Therapist-patient sex as sex abuse: Six scientific, professional, and practical dilemmas in addressing victimization and rehabilitation.

Abstract

Psychology, like other mental health professions, has experienced difficulty addressing the issue of therapist-patient sexual intimacies vigorously, carefully, and effectively. Six fundamental challenges, based on frequently made comparisons of therapist-patient sex to incest and rape, are identified as crucial in addressing forms of sex abuse in which perpetrators are predominantly male and victims are predominantly female: (a) acknowledging the scope of the phenomenon, (b) affirming the notion and the mechanisms of accountability, (c) assessing the validity of allegations, (d) evaluating the nature and validity of research evidence, (e) overcoming perpetrator stereotypes and inclinations to collude with or to enable sex offenders, and (f) confronting the notion of victim responsibility.In her Distinguished Professional Contributions award address, L. E. A. Walker (1989) reviewed evidence that sexual and psychological violence against women is. . .pervasive within the institution of psychology. It is embedded within psychologists'attitudes. . . , and it is perpetrated by individual psychologists in the therapy relationship, (p. 696) Her analysis rested not only on the fact that sexual intimacies with patients have long been recognized as unethical and abusive but also on the considerable indications that perpetrators are overwhelmingly (though not exclusively) male and victims are overwhelmingly (though not exclusively) female.One of the first, most persistent psychologists urging the profession to confront and eliminate this abuse was Keith- Spiegel (1977), who noted the ineffectiveness of appealing to perpetrators and potential perpetrators on the basis of a professional ethic of avoiding harm to patients or an ethic of refraining from sexual abuse of women. She reframed the issue to appeal more to self-interest, providing "ten reasons why {sex with clients ] is a very stupid thing to do." Her focus was "not on the devastation that may result for the client. . . but on what ensues for the psychologist" (p. 1).Despite such concern, however, sexual abuse of patients continues. The thesis of my article is that psychology's difficulties confronting the sexual abuse of (mostly female) patients by (mostly male) therapists parallel earlier professional attempts KENNETH S. POPE, PhD, received advanced degrees from Harvard and Yale and is an American Psychological Association (APA) Fellow and Diplomate in Clinical Psychology in independent practice. He was chair of the Ethics Committees of the APA and of the American Board of Professional Psychology and is a recipient of the Frances Mosseker Award for Fiction and the Belle Mayer Bromberg Award for Literature.

Mentoring, boundaries, and multiple relationships: opportunities and challenges

“…Engaging in such inappropriate sexual behaviors with clients is viewed as a mishandling of transference and is always viewed as harmful (Gottlieb, 1993;Pope, 1990). While non-sexual multiple relationships may occur as well, it is sexual intimacies with clients that are seen as the ultimate risk for those stepping onto the slippery slope.…”

“…Second, the boundary crossing should be perceived by the protégé positively and not as unwelcome, harmful, or exploitative (Gottlieb, 1993;Gutheil & Gabbard, 1993). Third, the boundary crossing should not occur to gratify the mentor's needs but be in the service of the protégé's professional growth and development (Borys, 1994;Pope, 1990). Finally, all boundary crossings must be consistent with prevailing professional standards and should withstand scrutiny (Doverspike, 1999).…”

Unwanted and damaging effects of psychotherapy

“…Als realistisch für die Prävalenz derartiger Übergriffe gilt bei konservativer Schätzung ("absolutes Minimum"; Bachmann u. Ziemert 1995) derzeit die Marke von mindestens 10% der männlichen und maximal 2,5% der weiblichen Therapeuten über alle Formen von psychiatrischer und psychotherapeutischer Tätigkeit und alle Qualitäten von Ausbildung und Ausbildungsstand (Moggi et al 1992;Fischer u. Becker-Fischer 2005;Bachmann u. Ziemert 1995 (Pope 1990a;Baylis 1993). Das gilt auch noch erwiesenermaßen für die Beziehungen, die Therapeuten nach Ende der eigentlichen Therapie zu ihren ehemaligen Patientinnen aufnehmen (Brown 1988;Lazarus 1992).…”

Sexuality, intimacy and subjectivity in social psychoanalytic thought of the 1920s and 1930s

“…(Sheppard & Enoch Pratt Hospital, 1926). I acknowledge that past studies in the history of medicine have seen a sign of abuse in this sort of secrecy. As scholars began to point out in the 1980s and the 1990s, there have been cases of sexual contacts between doctors and patients, and these contacts were often framed as examples of doctors abusing patients (Borys & Pope, 1989;Bouhoutsos, Holroyd, Lerman, Forer, & Greenberg, 1983;Brown, 1988;Burgess & Hartman, 1986;Casement, 2000;Dahlberg, 1970;Pope, 1990;Wright, 1985). This was the case with some studies of Sullivan, as seen in Arthur Chapman's biography and, to a certain degree, in Kenneth L. Chatelaine's book on Sullivan (Chapman, 1976;Chatelaine, 1981).…”