Sexual Misconduct in Psychotherapy

Course excerpt from Ethics & Boundaries in Psychotherapy

According to Barnett (2014), it is widely accepted that

psychotherapists experience feelings of sexual attraction toward
clients and engage in sexual fantasies about clients (Pope,
Tabachnick, & Keith-Spiegel, 1987; Pope, Sonne, & Greene, 2006).
This is a naturally occurring phenomenon that exists whether or not
it is acknowledged and appropriately addressed. In fact, Pope,
Tabachnick, and Keith-Spiegel (1986) found that 87% of
psychotherapists they surveyed acknowledged having been sexually
attracted to one or more clients.

Sexual misconduct within the context of psychotherapy represents one of the most egregious forms of
boundary violation. It consists of explicitly adding a sexual component to the professional relationship,
regardless of who might have initiated it (Nagy, 2011, p. 38). It has a high risk of harming the client and
is always prohibited within professional relationships.

The devastating effects to psychotherapy clients, who are, by definition, in a vulnerable position, have
been widely documented. According to Pope and Vasquez (2011, p. 211), the consequences for clients
who have been sexually involved with a therapist tend to cluster into 10 very general categories:

1. Ambivalence
2. Guilt
3. Emptiness and isolation
4. Sexual confusion
5. Impaired ability to trust
6. Confused roles and boundaries
7. Emotional liability
8. Suppressed rage

9. Increased suicide risk

10. Cognitive dysfunction, frequently in the areas of concentration and memory and often involving
flashbacks, intrusive thoughts, unbidden images, and nightmares

In an earlier classic national survey of psychologists, Pope and Vetter (1991) studied the characteristics
of patients who had engaged in sexual intimacies with a therapist. The following are selected statistics
from that study:

32% of the patients had experienced incest or other child sex abuse
20% of the patients were seen pro bono or for a reduced fee
14% of the patients attempted suicide
1% (7 patients) committed suicide
11% of the patients required hospitalization considered to be at least partially a result of the
intimacies
12% of the patients filed formal complaints, such as licensing board complaints or malpractice suits

These statistics bring to light the extensive damage that is done to patients by psychotherapists who
engage in this form of boundary violation. Among the most notable are the observations that nearly
one-third of the patients in this survey were among the most vulnerable of client groups: those who
were victims of child sex abuse; a large number (134 patients) attempted suicide; only 12% eventually
filed formal complaints.

In view of the documented damage sustained by clients, it is not surprising that nearly all professional
organizations and at least half the states have legal prohibitions against sexual relationships in
psychotherapy.

It is important that each therapist become familiar with the state statutes that cover violations of this
well-known prohibition against patient-therapist sexual relationships.

Many states proclaim a blanket prohibition against sexual activity between therapist and patient in any
of the three situations:

1. While in therapy
2. Within two years of a normal termination
3. By means of therapeutic deception. Therapeutic deception means the use of coercion to coax a
client into inappropriate sexual behavior (i.e., I can only help you if you let me massage you).

Ethics & Boundaries in Psychotherapy is a 3-hour online continuing education (CE/CEU) course intended
to give psychotherapists the tools they need to resolve the common and not-so-common ethical and
boundary issues and dilemmas that they may expect to encounter in their everyday professional
practice in the 21st century. Among the topics discussed are definitions of boundaries; resolving
conflicts between ethics and the law; boundary crossings vs. boundary violations; multiple relationships;
sexual misconduct; privacy and confidentiality in the age of HIPAA and the Patriot Act; ethics issues with
dangerous clients; boundary issues in clinical supervision; ethics and cultural competency; ethical
boundaries in use of social media; ethical practice in teletherapy; fees and financial relationships; and a
17-step model for ethical decision making. * This course satisfies the ethics & boundaries requirement
for license renewal of Florida counselors, social workers & MFTs. Course #30-77 | 2015 | 40 pages | 21
posttest questions

Professional Development Resources is approved by the American Psychological Association (APA) to

sponsor continuing education for psychologists; the National Board of Certified Counselors (NBCC ACEP
#5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of
Behavioral Sciences (#PCE1625); the Florida Boards of Clinical Social Work, Marriage & Family Therapy,
and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio
Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional
Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114)
and State Board of Social Worker Examiners (#5678).