Client A had not been formally discharged back to the general practitioner who had referred her to IVX;

1.3 At the time the relationship commenced IVX had taken no or insufficient steps to ensure Client A had received independent advice about entering into the intimate personal relationship; and

1.4 At the time the relationship commenced IVX had not sought supervision from a peer regarding his decision to enter the intimate personal relationship.

At all relevant times IVX was a registered psychologist and worked as a psychologist.

At all relevant times IVX was bound by the Code of Ethics and Ethical Guidelines prepared and distributed by the Australian Psychological Society, including:

• The Guidelines for managing professional boundaries and multiple relationships
• The Guidelines on the prohibition of sexual relationships with clients
• The Guidelines for psychological practice with women and girls.

Client A was referred to IVX by her general practitioner for treatment for anxiety. The referral referred to a history of abuse, depression and self-harm.

In the course of the professional relationship Client A disclosed a history of long term sexual, emotional and physical abuse and current practice of self-harming.

On 6 February 2012 IVX told Client A's general practitioner in writing that he believed Client A might be experiencing a long standing psychotic episode and that she might benefit from a trial of psychiatric medication.

There were no further consultation sessions after 6 February 2012.

From early to mid-February 2012 IVX saw Client A on multiple occasions for the purposes of her tattooing him at her tattoo parlour.

The intimate personal relationship commenced in mid February 2012.

IVX and Client A have lived together since February or March 2012.

On or about 17 February 2012 IVX and Client A attended a music concert together.

On 19 February 2012 IVX and Client A visited Client A's father and his wife and informed them they were in a personal relationship together.

On 14 March 2012 Client A was referred by another general practitioner to an alternate psychologist.

On 15 March 2012, in a letter to the GP who had referred Client A to him, IVX informed the GP that he had attended upon Client A for tattooing services in mid February 2012 and that she had decided that she would continue a friendship with him and seek psychological services from another practitioner.

On or about 7 and 8 April 2012 IVX socialised with Client A's family, including boating and dinner, during which he was physically affectionate to Client A.

On 10 April 2012, IVX sent a text message to Client A's parents in which he referred to his love for Client A and to the fact Client A calmed him down and made him feel at ease.

In June and / or July 2012 IVX and Client A travelled overseas together.

IVX and Client A remain in an intimate personal relationship.

Determinations available under the National Law

1. Under section 196 (2) of the National Law, if the Tribunal finds that a practitioner has behaved in a way that constitutes professional misconduct, the tribunal may decide to do any one or more of the following:
   • Caution or reprimand the practitioner
   • Impose a condition on the practitioner's registration including conditions for further education, training, counselling, reporting or practising in a particular way
   • Require the practitioner to pay a fine of not more than $30,000
   • Suspend the practitioner's registration for a specified period
   • Cancel the practitioner's registration.

1. We do not make orders to punish the psychologist, although, understandably, they may feel like a punishment to the person concerned.
2. The purpose of our orders is to protect the public, maintain professional standards, and uphold the confidence of the public in the psychology profession.
3. Our concern is to deter the psychologist from ever repeating the conduct, deter other psychologists from engaging in similar conduct by making it clear that such conduct will have serious consequences, and assure the public that professional standards are being maintained.
4. General deterrence may require a strong message to be sent to other practitioners that the particular conduct is outside the ethical and other standards of the profession. Where, as here, there is the potential for great harm to be done to clients or former clients, general deterrence becomes more important.
5. As Doyle CJ observed in Craig v Medical Practitioners Board:[1]

A disciplinary tribunal protects the public by making orders which will prevent persons who are unfit to practice from practising, or by making orders which will secure the maintenance of proper professional standards. A disciplinary tribunal will also consider the protection of the public, and of the relevant profession, by making orders which will assure the public that appropriate standards are being maintained within the relevant profession.

1. In formulating our orders, we are looking to the future. As Cosgrove J observed in Dickens v Law Society:[2]

There is high authority for the proposition that the powers given to the disciplinary committee to discipline a practitioner are entirely protective in character and no element of punishment is involved... But to say that is merely to say that the powers are to be exercised for the purpose of, and in a manner seen to be likely to achieve, the maintenance of that high standard of conduct within the profession which will continue its good reputation, and protect, not only the future of the profession, but also protect its clients from harm.

With this object in mind, the committee is required to look to the future. Even if the practitioner's conduct be relatively slight, he may yet be struck off, if his capacities and attitude have been revealed to be such that his continuance in practice constitutes a threat to the profession. On the other hand, conduct which is itself more grave in nature, may not warrant striking off, if it is seen as a temporary and explicable departure from the practitioner's own high standards. The committee's task is to uphold the dignity and standards of the profession.... The order which the committee is called upon to make is that order which, in its opinion, is necessary, and no more than is necessary, to maintain professional discipline and high standards of conduct.

1. In formulating orders, we take into account matters such as:
   • The nature and seriousness of the conduct, and what is required in the interests of general deterrence
   • Evidence as to character, insight, and the risk of repetition to determine what is required in the interests of specific deterrence
   • Determinations in other cases, although every case is different and will have its own combination of relevant factors
   • Other relevant matters, which may include the practitioner's personal circumstances at the time and any delay in the case coming to hearing.
2. We agree with the observations of the Tribunal in Psychology Board of Australia v Garcia [2015] VCAT 128, that insight may be reflected in a variety of ways, such as an understanding of the nature of the conduct; an acceptance that the conduct was wrong; an appreciation of why the practitioner engaged in the conduct and empathy with the consequences; and/or a willingness to take measures to identify risk factors and to do that which is necessary to avoid further transgressions.

CONSIDERATION OF THE EVIDENCE AND THE SUBMISSIONS

1. We consider first the question of the nature and seriousness of the conduct, relevant to specific and general deterrence.

1. We set out below, extracts from the report of Professor Anthony Love dated 14 July 2015 and filed by the Board, which itself sets out relevant extracts from the APS Code of Ethics and the APS Guidelines for Managing Professional Boundaries and Multiple Relationships. The extracts provide a useful description of the ethical framework relevant to this case. While Professor Love's conclusions about IVX's conduct were not accepted, both parties agreed that he set out the relevant framework.

