Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 145 No. 0506 (2015)

Therapist-client sex in psychotherapy: attitudes of professionals and students towards ethical arguments

  • Sebastian Hollwich
  • Irina Franke
  • Anita Riecher-Rössler
  • Stella Reiter-Theil
DOI
https://doi.org/10.4414/smw.2015.14099
Cite this as:
Swiss Med Wkly. 2015;145:w14099
Published
25.01.2015

Abstract

INTRODUCTION: Data suggest that a substantial proportion of psychotherapists engage in therapist-client sex (TCS), violating national and international ethical guidelines. The objective of our study was to find a new and effective starting point for preventive interventions.

METHOD: Using an online questionnaire, this study explored professionals’ attitudes toward aspects of a TCS-case example influencing the tendency to pursue colleagues’ TCS, including self-interest and responsibility ascribed to clients.

RESULTS: A total of 421 participants expressed preferences for courses of action and rated given information in a questionnaire. Results indicate that TCS is most often condemned for its inherent carelessness towards clients, its exploitative nature, the abuse of dependency and for counteracting the inherent intention of psychotherapy. Partial responsibility for TCS was attributed to clients by 41.3% of the respondents. Although self-interest related information was rated as an acceptable reason against pursuing TCS, a strong tendency exists to confront an abusive colleague, even at the risk of own disadvantages.

DISCUSSION: In the detailed discussion ethical arguments against TCS (other than the certainly inflicted, but hardly measurable harm) are elaborated. In particular the incompatibility of TCS with a psychotherapeutic relationship, the responsibility for TCS in the asymmetrical client-therapist relationship and the legitimacy of self-protection are discussed.

CONCLUSION: Reasoning against TCS can and should be based on explicit, ethical requirements for psychotherapists. Furthermore, integrating the topic in psychotherapists’ training is encouraged and a discrete procedure to report a colleague’s TCS is requested.

