Falling In Love with the Therapist: Erotic Transference and Psychotherapy
Sexual contact, in any form, between a psychologist or psychological Sexual relationships between health care professionals and their clients are never the. Sexual involvements with former clients and patients, however, are more complicated directly relevant to our ethical analysis, as the following six examples show: of any further professional relationship between the psychologist and client. The structure within which a therapist and client relationship occurs is beneficial for Sexual relationships with clients are undoubtedly unethical, and all of the main . process used for the case of Rachel would be to first define the problem.
Extensive research has led to recognition of the extensive harm that therapist-client sex can produce. Nevertheless, research suggests that perpetrators account for about 4. This chapter looks at the history of this problem, the harm it can cause, gender patterns, the possibility that the rate of therapists sexually abusing their clients is declining, and the mental health professions' urgent, unfinished business in this area. View citation and copyright.
They may be depressed, perhaps thinking of killing themselves. They may be unhappy in their work or relationships, and not know how to bring about change. They may be suffering trauma from rape, incest, or domestic violence. They may be bingeing and purging, abusing drugs and alcohol, or engaging in other behaviors that can destroy health and sometimes be fatal.
The therapeutic relationship is a special one, characterized by exceptional vulnerability and trust. People may talk to their therapists about thoughts, feelings, events, and behaviors that they would never disclose to anyone else. Every state in the United States has recognized the special nature of the therapeutic relationship and the special responsibilities that therapists have in relation to their clients by requiring special training and licensure for therapists, and by recognizing a therapist-patient privilege which safeguards the privacy of what patients talk about to their therapist.
A relatively small minority of therapists take advantage of the client's trust and vulnerability and of the power inherent in the therapist's role by sexually exploiting the client.A Couples Therapist Explains Iconic Film and TV Relationships
Each state has prohibited this abuse of trust, vulnerability, and power through licensing regulations. Therapist-patient sex is also subject to civil law as a tort i. The ethics codes of all major mental health professionals prohibit the offense.
The health care professions at their earliest beginnings recognized the harm that could result from sexual involvement with patients. The Hippocratic Oath, named after the physician who practiced around the fifth century B. Freud, a pioneer of the "talking cure," emphasized the prohibition in his writings.
The historical consensus among health care professionals that sex with patients is prohibited as destructive continued into the modern age. In the landmark i.
Hartogs, the court held: While the scientific and professional literature had contained carefully documented individual case studies and theoretical papers describing the harm that therapist-patient sex could cause, larger scale studies began to emerge in the s and 70s. William Masters and Virginia Johnson, for example, gathered data from many research participants for their report Human Sexual Response and the report Human Sexual Inadequacy.
They were surprised at the number of participants in their samples who had engaged in sex with therapists. The extensive data that Masters and Johnson collected on each participant allowed them to compare the consequences of sex with a therapist to the consequences of other events such as consensual sexual relationships with a spouse or life-partner, consensual sex occurring outside long-term relationships, and various forms of rape, incest, and abuse.
So striking were the harmful consequences associated with therapist-patient sex that Masters and Johnson wrote: She reported consequences among the sample of women whom she studied including severe depression and suicide. Pope and Vetter published a national study of patients who had been sexually involved with a therapist.
The three studies mentioned above represent only a few of the diverse sampling procedures used to study the harm that can result from therapist-patient sex. Diverse studies have gathered samples of patients who never again sought mental health services as well as those who later entered into therapy again with a new therapist. Patients who have experienced therapist-patient sex have been compared to carefully matched control groups of patients who have experienced sex with their treating physicians who were not therapists and of patients who have been in psychotherapy but not experienced therapist-patient sex.
The effects of therapist-patient sex have been assessed by independent clinicians, by subsequent therapists of the patients, and by the patients themselves. Data have been collected using structured behavioral observation, standardized tests and other psychometric instruments, clinical interview, and other methods.
What follows is a brief description of 10 of the most common reactions that are frequently associated with therapist-patient sex. While common, these reactions do not characterize all patients who have been sexually involved with a therapist. Ambivalence Extreme ambivalence can be one of the most debilitating consequences of sexual involvement with a therapist. Caught between two sets of conflicting impulses, those suffering this consequence may find themselves psychologically paralyzed, unable to make much progress in either direction.