APS Code of Ethics (2007) as supplemented by the Ethical Guidelines of the APS

1. The Code has been adopted by the Psychology Board of Australia for reference by registered psychologists in Australia.
2. General Principle C: Integrity:

The general principle, Integrity, reflects the need for psychologists to have good character and acknowledges the high level of trust intrinsic to their professional relationships, and impact of their conduct on the reputation of profession.

Psychologists recognise that their knowledge of the discipline of psychology, their professional standing, and the information they gather place them in a position of power and trust. They exercise their power appropriately and honour this position of trust. Psychologists keep faith with the nature and intentions of their professional relationships. Psychologists act with probity and honesty in their conduct.

Psychologists recognise that their position of trust requires them to be honest and objective in their professional dealings. They are committed to the best interests of their clients, the profession and their colleagues. Psychologists are aware of their own biases, limits to their objectivity, and the importance of maintaining proper boundaries with clients. They identify and avoid potential conflicts of interest. They refrain from exploiting clients and associated parties.

1. As Professor Love notes in his report, the 2007 Code indicates in Standard C.3: Conflict of Interest, that multiple relationships are particularly difficult territory to negotiate in terms of ethical conduct and, while not automatically proscribed, require very cautious consideration if ethical breaches are not to occur.
2. Professor Love refers in particular to standard C.3 .1:

Psychologists refrain from engaging in multiple relationships that may:

(a) Impair their competence, effectiveness, objectivity, or ability to render a psychological service;

(b) Harm clients or other parties to a psychological service;

(c) Lead to the exploitation of clients or other parties to a psychological service.

APS Guidelines for Managing Professional Boundaries and Multiple Relationships (2008)

1. The following is Professor Love's analysis and explanation of the Guidelines for Managing Professional Boundaries and Multiple Relationships, at p6 and 7 of his report. We consider it to be relevant in this case as outlining what IVX was required to do but failed to do. Professor Love's description of the way in which boundary crossings can deteriorate into fully fledged boundary violations is particularly apposite:

The Guidelines for Managing Professional Boundaries and Multiple Relationships (2008) state explicitly that the professional relationship between psychologists and their clients is one based on trust and so is essentially a fiduciary relationship.

Maintaining appropriate professional boundaries, it is asserted, provides the foundation for professional relationships by fostering a sense of trust and safety for clients.

Professional relationships create power imbalances between the parties, because of the different roles each has in the relationship. Such power imbalances mean that the client can be vulnerable to exploitation.

Psychologists owe a duty of care to ensure that the client is not harmed by his or her actions - the ethical principle of nonmaleficence (Beauchamp & Childress 1994).

While this ethical imperative can be easier to observe in relatively uncomplicated cases, increased complexity can make it harder to adhere to these standards, increasing risks of ethical transgressions. In particular, the power imbalance can frequently create ethical dilemmas when the professional relationship is combined with other relationships. These events are referred to as dual or multiple relationships. They are potentially problematic because it is generally accepted that the objectivity or judgement of the psychologist can be compromised or impaired by the competing demands and obligations of two or more relationships with the same client.

[The Guidelines] expand on the relevant standard of The Code and emphasise that while not always harmful, multiple relationships are potentially exploitative and/or harmful and may impair the judgement of the psychologist due to possible conflicts of interest. In particular, they note the risk of "slippery slope" phenomena, where small and ethically ambiguous but possibly justifiable boundaries crossings can deteriorate into fully fledged boundary violations.

To obviate this process, psychologists are encouraged to reflect carefully on each and every contemplated boundary crossing, only taking such actions when there are over-riding ethical considerations to do so (The Code, standard C3.3). Otherwise, self-interest can alter the equation and contribute to poor decision-making on the part of the psychologist, which can often be justified by reference to the clients' interests without consideration of the part played by more selfish motives. The result is harm can be done to the client.

[The Guidelines] identify several risk factors for boundary violations that research has shown to increase individual vulnerability. In summary, these factors are:

• Psychologists working in individual practices
• Use of home offices consultations
• Practising in small communities
• Cultural facts
• Psychologists'self-disclosure
• Emergency situations[3]

[The Guidelines] indicate that in determining the advisability of entering into multiple relationships with clients, psychologists need to consider:

• Whether personal needs are taking precedence over the needs of the current or former clients
• Their personal motives and what they stand to gain through the multiple relationship with the current or former client
• Whether entering the secondary relationship is necessary or can be avoided
• Whether the multiple relationship can potentially cause harm to the client
• If not harmful, would the additional relationship prove beneficial
• If the secondary relationship could disrupt the therapeutic relationship
• Whether or not they can evaluate the matter objectively.

1. At the time Professor Love prepared his report, the Board's allegations included an allegation that IVX had engaged in sexual activity with Client A. In the statement of agreed facts, the relationship was agreed to be an intimate relationship rather than a sexual relationship.
2. Professor Love's observations about the broad definition of sexual relationships are relevant, however, to what we considered to be IVX's mistakenly narrow focus on the importance of not having sex with Client A for two years, as an example of what we regarded as a blindness to the breadth and detail of his ethical obligations at the relevant times.
3. Professor Love observed that:

The Guidelines on Prohibition of Sexual Relationships with Clients (2008) refer to the relevant Standards in th_e Code_ that prohibit sexual relationships with current and former clients. They emphasise that the definition of sexual relationships is broader than one involving sexual intercourse and includes other behaviours that sexualise the psychologist - client relationship. They prompt psychologists to be mindful of this broader definition in their relationships with clients and former clients.

