Background
Mr Yusupoff is a registered clinical psychologist who commenced self-employed private practice in 1996. Mr Yusupoff divides his time between providing psychological therapy to adults and acting as an expert witness in personal injury claims.
Patient A was referred to Mr Yusupoff by her general practitioner in November 2008 for treatment for a phobia associated with dental treatment under anaesthesia. Patient A was due to have dental treatment shortly; hence her referral was an urgent one.
Arrangements were made for an initial consultation with Mr Yusupoff and they met for the first time on 10 November 2008 in his consulting rooms. Patient A described Mr Yusupoff’s approach as informal. Mr Yusupoff told the panel that he is known as being at ‘the more approachable end of the spectrum interpersonally.’
Mr Yusupoff and Patient A had a further consultation on 18 December 2008. The treatment of Patient A’s phobia had a satisfactory outcome in that she was able to have her dental treatment with anaesthesia following her consultations with Mr Yusupoff.
Between 14 December 2008 and 13 January 2009 Mr Yusupoff and Patient A exchanged a number of emails. The content of those emails was described by Mr Yusupoff as ‘very relaxed and informal in style.’ The email exchange developed from an attempt to re-arrange a second appointment to content which Mr Yusupoff concedes was flirtatious and sexualised.
On 21 December 2008 Patient A sent Mr Yusupoff an erotic poem she had written. In return he shared some photographs which he had posted to a social networking site. By 23 December 2008 Patient A was signing off her emails with an ‘x’ and on 24 December 2008 Mr Yusupoff reciprocated.
Patient A ended her therapeutic relationship with Mr Yusupoff by email dated 6 January 2009. She explained that she wanted to talk to him as a friend to find out more about him and observed that is ‘probably a little compromising with the therapist client dynamic.’ Her email also states: “If you can see a way to be friends and would like to stay in touch I’d really like that and can re-adjust communication accordingly!” and later “Up to you too how we proceed.”
Mr Yusupoff’s e-mail reply later on 6 January 2009 included the words: “I’m disappointed that you’re not coming on the 12th but not therapeutically, given the reasons for your decision. So goodbye, I wish you all the best, and hello when do you want to meet for coffee?”
On 7 January 2009 Patient A sent Mr Yusupoff an email which included some erotic fiction she had written. His response included a suggested date, time and place to meet up.
Between 9 January 2009 and 12 January 2009 the email correspondence between Mr Yusupoff and Patient A centred on arrangements to meet on 13 January 2009. This was to be their first encounter following the end of the therapeutic relationship by email of 6 January 2009.
The correspondence also included discussion about the kinds of erotic photography they each enjoyed. Patient A forwarded various pictures and links to Mr Yusupoff. In an email on 9 January 2009 he suggested that she would make a good subject for erotic pictures. On 10 January 2009 he writes that there is a car park near their planned meeting place which he would like to survey with her. On 11 January Patient A told Mr Yusupoff that she did not intend or want to be photographed nude and shown in an exhibition. Mr Yusupoff expressed himself to be totally open minded re: the car park shot. He concludes his e-mail by saying that “if you don’t want to be subject and just explore ideas that’s fine too, it would still be fun.”
On 13 January 2009 Patient A and Mr Yusupoff met for lunch outside a café. Mr Yusupoff greeted Patient A by kissing her. Mr Yusupoff discussed his personal relationships with Patient A and told her of a trip to London he was planning to make. They visited an open roof car park and Patient A took one or two pictures. They visited a tea shop and continued to talk. Mr Yusupoff disclosed some details of his relationship history to Patient A.
Mr Yusupoff walked Patient A back to her vehicle and she gave him a lift back to his consulting rooms. They continued to talk during the return car journey.
The lunch meeting was an awkward and uncomfortable encounter for both Patient A and Mr Yusupoff. Patient A emailed Mr Yusupoff after the meeting she told him that she was not interested in an affair although she had thought about it. She also apologised if she had given him the impression that she wished to have a sexual relationship with him and told him that ‘wasn’t the case at all.’
Mr Yusupoff sent an email reply assuring Patient A that he did not have any expectation of her and was ‘just truly following the flow’ and was ‘open to possibilities.’
Mr Yusupoff sent Patient A a text message the following day telling her that he was a bit upset at the ending of a really nice friendship. Patient A was affronted by Mr Yusupoff’s text message which she interpreted as a reprimand.
In March 2009 Mr Yusupoff opened a Twitter account and Patient A received a notification that he was following her on Twitter. She emailed him asking him not to contact her. When he realised that Patient A had been added as a Twitter contact Mr Yusupoff un-followed her.
On 8 March 2011 Patient A made a formal complaint to the HPC and on 19 May 2011 a panel of the Investigating Committee determined that there was a case for Mr Yusupoff to answer at a Conduct and Competence Committee panel hearing.