References

  1. Dahlberg CC. Sexual contact between patient and therapist. Contemp Psychoanal. 1970;6(2):107–24.
  2. Gartrell N, Herman J, Olarte S, Feldstein M, Localio R. Psychiatrist-patient sexual contact: results of a national survey. I: Prevalence. Am J Psych. 1986;143(9):1126–31.
  3. Williams MH. Exploitation and inference: Mapping the damage from therapist-patient sexual involvement. Am Psychol. 1992;47(3):412–21.
  4. Williams MH. How useful are clinical reports concerning the consequences of therapist-patient sex? Am J Psychother. 1995;49(2):237–43.
  5. Derosis H, Hamilton JA, Morrison E, Strauss M. More on psychiatrist-patient sexual contact. Am J Psych. 1987;144(5):688–9.
  6. Lamb DH, Catanzaro SJ, Moorman AS. Psychologists reflect on their sexual relationships with clients, supervisees, and students: Occurrence, impact, rationales and collegial intervention. Prof Psychol Res Pract. 2003;34(1):102–7.
  7. Pope GG. Abuse of psychotherapy: Psychotherapist-patient intimacy. Psychother Psychosom. 1990;53(1–4):191–8.
  8. Cullen RM. Arguments for zero tolerance of sexual contact between doctors and patients. J Med Ethics. 1999;25(6):482–6.
  9. DeLozier PP. Therapist sexual misconduct. Women Ther. 1994;15(1):55–67.
  10. Franke I, Riecher-Rössler R. Missbrauch in therapeutischen Beziehungen – Möglichkeiten zur kritischen Positionierung der Ärzteschaft. Abuse in therapeutic relations – options for a critical positioning of the medical profession. Nervenarzt. 2011;82:1145–50.
  11. APA Ethical Principles of Psychologists and Code of Conduct. Washington, DC: American Psychological Association (2003).
  12. WMA International Code of Medical Ethics. Ferney-Voltaire: World Medical Association (2006).
  13. Ethical Principles and Implementing Procedures. London: International Psychoanalytical Association (2007).
  14. Meta-Code of Ethics. Brussels: European Federation of Psychologists’ Associations (2005).
  15. Garrett T. Sexual contact between patients and psychologists. Psychologist. 1998;11(5):227–30.
  16. Lamb DH, Woodburn JR, Lewis JT, Strand KK, Buchko KJ, Kang JR. Sexual and business relationships between therapists and former clients. Psychother Theor Res Pract Train. 1994;31(2):270–8.
  17. Wincze JP, Richards J, Parsons J, Bailey S. A comparative survey of therapist sexual misconduct between an American state and an Australian state. Prof Psychol Res Pract. 1996;27(3):289–94.
  18. von Eye A. Robustness is parameter-specific. A comment on Rasch and Guiard’s robustness study. Psychol Sci. 2004;46(4):544–8.
  19. Rasch D, Guiard V. The robustness of parametric statistical methods. Psychol Sci. 2004;46(2):175–208.
  20. Benowitz M. Comparing the experiences of women clients sexually exploited by female versus male psychotherapists. Women Ther. 1994;15(1):69–83.
  21. Tröhler U, Reiter-Theil S, editors. Ethics Codes in Medicine. Foundations and Achievements since 1947. Aldershot: Ashgate Publishing Company; 1998.
  22. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. New York: Oxford University Press; 2004.
  23. Lindsay G, Koene C, Øvreeide H, Lang F. Ethics for European psychologists. Ashland, OH: Hogrefe & Huber Publishers; US; 2008.
  24. Sonne JL, Pope KS. Treating victims of therapist-patient sexual involvement. Psychother Theor Res Pract Train. 1991;28(1):174–87.
  25. Jehu D. Patients as Victims. Sexual Abuse in Psychotherapy and Counseling. Chichester: John Wiley & Sons; 1994.
  26. Pope KS. Therapist-patient sex as sex abuse: Six scientific, professional, and practical dilemmas in addressing victimization and rehabilitation. Prof Psychol Res Pract. 1990;21(4):227–39.
  27. Medau I, Jox RJ, Reiter-Theil S. How psychotherapists handle treatment errors – an ethical analysis. BMC Med Ethics. 2013;14:50.
  28. Moggi F. [Empirical results concerning patient sexual abuse]. Forschungsergebnisse zu sexuellem Missbrauch in therapeutischen Beziehungen. Psychoanal im Widerspr. 1995;13:37–47. German.
  29. Blaser A. [Sexual abuse in psychotherapy: Facts, prejudice, and consequences]. Sexueller Missbrauch in der Psychotherapie: Urteil, Vorurteil und Konsequenzen. Bachmann, Kurt Marc, Boeker, Wolfgang Sexueller Missbrauch in Psychotherapie und Psychiatrie. Bern: Huber (1994) 23–31. German.
  30. Waibl E. [Compendium of medical ethics for physicians, nursing professionals and laypersons]. Grundriss der Medizinethik für Ärzte, Pflegeberufe und Laien. Münster: LIT Verlag; 2005. German.
  31. Sollmann U. [The temptation to heal against the rules of the art.] “Als ich der Versuchung erlag, gegen die Regeln der Kunst heilen zu koennen”: ein Trialog zwischen Betroffenem, Beteiligtem und kollegialem Interviewer. Psychother Forum. 2007;15(1):12–6. German.
  32. Wood BJ, Klein S, Cross HJ, Lammers CJ, Elliott JK. Impaired practitioners: Psychologists’ opinions about prevalence, and proposals for intervention. Prof Psychol Res Pract. 1985;16(6):843–50.
  33. Tschan W. [Abused trust: Sexual boundary violations in professional relations. Causes and consequences]. Missbrauchtes Vertrauen. Sexuelle Grenzverletzungen in professionellen Beziehungen. Ursachen und Folgen. Basel: Karger; 2005. 336 p. German.
  34. Keeter S, Kennedy C, Dimock M, Best J, Craighill P. Gauging the impact of growing nonresponse on estimates from a national RDD telephone survey. 2006;70(5):759–79.
  35. Curtin R, Presser S, Singer E. The effects of response rate changes on the index of consumer sentiment. Public Opin Q. 2000 Winter;64(4):413–28.
  36. Visser PS, Krosnick JA, Marquette J, Curtin M. Mail surveys for election forecasting? an evaluation of the colombia dispatch poll. 1996;60:181–227.

Most read articles by the same author(s)