How Useful Are Clinical Reports concerning the Consequences of Therapist-Patient Sex?

By Williams, Martin H. PhD | American Journal of Psychotherapy, Spring 1995 | Go to article overview
Save to active project

How Useful Are Clinical Reports concerning the Consequences of Therapist-Patient Sex?


Williams, Martin H. PhD, American Journal of Psychotherapy


Harmfulness and prevalence of sex between therapist and patient are difficult to research because accurate rate of harm in the general population cannot be established. Outrage at professional-ethics violations must be separated from symptom assessment, and should not alter validity standards adopted by authors of clinical reports.

Many inferential problems are inherent in systematic research on the harmfulness and prevalence of sex between therapist and patient.1,2 Sampling bias and resultant limitations on the ability to generalize findings are substantial methodologic issues. Because of these inferential problems, conclusions regarding the degree of harm caused by therapist-patient sex can be difficult to draw. In fact, despite personal convictions to the contrary, the general ability of sex with a therapist to cause damage beyond the effects of the patient's pre-existing condition has not been substantiated empirically; neither has the ability of such sexual contact to cause more harm than that caused by sex between patient and nontherapist.1

Three familiar phenomena contribute to the inferential difficulties concerning the damage caused by therapist-patient sex either before or after termination of treatment: (1) degree of symptom expression sometimes changes unpredictably over time, which makes it difficult to attribute poorer psychologic functioning to a particular cause; (2) psychologic condition may be attributed to noncausal precursors, and such misattribution may occur in a reliable and therefore especially misleading way; and (3) sex between patients and nontherapists may be a clinically significant cause of subjectively perceived and objectively measured psychologic harm, which leads to questions about how much harm can be expected to result from any sexual relationship. These three phenomena may cause insurmountable inferential difficulties that preclude valid attribution of harm to prior sex with a therapist based on later interviews with the patient.1

Despite these inferential problems, I1 and others have asserted that a clinical picture of harm from sex with a therapist does exist. However, Brown et al.3 have led me to reconsider the extent to which clinical observations can legitimately substantiate cause-and-effect patterns of behavior. The Brown et al3 article was coauthored by nearly every important contributor to the empirical literature in English on therapist-patient sex. The article3 claimed that clinical findings substantiate what more systematic empirical studies do not: that sex with therapists after termination of therapy harms patients. Regarding Applebaum and Jorgenson's4 assertion that harm from such relations has not been substantiated by valid empirical studies, Brown et al. stated:

Dr. Applebaum and Ms. Jorgenson also argued that there is no strong evidence for harm as a result of such relationships. While we would agree that the published literature is short on such information, and consider ourselves partly responsible for not having collected and published the information we have gathered in the course of our clinical work, our impressions are otherwise. That is, we have seen the same type and severity of harm devolving from posttermination relationships as from those initiated by therapists with less effective impulse control (p. 980).

Would gathering and publishing all instances of patient harm that these authors observed clinically have made a difference? I propose that such publication would not, and should not, affect general conclusions concerning the consequences of therapist-patient sex after termination of therapy. My reasons may appear self-evident, but they require review here because, perhaps especially in the area of therapist-patient sex, concern about patient victimization may cloud otherwise clearly recognized limitations on inferences that can be drawn from clinical observation.

FACTORS THAT LIMIT USEFULNESS OF CLINICAL REPORTS

Three factors limit usefulness of clinical reports of harm for drawing general conclusions about the harmfulness of therapist-patient sex:

1.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
Loading One moment ...
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited article

How Useful Are Clinical Reports concerning the Consequences of Therapist-Patient Sex?
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

While we understand printed pages are helpful to our users, this limitation is necessary to help protect our publishers' copyrighted material and prevent its unlawful distribution. We are sorry for any inconvenience.
Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.

Are you sure you want to delete this highlight?