Decision on Facts
The Panel heard evidence from Mr Yusupoff. It found him to be a straightforward witness who did his best to assist the hearing by answering questions clearly and honestly.
During the course of Mr Yusupoff’s evidence the Panel acceded to an unopposed application to hear a small part of that evidence which related to the health of third parties not otherwise involved in these proceedings, in private. Before doing so the Panel gave an opportunity to both parties to make representations, considered the HCPC Practice Note on hearings in private and accepted the advice of the Legal Assessor.
Patient A provided a signed written statement of her evidence to hearing but did not attend to give oral evidence. Accordingly, her evidence was not tested by cross examination. The Panel heard submissions from both parties on the status and weight it should give to Patient A’s evidence. It also accepted the advice of the Legal Assessor. In reaching its decision on the facts the Panel has carefully considered what weight, if any, to give Patient A’s evidence which it considers to be hearsay evidence, where it is unsupported by any other evidence of fact.
Particular 1:
The Panel finds this particular of the allegation proved.
This particular is admitted by Mr Yusupoff. In addition there is a plethora of email correspondence between 14 December 2008 and 6 January 2009 which supports this allegation.
Particular 2:
The Panel finds this particular of the allegation proved.
Mr Yusupoff admitted that he added Patient A to his list of contacts on Facebook and MySpace. The panel notes that to add a person to these sites requires that person to consent to the request to be added.
The Panel accepts Mr Yusupoff’s evidence that he inadvertently followed Patient A for a short period on Twitter when the app he used to sign up for Twitter sent out automated messages to all those in his email contact list, which included Patient A. When he became aware of this Mr Yusupoff un-followed Patient A. The panel is satisfied that Mr Yusupoff’s actions in relation to Twitter were not in any way predatory.
Particular 3(a)
The Panel finds that particular 3a has not been proved.
Patient A’s evidence on this matter is not consistent. In an email written later in the day of their meeting Patient A thanks Mr Yusupoff for trying to shock her by ‘almost inviting [her] down to London with him.’ Her written statement of evidence which was signed and dated 25 August 2011 asserts that Mr Yusupoff invited me down to London to spend the weekend away with him.
In his written and oral evidence Mr Yusupoff denied that he had issued such an invitation to Patient A. He told the Panel that he had said to Patient A that he was going to London for a professional meeting and would be taking in an art fair whilst he was there. There was no discussion of any arrangements about travel or accommodation such as would be necessary for a weekend away.
Particular 3(b)
The Panel finds particular 3b proved.
Mr Yusupoff admitted that he did kiss Patient A on meeting her on 13 January 2009. His evidence to the Panel was that he greeted her with a kiss in the same way that he would have greeted any other female friend or acquaintance of his. He could not recall whether the kiss was to the cheeks or on the lips. Patient A was taken aback by the greeting and suggested that it was a kiss on the lips.
Particular 4
The Panel find this particular proved. Mr Yusupoff admitted this particular.
A number of comments made by Mr Yusupoff in his email correspondence with Patient A indicate that he had transgressed the boundaries of an appropriate therapeutic relationship with her before that therapeutic relationship ended on or around 6 January 2009. For example on 23 December 2008 Mr Yusupoff writes: “Am prob far too open to be your therap…” on 24 December 2008 he writes: “Now we’ve flowed we can’t flow back, physics yea? There are implications, like the transferential aspects…..Also now that you’ve seen some of me, therap might turn out to be co-therap, denying you of your ful-fill. AND I get to be dwizarded fast.”
Also on 26 December 2008 Mr Yusupoff writes: “Suppose I asked re email readership cos am still getting used to an open dialogue situation with a client, and wondering how much I should open and share.”
In addition, the Panel considered paragraph 4.2 (v) of the British Psychological Society Code of Ethics and Conduct (2006) which provides that psychologists should recognise that conflicts of interests and inequity of power may still reside after professional relationships are formally terminated, such that professional responsibilities may still apply.
Particular 5:
This particular is not proved.
Mr Yusupoff admitted that he had a romantic interest in Patient A. He told the Panel that he was intrigued by her and wanted to get to know her better. He explained that difficulties in his family life and personal circumstances meant that he considered developing a friendship with Patient A but that his motivation was in acquiring companionship and intimacy rather than establishing a sexual relationship with Patient A. Having had an opportunity to hear and see Mr Yusupoff give his evidence and be cross examined about it, the Panel finds that the HCPC have failed to establish any sexual motivation for the actions found proved above.
Decision on Grounds
Notwithstanding that the Panel has not found that Mr Yusupoff’s actions were sexually motivated, the Panel is satisfied that the matters it has found proved constitute misconduct. Mr Yusupoff has admitted misconduct, although whether or not the facts found amount to the statutory ground of the allegation is a matter for the judgment of the Panel.