1. The parties agree that Client A was a vulnerable client. In the course of the professional relationship with IVX, she disclosed a history of long-term sexual, emotional and physical abuse and a current practice of self-harming.
2. As at 6 February 2016:
   • IVX had raised with a meeting of psychologists some of the issues involved in her case, including that she may be having a psychotic episode;
   • he had determined, and suggested to Client A that she may need psychiatric intervention and/or medication;
   • he had written to her GP to say that he believed Client A might be experiencing a psychotic episode and might benefit from a trial of psychiatric medicine. The letter referred to her self-harming and IVX's concerns about her state.
3. IVX did not mention in his 6 February 2012 letter to the client's GP that she should see another psychologist, and did not do so until his 15 March 2012 letter to the GP, which referred to the fact that Client A had herself requested a referral to her previous psychologist the day before. Client A did not have her first session with the other psychologist until 5 April 2012.
4. An intimate relationship developed rapidly. By the end of February 2012:
   • IVX had visited Client A's tattoo parlour and had been tattooed by her on multiple occasions;
   • (As disclosed by Client A to her psychologist in May) IVX and Client A had spoken about the fact that they had dreamt of each other the first night after she tattooed him;
   • IVX and Client A had gone to a music concert together (17 February);
   • IVX and Client A had gone together to her father's home and informed her father and step-mother that they were in a personal relationship together (19 February);
   • IVX had agreed that Client A could move into her house;
5. By the end of April 2012:
   • IVX were socialising as a couple with Client A's family;
   • IVX had sent a text to Client A's father and step-mother in which he referred to his love for Client A, said she calmed him down and made him feel at ease, and that he intended to buy a ring for her;
   • The Board had received a notification about IVX's conduct.
6. IVX and Client A have lived together since February/March 2012 and have planned to marry for some time. We were informed at the hearing that they had made concrete arrangements but that the date coincided with the hearing in this case, and they had postponed the arrangements.
7. As the agreed Findings state, IVX's conduct is professional misconduct: from mid-February 2012, he engaged in an intimate personal relationship with Client A, who he knew to be vulnerable to emotional and physical exploitation, in circumstances where at the time the relationship commenced:
   • Client A was yet to be referred to an alternate psychologist and had not been formally discharged back to the general practitioner who had referred her to IVX;
   • IVX had taken no or no sufficient steps to ensure that Client A had received independent advice about entering into the intimate relationship; and
   • IVX had not sought supervision from a peer regarding his decision to enter the intimate personal relationship.

What is the relevance of the impact on the client?

1. Counsel for IVX submitted that in considering determination where the conduct is engaging in an inappropriate relationship, the Tribunal will also look at the impact of the relationship on the former client. The submission is based on a comment made by this Tribunal in Psychologists Registration Board of Victoria v Mair [2010] VCAT 534, at [3]:

However, it is very difficult for us to look at the conduct of the respondent in isolation without having the benefit of whether such conduct was detrimental, of benefit or otherwise to [the client].

1. The Board submitted that the actual impact on the client of the conduct is irrelevant to determinations. It is the risk of harm that is important, whether or not that risk has been realised in the particular case.
2. We set out below the evidence before us about how Client A has fared during the course of the relationship and then our views on the relevance of the evidence.

Evidence about the impact of the conduct on Client A

1. IVX provided a reference from a woman who is close to Client A, describing herself as having been a substitute mother for Client A for almost 15 years. She speaks well of IVX, observing that during the early days of their friendship, he was nothing but a caring, respectful and loyal friend to Client A. She says that he has been one of the few stable influences in the life of Client A.
2. We also had in evidence an affidavit of Dominie Dale, who is a registered psychologist and who has been the treating psychologist for Client A for several years, both before and after the period when IVX saw Client A.
3. Ms Dale provided a report which gave an update in relation to her ongoing treatment of Client A and also contained an opinion in relation to the detrimental effect that coming to court and giving evidence would have on Client A. The Board agreed that Client A need not attend the hearing.
4. Ms Dale describes Client A's psychological health as fluctuating over the last three years due to various stressors. She has been hospitalised on a number of occasions, including three occasions in 2015, due to a trauma earlier in the year that Ms Dale says was in no way caused by IVX. She notes that throughout the time she has seen Client A since February 2013, Client A has had the unwavering support of IVX.
5. Ms Dale said that she has discussed with Client A that it is not considered ethical for psychologists to engage in social, particularly sexual relationships with their former clients. Ms Dale says she knows that Client A was aware that the guidelines include that it is necessary to wait for a period of two years before commencing a sexual relationship with a former client.
6. We pause to note that the guidelines go further than simply requiring that a psychologist wait two years before engaging in sexual activity with a former client. As noted in section 4 of the APS Guidelines on the Prohibition of Sexual Relationships with Clients, Standard C4.3(c) of the Code of Ethics states:

[psychologists] who wish to engage in sexual activity with former clients after a period of two years from the termination of the service, must first explore with a senior psychologist the possibility that the former client may be vulnerable and at risk of exploitation, and encourage the former client to seek independent counselling on the matter.

1. Ms Dale reports that Client A has always maintained that her relationship with IVX was non-sexual for more than two years after they had formed a friendship. Ms Dale said that, accepting this at face value and monitoring Client A's psychological condition, she observed that she was stressed by many things, particularly by the relationships with her extended family, and the ongoing AHPRA investigation, but rarely in her relationship with IVX. She says that Client A has consistently said that IVX has always shown her genuine love and concern, initially as a friend and then as a partner. Ms Dale said that she had formed the view that IVX's behaviour was never predatory nor abusive.
2. Client A made an affidavit. In her affidavit, she refers to and confirms the truth of a letter she wrote to AHPRA in November 2012. In that letter, she stated that during the time of sharing the house, she and IVX became good mates and developed an emotional connection, however there had been no physical intimacy between IVX and herself. She stated that this decision was made by both parties involved to honour not only both personal, religious beliefs but also the Code of Ethics which she and IVX respect.
3. Client A describes her relationship with IVX in the following terms:

My relationship with [IVX] has been very different from other relationships I have been in. From the start it was purely based on conversation and an intellectual connection. In the past I've had people who just want me on their arm or for their image. It was the first time someone wanted to get to know me for what was in my mind and not on a physical basis. It was quite unique.

As I said in my letter from November 2012, I know this case is not about me and that it is about [IVX] and his professional obligations. But I would like to say that I never felt taken advantage of by him. I feel that [IVX] is one of the first people in my life who made me feel equal and he respected my thoughts and opinions.

