Academic journal article American Journal of Psychotherapy

Why No Sex?

Academic journal article American Journal of Psychotherapy

Why No Sex?

Article excerpt

REFLECTIONS

As we seek to widen our psychotherapeutic armamentarium to reach patients more effectively, our challenge is to consider novel interventions while maintaining the safety of the psychotherapeutic situation. Although we may disagree about the propriety of certain interventions [e.g., physical touching (1), or extending the length of a session in special circumstances], therapists of all theoretical stripes have identified the boundary of sexual engagement between patient and therapist as an absolute barrier.

We will attempt to explain briefly why sexual contact between patient and therapist always lies outside the limits of therapeutic boundaries. Our field tends to take this at face value. Theoretical murkiness around the reasons for this prohibition might contribute to its trespass, especially given the immense transference pressures therapists confront, sometimes in the context of their own vulnerabilities (2). From the vantage point of therapeutics, there are many risks that accompany sexual contact between patient and therapist. These involve the therapist's abuse of his/her relatively powerful position, the questionable nature of the patient's consent, subsequent psychological harm to the patient, and legal complications. However, these do not constitute an exhaustive explanation for its never being acceptable.

We assert that it is the nature of sexual contact itself that renders it incompatible with the therapist's maintaining his therapeutic position. We should add that we are emphasizing the therapist's perspective here, for elements of the therapist's role must remain constant amidst the patient's fluctuating needs, wishes, and vulnerabilities in order for the relationship to remain therapeutic. To be specific, the following three aspects of sexual interaction permanently erode the possibility of a therapeutic relationship between the two parties:

(a) A sexual encounter is necessarily accompanied by a dilution, if not suspension, of reality testing on the part of both parties. This occurs across the dimensions of time, space, gender roles, and social prosperity. It thus dislodges essential anchors for the therapist. Moreover, psychic functioning during intimacy is likely to be dominated by fantasy and regressive thinking, moving the therapist from his concomitant grounding in yet another sphere. …

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