As noted above the Panel consider, that by reason of the matters found proved Mr Yusupoff has acted in breach of paragraph 4.2 of the British Psychological Society Code of Ethics and Conduct (2006).
Decision on impairment
The Panel considered the detailed oral evidence it heard from Mr Yusupoff. It also read carefully the documents submitted on his behalf and the documents relied on by the HCPC. Before reaching its decision the Panel heard helpful submissions from both parties.
The Panel considered the HCPC practice note on ‘Finding Fitness to Practice Impaired’ and accepted the advice of the Legal Assessor.
The Panel accepts that Mr Yusupoff’s expressions of remorse and regret in his evidence are genuine. The Panel finds that in his evidence he has demonstrated considerable insight into the causes and effect of his misconduct. He has recognised and reflected his failings and has taken substantial steps to address them in both his professional practice and his private life. The Panel heard evidence that Mr Yusupoff has worked on issues in relation to transference, counter-transference and the boundaries of therapy in supervision and his own therapy sessions which commenced in about September 2009 and are on-going.
In terms of his professional practice Mr Yusupoff has put in place administrative and other mechanisms to assist the observance of the boundaries of therapy. He now prints out emails sent to him by clients and places them in their clinical files. He encourages them to bring any substantive issues raised in email correspondence to the therapy sessions for discussion. Mr Yusupoff continues to receive regular supervision from two established practitioners who provide him with relevant guidance and support. He has included as an integral part of his supervision sessions questions about any potential boundary transgression issues. He has found that this helps him in his own practice by providing a safe and appropriate place to discuss any concerns that he may have.
The Panel is satisfied on the basis of Mr Yusupoff’s evidence and the testimonials that he has produced that he has made significant progress. There are no concerns with regard to his clinical skills or current behaviour. The Panel has no concerns in relation to the personal component of the ‘current impairment’ test.
The Panel rejects any allegation that Mr Yusupoff has acted in a predatory manner towards Patient A. It does not regard Mr Yusupoff as a danger to service users or the public more generally. However, the Panel is mindful of its role in declaring and upholding proper standards of behaviour in the profession. Transgressing the boundaries of a therapeutic relationship and failing to recognise and act on the inappropriateness of having a relationship with Patient A after the client relationship was terminated are serious matters. Whilst the Panel recognises that Mr Yusupoff’s misconduct was not of the most serious and culpable kind, it considers that public confidence in the regulatory process and in the profession would be damaged if it did not make a finding of current impairment in the circumstances of this case.
Accordingly, this Panel has determined that Mr Yusupoff’s fitness to practice is currently impaired.
Decision on Sanction
On behalf of the HCPC Ms Gillet referred the Panel to the Indicative Sanctions Policy and reminded it of the importance of applying the principle of proportionality, balancing the interests of Mr Yusupoff and the interests of the public.
On behalf of Mr Yusupoff Mr Lazarus submitted that in the light of the findings the Panel had made this was a case in which it would be appropriate to make no order as to sanction since any order would have a punitive effect and that was not the intention of the HCPC Indicative Sanctions Policy. In the alternative he submitted that a Caution Order was the proportionate sanction to apply in this case.
Mr Lazarus reminded the Panel that the misconduct found was an isolated incident in an otherwise unblemished career. He said Mr Yusupoff had been an honest witness who had shown genuine insight into the cause and effect of his misconduct and had put in place steps to prevent any recurrence. In practical terms he submitted that Mr Yusupoff is entirely fit to practise and there were no on-going concerns.
In reaching its decision the Panel has taken into account the HCPC Indicative Sanctions Policy and has accepted the advice of the Legal Assessor.
The Panel has reminded itself that the primary function of any sanction is to address public safety from the perspective of the risk which Mr Yusupoff may pose to those who use or may need his services. The Panel must also give appropriate weight to the wider public interest which includes the deterrent effect to other registrants; the reputation of the profession concerned; and public confidence in the regulatory process. In deciding what, if any, sanction to impose the Panel has sought to apply the principle of proportionality, balancing the interests of Mr Yusupoff against the interests of the public.
The Panel notes that in the considerable lapse of time since the misconduct found proved occurred; there have been no further complaints or concerns about Mr Yusupoff’s professional practice. The Panel has already expressed its view that the misconduct found proved does not sit at the most serious end of the spectrum. Mr Yusupoff has apologised for his actions. The Panel has been impressed by the extensive corrective action that Mr Yusupoff has undertaken and by his efforts to reflect upon his personal behaviour and his professional practice. The Panel is satisfied that Mr Yusupoff understands the nature and effect of his conduct. The Panel considers that its finding of current impairment in this case will have a sufficient deterrent effect on other registrants; uphold the reputation of clinical psychologists and maintain public confidence in the regulatory process.
In the particular circumstances of this case the Panel is satisfied that the appropriate outcome is to make no order in relation to sanction.
