A South Coast psychologist had an improper sexual relationship with a vulnerable, complex patient who was said to fascinate him and give him a sense of "personal, clinical aggrandisement", a tribunal has heard.
The patient began seeing the psychologist in 2012, attending for monthly sessions following the sudden death of a partner.
The patient, who was born a woman, presented to the clinic as a man, and within months had disclosed having a past diagnosis of dissociative identity disorder.
It was a complex case that other experts argued was beyond the skill of the psychologist, who cannot be named to protect the woman's identity.
He began to see the patient more and more frequently, and began home visits from November 2013.
Soon after, the patient asked for help to transition back to her female identity.
About the same time, the pair began having sex and entered into a relationship.
He took out loans to fund a series of surgeries for the woman.
They moved in together and, he became her guardian and obtained power of attorney rights.
The NSW Civil and Administrative Tribunal, which heard the complaint in December, was told by experts that the psychologist had found her case and their situation "clinically fascinating and challenging".
One expert, psychologist Chris Symonds, told the tribunal: "Any personal gain present is more likely to have been connected with some personal, clinical aggrandisement connected with treating such a complex case.
"It does seem that the more he became committed to the treatment, the more deluded he became about what he was trying to accomplish, and the means he was using to do this."
The relationship broke down in 2014, and the psychologist phoned a colleague and made admissions about his situation.
He was distressed, showed signs of delusional thinking, and was later admitted himself for psychiatric care at a private hospital.
The relationship appears to have further deteriorated, with each going to police to complain of harassment by the other. The psychologist took out an apprehended violence order against his former patient.
Mandatory reporting of the relationship was made to the Australian Health Practitioner Regulation Agency, and the psychologist agreed to a condition preventing him from any further practice.
The Health Care Complaints Commission brought two complaints of unprofessional conduct and professional misconduct against the psychologist to the NSW Civil and Administrative Tribunal.
The psychologist conceded that the sexual relationship occurred, but argued it began in a different context.
He said the relationship arose as "part of a pattern of violence, abuse, and intimidation at the hands" of the patient.
The psychologist argued he was victimised and lived in fear, and was impaired at the time the improper relationship commenced.
The commission, however, argued he was of sound mind when the relationship began. It argued he was in a position of power and that he should have determined the terms of the relationship.
An expert report, offered by a psychiatrist, said the psychologist's "clinical immaturity and inexperience" contributed to the relationship beginning.
The tribunal found that the practitioner, who gave evidence in the December hearings, still would not take responsibility for the power and trust he held and misused.
"As such we find that the practitioner continues to pose a substantial risk to public and that prohibition order is also required in this case," the tribunal members wrote.
It barred him from practicing, ordered he not be able to apply for new registration until for five years, and prohibited him from providing any health services.