1. We consider that evidence about the impact on the client or former client can be useful, and that the Tribunal in a particular case may decide that the consequences are relevant as an aggravating factor.
2. We agree with the submission put on behalf of the Board, however, that the potential for harm is what makes the conduct serious. When general deterrence is taken into account, as it must be, the risk of harm itself is an important consideration.
3. In this particular case, IVX's conduct exposed Client A to a risk of great harm. As Counsel for the Board submitted, because of the high vulnerability of the client at the time the relationship started, 'it hardly bears thinking about what would have happened if this had worked out badly'.
4. As far as it is possible to say on the evidence before us, the relationship with IVX does not appear to have done serious obvious harm to Client A, and we accept that it is considered by her to be equal, supportive, loving and respectful. That is fortunate, and it is to be hoped that that continues to be the case.
5. We recognise that, in this particular case, the former client and a person close to her regard the relationship as a positive force in her life. In making the following observations, we mean no disrespect to her perspective on her relationship with IVX.
6. The reason why psychologists are prohibited from entering into inappropriate personal relationships with clients and former clients, is because of the very real and widely documented potential for harm. The harm may be immediate. The harm may not manifest itself until sometime in the future. There may be no obvious harm in a particular case, but that does not make the conduct any less serious.
7. At the very least, the prohibition protects vulnerable clients from confusion, from misunderstanding the interest shown in them, and from making a decision distorted by the closeness and the influence of the professional relationship.
8. As the guidelines recognise, there may be issues with the extent to which the psychologist and the former client can establish an equal relationship.
9. In simple terms, the very foundation of the relationship may be distorted by the inevitably blurred lines between the professional and the personal relationships.

1. We consider this case to involve very serious conduct. It did not, like other cases discussed below, involve conduct that could be described as predatory or opportunistic but it had the potential for great harm. The fact that the relationship has been a stable and long-term one is fortunate but it might not have been. IVX may have been well-intentioned but as Counsel for the Board submitted, clients and former clients of psychologists are entitled to be protected from good intentions where there is a risk of harm.
2. We have considered whether the fact that IVX and Client A postponed sexual intercourse lessens the seriousness of the boundary violation. We tend to agree with the views of Mr Johnson, IVX's supervisor from June 2012, discussed below, that harm can be done whether or not the relationship involves sex, particularly where the relationship quickly becomes intimate and close in other ways, with a high level of mutual dependence, as was apparent here. It is quite possible, in our view, that the risk of harm if it goes badly may be greater, depending on the circumstances.
3. The Code and the guidelines are clear that the inherent power imbalances in the professional relationship mean that the client can be vulnerable to exploitation; and that psychologists owe a duty of care to ensure that the client is not harmed by the psychologist's actions - the ethical principle of nonmaleficence referred to by Professor Love.
4. What makes IVX's conduct so serious, in our view, is that his client was an extremely vulnerable young woman, yet other than an apparent resolution that they not have sex for two years, he gave no thought to his broader duty of care to her.

1. As discussed above, whether or not the practitioner has insight into his or her conduct is relevant to the risk of repetition and to specific deterrence. It will also be relevant when formulating any orders for further education or supervision.
2. A respondent in disciplinary proceedings is not required to give evidence in their own cause; for whatever reason they may choose not to do so. By giving evidence and submitting to cross-examination, however, a respondent gives the Tribunal the opportunity to hear how they describe their conduct, any explanations they may give about how the conduct came to happen, and how they now see their conduct. The Tribunal may be able to clarify matters which may not have clear on the papers. The Tribunal will usually be able to make a better-informed assessment of the person's insight.
3. In Mair, for example, which we discuss further below, the respondent gave evidence and was cross-examined. It is apparent from the Tribunal's reasons for decision that it paid a great deal of attention to Ms Mair's evidence at the hearing, and made a number of favourable comments about her insight, based on hearing her evidence.
4. IVX did not give evidence in person at the hearing. Although IVX made an affidavit and wished to rely on it, he sought to do so on the basis that he not give evidence in person and not be cross-examined. The Board objected on the basis that it would be unfair to allow the affidavit in, but to deny them the ability to cross-examine him on the contents.
5. As we have said, a respondent is not obliged to give evidence in their own cause. If they choose to make a witness statement and wish to rely on it, however, it is the usual practice to allow the other party to cross-examine them on the contents of the document, unless the other party declines to do so. This is not a 'hard and fast rule', and, as IVX's Counsel submitted, the Tribunal is not bound by the rules of evidence, it can receive evidence in a range of ways. The weight of the evidence will necessarily be reduced, however, and in some cases no weight will be able to be given to a document that traverses controversial matters if the maker of the document does not confirm the contents as true and correct at the hearing and submit to cross-examination.
6. In circumstances where the contents of IVX's affidavit would be untested, we considered that little or no weight could be placed on the contents, to the extent they went beyond agreed matters and we declined to admit IVX's affidavit.
7. Importantly we had other relevant, and objective evidence about IVX's level of insight from a witness called to give evidence on IVX's behalf. Mr Ross Maxwell Johnson acted as IVX's supervisor at IVX's request, from June 2012. Mr Johnson was able to give evidence about how IVX saw his conduct at the time and in the period since. In circumstances where Mr Johnson's evidence was available we considered that IVX was not disadvantaged by the decision not to allow his affidavit into evidence.
8. We had some reservations about the structure and relative informality of IVX's sessions with Mr Johnson. It was not paid supervision and appeared very informal - Mr Johnson said that as long as IVX brought him lunch he was happy.
9. We consider, however that it is to IVX's credit that he sought supervision, and in particular that he sought supervision from Mr Johnson, given that he knew that they had differing views on some issues and that it was likely that Mr Johnson would challenge him. Mr Johnson's evidence gave a clear picture of IVX's insight, and its development over the period of supervision.

