The temptation and consequences of patient-therapist sex.
Secrets, dreams, fears, fantasies -- all are shared with the professionals we hire to guide us toward optimal mental health. It's no surprise that patients often become attracted to their therapists.
But woe to the shrink who allows this attraction to develop into a sexual relationship. In its Code of Conduct, the American Psychological Association (APA) forbids sexual relationships during therapy and for two years after therapy ends. Violating this code can bring expulsion from the APA, a revoked license, and a nasty lawsuit.
Every year, about 17 therapists are expelled or asked to resign from the APA due to sexual misconduct, according to the organization, which began keeping track of the numbers in 1993.
Now, the APA is considering changing its Code of Conduct to forbid post-therapy sexual relationships forever. This means that if a woman runs into her former therapist 10 years later, for example, and the two begin a sexual relationship, the therapist could risk his entire career.
Once Vulnerable, Always Vulnerable
Why such a hard-line attitude? "Because of the possibility of the patient being harmed," says Rhea Farberman, spokeswoman for the APA. People often arrive at therapy with many concerns, sometimes focusing on sexuality issues and distress about how they were parented, says Farberman. ''These vulnerabilities can remain for a lifetime, and a sexual relationship with a therapist could compound their problems," she adds.
Furthermore, says San Francisco psychotherapist Dorothea Lack, Ph.D., the process called transference almost always occurs during intensive therapy. This happens when the patient transfers onto the therapist the feelings he or she had for an earlier authority figure, typically a parent. "Transference lingers for life," she says, which is why a sexual relationship can never be equal, even years after therapy has ended. (Transference is not common, however, in short-term counseling, such as the two to six visits typically provided by managed-care programs.)
A Hug-Free Zone?
Since it's part of an in-depth review of the Code of Conduct, the APA's code on sexual relationships won't change for two to three years, if at all. Members are expected to comment on the proposed change by the end of this year. The final decision will be made by the APA Council of Representatives, which includes its board of directors and state and regional representatives.
But, in the meantime, the issue is stirring up controversy within the ranks of psychologists. The threat of lawsuits, the already strong language in the APA code, and the general litigiousness of society have prompted many therapists to erect barriers between themselves and their patients when it comes to any physical contact. No more hugs for a sobbing patient. No encouraging pats on the back. Even friendly chitchat outside office walls is shunned.
"I used to not have any social contact with former patients for two years, but now I don't do it at all," says Lack. "It's just too controversial."
The Case for Dual Relationships
But Ofer Zur, Ph.D., a private-practice therapist in Sonoma, CA, is leading a fight to support "dual relationships" -- patient-therapist bonds that never turn sexual but are nonetheless close and nurturing. "Most of our clients suffer from detached and cold parents," he says. "So how can we fathom that detached, cold therapists might be able to heal those wounds?"
He contends that sympathetic hugs very rarely lead to sexual advances, and small-town living has convinced him that you can play on the same softball team with a patient outside the office.
"I believe it's time for patients to file lawsuits against therapists who act in an indecent, uncaring, or inhumane way when they do not hug a grieving mother or anyone else who is in pain," he says.
But Zur is in the minority. The trend is toward more detachment from therapists, he and Lack agree. How this may affect the therapeutic process will take years to discover.
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