Sex with Therapy Clients: Its Prevalence, Potential Consequences and Implications for Psychology Training

Article excerpt

Abstract Sexual contact between psychotherapists and clients has received growing public and professional attention in the past 15 years. Although such contact is explicitly prohibited by the national psychological associations in Canada and the United States, some psychologists become sexually involved with their clients. A review of the literature suggests the potential consequences for clients can be serious and wide-ranging, including anxiety, depression, and other symptoms resembling post-traumatic stress disorder. Offending psychologists face a variety of professional and legal penalties if they are identified and prosecuted. The recent decision by the Supreme Court of Canada on Norberg vs Wynrib and the amended Ontario Regulated Health Professions Act of 1991 are discussed in terms of their possible impact on the legal status of therapist-client sex. Suggestions for psychology training programs on how to prepare students to appropriately handle sexual attraction to clients and deal with related ethical issues are summarized.

Concerns about sexual contact between providers of health care and their clients were expressed as long ago as the fourth century B.C., as indicated in the Hippocratic Oath:

In every house where I come, I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction, and especially from the pleasures of love with women and men. (Dorland's Medical Dictionary, 1988, p. 768)

Today, the national psychological associations of Canada and the United States completely prohibit sexual involvements with current therapy clients and partially prohibit sexual involvements with former therapy clients in their ethical codes. The Canadian Psychological Association (CPA, 1991) cautions its members to "be acutely aware of the power relationship in therapy and, therefore, not engage in sexual intimacy with clients, neither during therapy nor for that period of time following therapy during which the power relationship could be expected to influence the client's personal decision making" (Principle II.26). Similarly, the American Psychological Association (APA, 1992) states that psychologists "do not engage in sexual intimacies with current patients or clients" (Principle 4.05), and "do not engage in sexual intimacies with a former therapy patient or client for at least two years after cessation or termination of professional services... [and even after two years have passed] the psychologists who engages in such activity ... bears the burden of demonstrating that there has been no exploitation" (Principle 4.07). The APA code also prohibits psychologists from providing therapy to "persons with whom they have engaged in sexual intimacies" (Principle 4.06). The texts of both ethical codes do not specifically prohibit sexual involvement with a client receiving psychological services outside of therapy. However, prohibitions of sexual involvement after therapy ends or with clients receiving psychological services outside of therapy have been made at the regional level (e.g., Ontario(f.1).

PREVALENCE

Although the true base rate of therapist-client sexual contact is unknown, estimates based on self-report surveys of therapists are consistent. These survey results probably underestimate the prevalence of therapist-client sexual contact because some therapists who engage in this behaviour will not acknowledge it, even if they are assured of anonymity. On the other hand, it is unlikely that therapists would report sexual contact that did not actually occur. Pope (1988) reviewed eight American prevalence studies published between 1983 and 1987 and reported that, unadjusted for sample size, 8.3% of male and 1.7% of female psychologists and psychiatrists reported having sexual contact with a client. Most cases involved male therapists and female clients but other therapist-client combinations, including triads and larger groups, were also represented. …