1. Mr Johnson has been a psychology practitioner for over 10 years. He belongs to a rural network of psychologists who meet every three months. IVX is also a member of the network. The members of the network would bring issues to the network meetings for discussion.
2. The following summarises his evidence in chief.
3. He recalls that at the network meeting on 3 February 2012, IVX brought up an issue that caused heated discussion, concerning the situation where a person is showing psychotic signs but calling that a spiritual journey.
4. Mr Johnson recalled that he was quite strong in his opinion which was that the person should see a psychiatrist. He said that sometime later, IVX asked him for supervision. He believed the request was in March or April 2012, and that it related to the scenario IVX raised at the meeting. He agreed to do so but because he was going overseas it could not start until June. They met weekly over lunch over a period of about two years and have now gone to fortnightly sessions.
5. When the supervision started, IVX told Mr Johnson about the relationship with Client A and the AHPRA complaint (made in March). Mr Johnson said that IVX was clearly concerned and wanted some guidance about whether or not he had made a bad decision.
6. Mr Johnson said that he had disagreed with IVX's decision to allow Client A to move in and to start a relationship with her. He said they had a great deal of discussion about transference and counter-transference. He thought that through this process (about three months), IVX became more aware that his decisions had been wrong.
7. Mr Johnson said that he disagreed with the decisions that IVX had made because they are largely unethical. There are possible long-term implications. The psychologist is not thinking sufficiently of the patient. His impression was that IVX did not think it through.
8. Mr Johnson was asked whether he thought IVX had acted with a predatory intent. He said that he genuinely felt that the decision to ask Client A to move in was as a last resort, after IVX had explored other options, that IVX was trying to do the right thing without thought of where it might lead. He said there was no indication that IVX was grooming Client A.
9. Mr Johnson said that it was clear that the relationship moved quickly. He said that IVX was emphatic that it was not sexual but that they kissed and held hands. He suggested to IVX that he wait for two years. He did not think that IVX would put pressure on Client A, and said that her circumstances were 'pretty dire'.
10. Mr Johnson said that they discussed the power imbalance in the therapeutic relationship "time and time again". He said that one of the hardest conversations he had with IVX was when he was asking him to examine Client A's true feelings and the reasons for her care for him and her attraction to him. Mr Johnson said the possible reasons were that she genuinely cared, she identified him with parental approval, or, as her therapist, considered him in a godlike way. Mr Johnson said that IVX undertook the task reluctantly at first, and then had a catharsis.
11. When asked his opinion of IVX's level of insight, Mr Johnson said that at the start, he supposed that IVX was not thinking about the full extent of his obligations but that IVX's insight into the ethics and boundaries had gone 'through the roof'.
12. When asked his opinion of the level of risk IVX poses to patients, Mr Johnson said that he refers patients to him. He said he has no doubt that IVX will not do this again because of the insight he has and his experience with AHPRA.
13. Mr Johnson was asked about application of the guidelines in a country setting. He said that the guidelines don't change but there can be challenges in managing the guidelines in a small community. He said that one can run into patients going to the supermarket or the hairdresser - Mr Johnson said you need to develop a new or a different set of boundaries such as waiting for the patient to acknowledge you. Mr Johnson said that while it was difficult, he still thought it was a bad decision for IVX to go into Client A's tattoo shop.
14. Mr Johnson was asked about the impact if IVX is suspended from practice. He said he thought it would be a serious matter, there are only three psychologists in the town, all psychologists are booked well ahead and he is genuinely worried how his patients would be serviced.
15. In cross-examination Mr Johnson:
    • Agreed that the client was "incredibly vulnerable"
    • Agreed that because of her past history she was vulnerable to transference; he thought that it would have crossed IVX's mind that Client A was vulnerable but thought that IVX's intent was to care for her
    • In answer to the question, why that work on transference and countertransference had to be done, Mr Johnson said that he supposed that it concerned him a little. IVX had a good understanding of it but didn't apply it to himself
    • He said that there was a short time when IVX was simply defending himself, but when he started to pull back that is when "the light bulb" went on
    • Said that it was 'more than possible' that an infatuation began
    • Said his understanding of the relationship was that it was close, strongly spiritual, included a plan for a joint future, and that IVX had bought Client A a ring.
    • He said he completely agrees that harm can be done whether or not sex is involved and expressed the view that "unfortunately the guidelines play up the sexual aspect". He did not think that the guidelines left any doubt that even if there is no sex, a psychologist should not involve themselves in a close relationship with the client.
    • He said they had talked about how badly it would have gone for Client A if the relationship had broken down
    • He said that he had discussed with IVX the implications for him and said he told IVX that it was a misguided caring impulse.
    • He said that IVX does have an understanding of the implications for him but that as the relationship has matured the implications have become more in the background.
    • He said that in his view it is an equal relationship between two people trying to get on with their lives. He believes the power imbalance has dissipated over time. His assessment from seeing them in public and dinner groups is that the relationship is going well and the power imbalance is gone
    • He said that if IVX had come to him in early to mid-February and asked about Client A moving in, he would have said "what are you doing, it is inappropriate, do not go ahead."

1. We accept Mr Johnson's evidence about the content of his discussions with IVX.
2. We are satisfied that IVX gave little or no thought to his broader ethical obligations at the time, did not see that his decisions at the time were wrong and did not think through the consequences for Client A of those decisions. We are satisfied that IVX was blind to those matters at the time, and took some time to understand them.
3. On the basis of Mr Johnson's evidence, we consider that it is more probable than not that IVX now has better insight into his conduct, but we have no satisfactory explanation of what he was thinking when he took the step of going to Client A's tattoo parlour. In 'slippery slope' terms, that step was the boundary crossing that provided the factual catalyst for the major boundary violations that followed.
4. It remains strange that IVX would ask Client A for tattoo services Even though they live in a small town, getting a tattoo or having one corrected is not in the same category as having to go to the same supermarket.
5. It is possible, as Mr Johnson believed, that IVX was infatuated with Client A. Whether or not that is the case, the conduct is serious.
6. We agree with the submissions of both parties that the risk of repetition of low. While it should not be necessary that a practitioner be investigated by AHPRA to realise that they have done something wrong, we accept that IVX is unlikely to engage in another such relationship. We remain concerned, however, about whether IVX even now understands the full scope of the guidelines in relation to multiple relationships and consider that further education is required, in addition to other orders discussed below.

1. IVX provided letters from a number of professional colleagues in the region in which he works. They include letters from general practitioners who refer patients to him, a Chinese medical practitioner who treats Client A, and the director and co-founder of a company that provides psychology services through a network of business associates.
2. All the references speak well of IVX's approach to patients, described as caring and gentle, and his professionalism, and report positive feedback from patients referred to him. They also speak of his high ethical standards. Many of them referred to the role he plays as one of a limited number of psychologists in the region, and the concerns they would have if he were not to practice for a period of time.
3. We gained the impression that IVX's professional skills are well-regarded and that he is generally an effective psychologist. This case does not raise concerns about his professional skills, however it is about his professional and personal judgment and his understanding and application of ethical requirements in relation to dual or multiple relationships.
4. We note that, other than this case, he has not been the subject of any other disciplinary inquiries by the Board.