On one hand, they may want to escape from the abusive therapist, from the destructive relationship, and from the continuing effects of the abuse. They may wish to break the taboo of silence that the therapist has imposed, to speak out truthfully about what has happened to them.
They may seek justice and restitution in the courts. They may try to prevent the therapist from abusing other patients by filing formal complaints with professional ethics committees, the hospital or clinic if any employing the therapist, and licensing agencies, in part to see if to what degree these organizations are serious about protecting patients from abuse.
They may try to make sense of and work through their experience of abuse so that they can move on with their lives. But on the other hand, they may believe that they need to protect the abusive therapist at all costs.
Abusive therapists are often exceptionally adept at creating and nurturing these dynamics. After facilitating and encouraging me to process through the events, they asked me if I wanted to press charges.
There was the question of the year … did I want to press charges? What would happen to him? Would he shut down and be defensive to future treatment? These were the only questions I was asking at that point. However, my supervisor sat me down and pointed out that in this situation, I was not just a therapist, but a woman who had just been violated. After long deliberation, many hours of supervisionconsultation, and extreme ambivalence, I chose to press charges against my client.
This choice was considered in the long term interests of the client as well as my own self-care obligations. Yet the obstacles were not over. After pressing charges, the next step I faced was deciding whether or not to continue working with my client as his therapist.
It also warns psychologists against entering into a multiple relationship that could cause risk of exploitation or harm to the client. Part b of Standard 3. As a novice psychologist in training, I felt that I had a lot to prove. I wanted to continue working with my client and also felt the need to demonstrate that I was capable of leaving my personal issues at the door.
I wanted to be the best therapist that I could have been. Yet continuing therapy with my client would have been entering into a multiple relationship, one in which not only was I the therapist, but also his victim.
In addition, by pressing charges I had added a level of power over my client that could have negatively affected his ability to truly and successfully gain something from treatment. Swallowing my pride, I terminated treatment with my client. This was done through a monitored session by my supervisor where my former client was given the opportunity to verbally and personally take accountability for his actions, express his feelings toward the termination of our professional relationship, and for me to express my own feelings about his actions and the subsequent consequences.
Sexual and business relationships, for example, pose inherent risks regardless of who is involved. Neither can be defended as reasonable dimensions to impose on a therapy relationship. Finally, we will comment on how easy it is to rationalize, to convince ourselves that an action is justifiable in a particular situation.
Dual relationship - Wikipedia
All therapists are vulnerable to self-delusion when their own needs get in the way, even those who are competent and have been scrupulously ethical in the past e. Risk Assessment Kitchener suggests assessing the appropriateness of boundaries by using three guidelines to predict the amount of damage that role blending might create.
Role conflict occurs, says Kitchener, when expectations in one role involve actions or behavior incompatible with another role. First, as the expectations of professionals and those they serve become more incompatible, the potential for harm increases. Second, as obligations associated with the roles become increasingly divergent, the risks of loss of objectivity and divided loyalties rise.
Third, to the extent that the power and prestige of the psychotherapist exceeds that of the client, the potential for exploitation is heightened. Thus, if after two years of intense therapy and a tenuous termination whereby the client may need to return at any time, no additional roles should be contemplated. The success or failure of this new role relationship would be more about what the parties do as consenting adults as opposed to the brief professional experience.
Brown adds two additional factors that, if present, heighten the risks of harm. Second, boundary violations usually arise from impulse rather than from carefully reasoned consideration of any therapeutic indications.
Thus, hugging a client is not unethical per se, but an assessment of any potential hazards or misunderstandings should precede such an act. Risky Therapists All therapists face some risk for inappropriate role blending Keith-Spiegel, Those with underdeveloped competencies or poor training may prove more prone to improperly blending roles with clients.
However, even those with excellent training and high levels of competence may relate unacceptably with those with whom they work because their own boundaries fail. Some may feel a need for adoration, power, or social connection. The settings are private and intimate. The authority falls on the side of the therapist.
Moreover, if things turn sour, the therapist can simply eliminate the relationship by unilaterally terminating the client and can deny that anything untoward occurred should a complaint be initiated by a client. Indeed, when a client walks through the door, immediate clues become apparent: Multiple authors have discussed the advantages of self-disclosure. Done thoughtfully and judiciously, revealing pertinent information about oneself can facilitate empathy, build trust, and strengthen the therapeutic alliance e.
