The stuff of soap operas has come to life this week in Montgomery County Circuit Court, where a Silver Spring psychiatrist is accused of medical malpractice for having an affair with a patient. The doctor acknowledges the affair, but contends the lawsuit arises from a broken romance rather than a violation of medical ethics.

The patient, Frances M. Dawson, a 44-year-old corporate secretary, won the first round when a state Health Claims Arbitration Panel last Aug. 22 ordered Dr. Gerald H. Fink, 53, to pay her $274,946 in compensatory damages and $100,000 in punitive damages.

Fink has appealed that award and a jury of nine women and three men must decide whether Fink's actions constituted medical malpractice.

The Montgomery case is one of at least two dozen pending lawsuits nationwide brought by female patients against their psychiatrists for what the American Psychiatric Association calls "undue familiarity," according to Joel Klein, an attorney for the 3,100-member professional association.

The players in the Montgomery case fit a pattern of therapists and their patients who become sexually involved, according to Dr. Annette Brodsky, chief psychologist at the Harbor-UCLA Medical Center in California, who has researched the problem for the past decade.

"The most common pattern is a middle-aged male therapist in some kind of personal difficulty or crisis in his personal life, usually involving women, having a sexual relationship with a woman patient whose average age is 16 years younger than he," Brodsky said. The patient generally has been the victim of an abusive husband or was sexually molested as a child, Brodsky said.

In opening arguments, Steven R. Migdal, Fink's lawyer, told Judge DeLawrence Beard and the jury, "When things were going well for Frances Dawson this was a love affair, but when things were going badly, this became sexual abuse by a doctor; this became medical malpractice."

The jury listened for hours this week as friends and family of Dawson testified that Fink seduced her away from her 18-year marriage, maintained a sexual relationship with her for 2 1/2 years -- which included their living together for nearly a year -- and then broke up with her after she signed a paper releasing him from liability.

Dawson did not attend the first days of the trial on the advice of her present psychiatrist, according to her lawyer, Henry E. Weil, but may testify today. Weil told the jury that Dawson has been hospitalized for depression and suicidal tendencies four times since her affair with Fink ended in March 1983.

The balding, bespectacled Fink has sat through much of the testimony with his hands clasped, frequently shaking his head in disagreement.

Dawson's mother, Camille Jensen, testified Tuesday that her daughter's husband, Donald Dawson, abused his wife emotionally and physically, once threatening to throw acid in her face. Then, under harsh questioning about her eight marriages and placement of Dawson in foster homes when she was a child, Jensen burst into tears and scolded Migdal for prying.

Gay Smith, who said she is Frances Dawson's best friend, testified that she took Dawson to Fink in September 1979 for therapy because Donald Dawson had been convicted of illegal gambling charges and was facing a 10-year prison term. Dawson, whom Smith described as "completely and totally devoted and subservient" to her husband, "needed to become more independent," Smith testified.

Instead, Smith added, Dawson underwent a personality change as her sexual relationship with Fink developed and transferred her slavish devotion from her husband to Fink, finally leaving her husband and three children for Fink in 1982.