1. Both parties provided copies of other Court and Tribunal decisions and made submissions about whether and how they might be relevant to the determination in this case.
2. As observed above, every case is different and each case usually has its own combination of relevant factors. Other cases can be helpful, however, as illustrating the range of orders that may be made in particular cases, and the range of conduct that has come before the Tribunal and the Courts.

Psychology Board v Garcia [2015] VCAT 128 (Garcia)

1. In Garcia, the Tribunal found that the respondent psychologist had engaged in an inappropriate and/or sexual relationship with a former client within two years of terminating the professional relationship.
2. Ms Garcia was reprimanded, suspended for six months, and required to undergo mentoring, education, and 12 months supervision at fortnightly intervals.
3. In summary, a friendship between Ms Garcia and a client developed into a romantic relationship after Ms Garcia referred the client to another psychologist. She failed to disclose to the other psychologist at the time of referral that she had engaged in or was engaged in an inappropriate relationship with the client. Three or four months later, she and the former client commenced a sexual relationship and lived together. They remained in a committed relationship and married two years later.
4. The Tribunal made a number of observations about the circumstances of the case. Our comments by way of comparison with IVX's case are in parenthesis:
   • At that at no time did Ms Garcia consult a supervisor or senior member of the profession for advice as to the appropriateness of her actions or for guidance as to the risks that the relationship may have for her former client [37]. Ms Garcia did not seek counselling and supervision until the Tribunal hearing was imminent. [IVX sought supervision early, although we note that in his case, the notification to AHPRA came soon after the relationship commenced]
   • The client was vulnerable, particularly in the area of relationships.[Client A was highly vulnerable, with a history of abusive relationships and self-harm in the form of cutting]
   • There was no evidence of predatory behaviour. [There is no evidence that IVX engaged in predatory behaviour]
   • When contacted by AHPRA, Ms Garcia's response was quick and open, before the tribunal, she accepted that her behaviour constituted professional misconduct.[IVX's response to AHPRA was less open in a number of respects: he denied they had attended a concert, he described the allegations as frivolous and misconceived and made purely in an attempt to harm his reputation. On the other hand, he responded to all the allegations, cooperated with the investigation and sought supervision soon after the allegations were made. Further, like Ms Garcia, he admitted at the hearing that his conduct was professional misconduct]
   • The Tribunal accepted that Ms Garcia herself was in a position of vulnerability given the proximity of her bereavement [42] [There was no evidence of any particular vulnerability on IVX's part]
   • The Tribunal accepted that she had insight into the inappropriateness of her behaviour, the likelihood of any repetition was minimal and specific deterrence was not an important factor [We accept that IVX now has greater insight into the inappropriateness of his conduct, is unlikely to repeat the conduct and that specific deterrence is less important than general deterrence]

1. In relation to general deterrence, the Tribunal said at [46]:

General deterrence is a more important factor in the case. Psychologists treat vulnerable people. There is an inherent imbalance in the professional relationship. If this is allowed to transfer into a personal relationship, the potential exists for damage to the client. This is why there are rules designed to prevent such occurrences. These rules are fundamental to the regulation of the psychologist/client relationship. The disposition must reflect the Tribunal's support of this regulation and the requirement to illustrate that failing to meet the standard has disciplinary consequences.

1. We agree with that statement.
2. In Garcia the Tribunal hearing was approximately two years after the notification. The delay was longer in this case - the notification was made in March 2012 and the case came on for hearing in November 2015. As Counsel for IVX submitted, delay can be a relevant factor.
3. We agree with the submissions that Garcia is the closest case to that of IVX, of the ones referred to us. In both cases the behaviour was not considered to be predatory, and the relationship was a long-term one. There are some differences. Unlike IVX, Ms Garcia did not seek supervision until quite late, and a sexual relationship commenced relatively early. Although in both cases the patient was vulnerable, particularly in the area of relationships, we consider that Client A was highly vulnerable in almost all respects, including relationships.

Psychologists Registration Board of Victoria v Pallini [2008] VCAT 2632 (Pallini)

1. During the course of the professional relationship, the psychologist applied for a job at the place of work of his client, there were a series of social interactions prompted by the fact that they were working in the same setting, and he sent numerous sexually suggestive text messages. The Tribunal characterised the conduct as predatory and persistent, despite the unwelcome nature of the suggestions he was making to his client.
2. The Tribunal found that Mr Pallini engaged in unprofessional conduct of a serious nature.
3. The Tribunal ordered that Mr Pallini's registration be suspended for 6 months, with no private practice for at least 24 months from the date of expiration of the suspension. Mr Pallini was ordered to refrain from providing supervision to psychologists providing direct counselling services to members of the public for a period of not less than five years and was ordered to undergo education and counselling.
4. Mr Pallini gave evidence and was cross-examined. He called his nominated supervisor appointed by the board to give evidence, and also filed a brief letter from his treating psychologist confirming that he was having ongoing counselling.
5. The Tribunal clearly took the view that Mr Pallini had some way to go in understanding the seriousness of his conduct and the effect it had on his client.
6. At [80] the Tribunal said that "how low a base Mr Pallini started from is apparent from the response he made to the board about the complaint in October 2007". The Tribunal's concerns included that Mr Pallini apparently thought that self-disclosure enhanced the therapeutic relationship, that it was beneficial that he came to work in the same workplace, that he had no idea that it was his responsibility not to act on any perceived flirtation on the part of his client, and that he persistently categorised the text messages he sent, which in the Tribunal's view were plainly sexual propositions, as the "banter of friends about life events".
7. The case of Pallini involved quite different conduct to that of IVX in our view.