However, those who engage in considerable and revealing self-disclosure with clients stand at greater risk for forming problematic relationships with them. Instead, this client began to feel that the therapy environment was polluted rather than safe and clean. She quit therapy feeling even more adrift.
It is difficult to know in advance how a given client will respond to a self-disclosure, particularly when the subject is in sensitive territory for the client. It seems reasonable to expect that some clients would want to know as much as possible about the person in whom they are placing so much trust.
A skillful therapist can respond without demeaning the client in the process. At the same time Internet searches make considerable information on anyone readily available. Like any other individual who prefers some modicum of privacy, psychotherapists must understand that information posted on personal and social sites will become known to curious clients and may lead to inquiries or promote some other types of boundary blurring.
See Kolmes, ; Reamer, The next case involves an indignant response to a fading career, compounded by an absence of close ties with family or friends. Grandiose might elicit some sympathy were it not for her ill-conceived approach to dealing with her own issues.
A well-known and outspoken therapist, Panacea Grandiose, Ph. However, Grandiose continued to maintain a successful practice, and her clients became the focus of her life. She hosted frequent social events in her home and invited herself along on clients' vacations. It seems that something about therapists either choosing to work in isolation, or the isolating conditions themselves, foster the potential clouding of professional standards of care.
Or perhaps some therapists have experienced rejection by their colleagues, as with Dr. Grandiose, and turn to inappropriate substitutes for support and validation. Regardless of the reason, an insular practice with no provisions for ongoing professional contact diffuses professional identity, thus putting appropriate decision-making at risk.
Therapeutic Orientation and Specialty Practices Some therapists practicing within certain therapeutic orientations are probably more vulnerable to charges of boundary violations. For example, Williams notes that humanistic therapy and encounter group philosophies depend heavily on tearing down interpersonal boundaries. Such therapists often disclose a great deal about themselves, hug their clients, and insist on the use of first names.
These therapists also become, according to Williams, vulnerable to ethics charges even though their practice is consistent with their training. Some therapists who specialize in working with a particular population or in certain settings may need to exercise extra vigilance because the nature of the services or service settings are conducive to or even require relaxed boundaries.
In such instances, very fuzzy edges may constitute an inherent element of practice rather than qualifying as inappropriate.
Ethical Considerations When a Client Crosses Sexual Boundaries
Devine experienced deep sadness, hopelessness, and questioned her faith. At that time, Pew was dealing with his own troubles and struggling to manage his large congregation. Devine relayed her feelings, blaming God for having forsaken her, Rev. Pew responded by pouring out details of his own family problems, including the particulars of a drinking problem in his youth.
Pew hoped this intense session would prove helpful, figuring that Devine would gain confidence from knowing that even he had to face and overcome hardships. Devine, however, became upset by these revelations, passed them along to other parishioners, and left the church. He also interjected too much of his own life while failing to recognize that Ms. Devine asked Pew for spiritual guidance only. Pew should have focused on his role as a pastor and simultaneously referred Ms.
Devine to someone competent to treat her depression. However, therapists who belong to a religious community as parishioners can also easily experience challenging multiple roles.
Funnel Mask sought the professional assistance of Shudi Tell, M. Mask needed to talk to someone because, as the church treasurer, he was embezzling small amounts of money every week. He was in debt due to family illnesses, and seemed to want Mr. Tell attempted to convince Mask to create some plan to make things right, but Mask expressed disappointment and left the room.
Tell is in a bind. Even if he told someone, Mask had hidden his tracks well and could deny it. Finally, as job prospects become tighter, therapists have invented new marketplace niches for themselves.
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Fido, the parents complained, charging him with incompetence. Fido defended himself by saying that he was a licensed professional who loved dogs and that the family interfered with his relationship with the animal in ways that derailed the therapy.
This defense was not persuasive to an ethics committee. Training standards for many offshoots of psychotherapy are virtually nonexistent, expectations on the part of clients run high, and boundaries seem more likely to become confusing for both clients and therapists. Risky Career Periods No matter how long you have practiced as a mental health professional, specific risks link to each career development period. We will briefly describe those that can be associated with early, mid-level, and later career stages.
Therapists who engage in inappropriate role blending often come from the ranks of the relatively inexperienced.