Psychology Board of Australia v Huson [2013] VCAT 145 (Huson)

1. Mr Huson's conduct involved two patients. The Tribunal found that he had engaged in professional misconduct in that he transgressed the professional boundaries that should, and ordinarily do, exist between the psychologist and his or her client
2. During a session with a vulnerable patient, he hugged the patient, at a subsequent session he told her that he was attracted to her and asked to go for coffee or a meal with him. He said that if she did not wish to do so while she was his patient, perhaps she would do so after she had completed her treatment, and again hugged her. She did not attend any further appointments.
3. In relation to the second patient the conduct included telling her that she was his favourite patient, hugging her, complimenting her on her perfume and kissing her. She did not attend any further appointments.
4. In that case, Mr Huson's registration had been suspended immediately the notifications were received. The Tribunal hearing was some 3 years after that. He was reprimanded, cautioned, given 6 month's suspension backdated to October 2010, and required to undergo personal counselling.
5. Information about Mr Huson's personal circumstances at the time included that he was experiencing marital and financial difficulties, he had become depressed and was in poor physical and psychological health.
6. We consider that the conduct in Huson was very different to that of IVX and it is difficult to make a useful comparison. As Counsel for the Board submitted, in that case there were some personal and other circumstances that gave rise or contributed to the lapse in conduct.

Psychology Board of Australia v Cicconi [2013] VCAT 516 (Cicconi)

1. Cicconi concerned boundary violations during the therapeutic relationship, failure to manage transference and countertransference in the professional relationship, failing to manage the termination of the professional relationship, commencing a romantic and sexual relationship shortly after which lasted for two years, an assault by the psychologist on the former client and the giving of false information to the Board during its investigation
2. Mr Cicconi's registration was cancelled and he was disqualified from applying for registration for a period of 15 months.
3. The Tribunal observed that the blurring of boundaries took many forms, and that the incidents of violence toward his vulnerable patient were reprehensible. The Tribunal considered his misleading conduct towards the Board to be equally grave. There was evidence of significant emotional harm to the patient.
4. We agree with the submissions that the conduct in that case was more serious than that of IVX

Medical Board of Australia v Chiappalone [2014] QCAT 170 (Chiappalone).

1. In Chiappalone, a medical practitioner engaged in a personal and sexual relationship with a former patient shortly after the termination of the professional relationship. At the time of the hearing, the practitioner was no longer registered. The Tribunal cancelled his registration and disqualified him from applying for registration for 12 months.
2. At [30], the Tribunal referred to the observations of Dowsett J in Re a Medical Practitioner[4]:

It is professional misconduct to exploit a discontinued professional relationship. Thus, a medical practitioner should only commence or continue an association with the former patient if they can be no suggestion that he or she is exploiting a dependency in the course of the professional relationship.

1. At [32] the Tribunal observed that 'there is clearly no absolute prohibition against a medical practitioner commencing an intimate relationship with a former patient'. In that case, it was relevant that the former patient discussed her ongoing mental health issues with Dr Chiappalone. The Tribunal took into account a number of considerations but observed that notwithstanding those factors there was a power imbalance between the former patient and the doctor, the former patient was clearly vulnerable, suffered depression and had problems with alcohol, all of which were factors well known to the doctor.
2. We observe that in this case, Client A's high level of vulnerability was well known to IVX, and that the relationship commenced shortly after he had recommended to her GP that she be assessed for psychiatric medication because of his concerns that she may be in a psychotic state.

Psychology Board of Australia v Cook [2014] QCAT 162 (Cook)

1. In Cook, the psychologist had intercourse with her patient four times during the course of the therapeutic relationship. The patient had told her he had a crush on her. He made between 100 - 200 telephone calls to her over the three-month period during which they had sexual intercourse on four occasions. The patient was married at the time and told Ms Cook they had to end it after he was confronted by his wife about the affair.
2. The Tribunal suspended Ms Cook's registration for six months with conditions, and ordered her to pay costs, after a joint submission by the parties on determination. The Tribunal noted that the conduct had occurred more than four years before the hearing and that Ms Cook had remained in practice as a psychologist without further trouble.
3. In relation to the suspension, the tribunal noted at [37] that Ms Cook initially strongly contended that there should not be any suspension at all but eventually concurred with the board. The Tribunal said that "her original submission opposing suspension was not realistic, as such an order would provide insufficient general deterrence for such a serious and obvious violation of professional practice.
4. In our view, the facts in Cook are quite different to those in this case.

Psychologists Registration Board of Victoria v Mair [2010] VCAT 534 (Mair).

1. In Mair, a psychologist, who worked for Corrections Victoria at the time, developed reciprocated romantic feelings for a prisoner on parole.
2. After the counselling sessions had concluded for that time, the psychologist made a visit to the client's house, they expressed their feelings for each other and there was some physical contact. There were a number of further visits by the psychologist to the client's house where eventually intercourse took place. There was a sexual relationship for a period of one - two months. The relationship terminated following an incident when the client became violent.
3. After she terminated the relationship, the client was arrested for assaulting his father. Because this was a breach of parole he returned to prison for approximately three months. On his release on parole he made numerous telephone calls to her. She went to the house where he was living with his parents, intending to end the relationship. This was unsuccessful. They had sex. She said in evidence she did not want it to happen but was too afraid to resist that. There was then a further period with numerous telephone calls. Eventually the psychologist applied for and was granted an intervention order against the client. At that time she decided to make a confession of her relationship to the board.
4. The Tribunal made a finding of unprofessional conduct of a serious nature in that there was a transgression of professional boundaries allowing an inappropriate personal relationship to develop between the psychologist and client.
5. The Tribunal reprimanded the psychologist, suspended her registration for nine months, required her to undergo therapy and reporting, and supervision for a period of at least two years after her registration resumed.
6. The Tribunal accepted that the psychologist's behaviour was not predatory In relation to a submission from the Board that the client was extremely vulnerable, the Tribunal made the observation referred to in part above:

There has been no evidence put before us as to the effect that the respondent's conduct had upon ON. When we say this, it is not a criticism of the applicant because the applicant subpoenaed ON to give evidence. However, ON refused to obey the subpoena and thus, we were deprived of the advantage of knowing what effect, if any, the relationship with the respondent had on ON. In our view, we should not accept the fact that ON's psychological state worsened in any way because of the respondent's behaviour. It is not suggested, in any way, that the lack of evidence as to any causal relationship between the acts of the respondent and ON's psychiatric state excuses the respondent for her wrongful conduct.[our emphasis] [38]

However, it is very difficult for us to look at the conduct of the respondent in isolation without having the benefit of whether such conduct was detrimental, of benefit or otherwise to ON.

1. In comparison to IVX, we note there was a different context to the development of the relationship. Like IVX, there had been no conduct issues before since.
2. We note that Ms Mair gave evidence and was cross-examined. The Tribunal was therefore in a position to make positive observations about her credit and her sincerity. [5]
3. Ms Mair realised she had done the wrong thing and self-reported to the Board. By comparison, IVX took no action to obtain supervision until after the notification. Even after the notification, and despite the challenge to his behaviour given by his supervisor, he continued the relationship.
4. Some of the submissions before us were to do with whether IVX could be said to have acted with reckless indifference, based on a discussion in Mair at [61]:

In this particular instance, we find that the respondent in having a romantic and sexual relationship with ON did not conduct herself with reckless indifference to the possible consequences of her acts.

1. We note that the charge in Mair was of infamous conduct, based on earlier legislation. In that context it was relevant to determine whether the conduct could be categorised as reckless indifference or a high degree of negligence. The Tribunal clearly confined its analysis of the character of the psychologist's conduct to the particular facts in the context of the charge.
2. We consider next the appropriate determination in this case.

1. As discussed earlier, the nature and seriousness of the conduct mean that general deterrence is very important in this case.
2. The allegations, as admitted, involve conduct that falls substantially short of the standards of professionalism and ethics required of a registered psychologist. Clients entrust their minds and their well-being to psychologists. That high level of trust must never be exploited.
3. The clear prohibition on dual relationships reflects the recognised risk that the inherent power imbalance in the professional relationship will distort the personal relationship, with the potential to do very real harm to the client or former client. The more vulnerable the client the greater the risk of harm.
4. As the APS guidelines for managing professional boundaries and multiple relationship guidelines note, at [2.4];

In practice, major boundary violations are frequently preceded by lack of attention to minor boundary crossing. The process of boundaries gradually eroding is sometimes referred to as the "slippery slope" phenomenon.

1. The fact that a boundary violation may begin with a well-intended boundary crossing does not mean that the risk of harm is any less. The public is entitled to protection from well-meaning but unethical conduct that carries a high risk of harm.
2. As the Guidelines note at [2.2], multiple relationships carry the risk for the psychologist of impaired judgment due to possible conflicts of interest. We observe that in this case IVX's judgement was clearly impaired at the point where he asked for Client A's services at her place of business. He had no good reason to go to her tattoo shop. He could and should have gone elsewhere. If he had gone elsewhere, recognising the potential complexity of the situation for him and for Client A, much that followed would have been avoided.
3. We consider that IVX's judgement was also impaired at the point where he agreed that Client A could come and live in his house. That decision created the opportunity for a highly inappropriate relationship to develop. Whatever his motivation, he ought to have recognised that it would be difficult, if not impossible, to stay on the right side of his professional and ethical obligations to a vulnerable client. As it transpired, an intimate personal relationship developed very quickly, without any thought given as to whether IVX should seek supervision in respect of the decisions he was making, and Client A should have independent counselling before she moved in.
4. We give IVX credit for seeking supervision but we remain concerned that he only did do after notification was made and, despite the strong views of his supervisor, he took some time to develop any insight into his conduct, and at no time took any steps to bring the relationship to a safe end.
5. We take into account the submissions made on IVX's behalf. We accept that this is the only ethical transgression IVX has committed, but we consider it to be a very serious transgression. We take into account that there may be greater challenges in maintaining appropriate boundaries in a rural location, but our view is that appropriate boundaries must nevertheless be observed, and in any event regardless of the rural location, a psychologist is never obliged to agree to a client moving into his or her home. We take into account that IVX agreed to a finding of professional misconduct and that there was a period of three and a half years between notification and the hearing.
6. We accept that IVX's conduct was not predatory, but we do not accept the submission that his conduct should be characterised as "innocent". We consider that at the relevant time he had sufficient understanding of his ethical obligations in general, and some of his specific obligations. We agree with the observation of Mr Johnson that IVX knew what the guidelines were, he just didn't apply them to himself. He showed an astonishing blindness to his obligations towards his former client.
7. We have carefully considered the evidence about the relative shortage of registered psychologists in the area where IVX lives and practices. We accept that any suspension of IVX's registration will have an impact in the short term. Ultimately however, it is to the longer term benefit of patients in that region and elsewhere that they are protected from conduct which has the potential to do great harm to them.
8. We have also considered the submissions based on the evidence that at present IVX is the sole breadwinner in the relationship. We accept that there would necessarily be a financial impact on IVX were he to be suspended from practice. As observed by the Tribunal in Garcia, at [32] however:

Personal matters such as shame[6], personal ordeal[7], and financial difficulty[8] likely to be occasioned by a determination are of little relevance except insofar as they contribute to the specific deterrence of the practitioner.

1. In our view, suspension is required in this case in the interests of general deterrence, and for a period sufficient to send a strong message that the conduct is absolutely inappropriate and potentially dangerous. Taking into account the cases referred to us and our observations above about similarities and differences, and keeping in mind the need to ensure that highly vulnerable clients, such as Client A are protected, we have set that period as 9 months. The suspension takes effect from 10 March 2016 to enable arrangements to be made for IVX's current clients.
2. We also reprimand IVX, which is a serious sanction in itself. Additional orders, similar to those made in Garcia, will address the need for further education, mentoring and a period of supervision after IVX's registration resumes.

[1] [2001] SASC 169 at [4]

[2] Unreported, Supreme Court of Tasmania. See also Chiropractic Board of Australia v Hooper [2013] VCAT 1346 at [22]

[3] We note that individual practice and practising in a small community were both factors present in this case.

[4] [1995] 2 Qd R 154 at 163

[5] Similarly, in Psychologists Registration Board of Australia v Gerald Egan [2011] VCAT 2443, the Tribunal recorded [at 25] that Mr Egan's sworn evidence help them understand his appreciation of the wrongfulness of his conduct and the reasons for his various lapses. They observed, "most significantly, we are impressed by his candour and the insight he has exhibited. We take this very much into account when considering the appropriateness of the joint proposals.

[6] Buttsworth v Walton [1991] NSWCA 40 at p 8 per Samuels JA.

[7] Buttsworth v Walton [1991] NSWCA 50 at p 8 per Samuels JA.

[8] Varnavides v Dental Board of Victoria, unreported, Vic Sup Ct, 1 May 1998 per Mandie J.