Therapist-Patient Sexual Relations: Results of a National Survey in Israel
Aviv, Alex, Levine, Joseph, Shelef, Assaf, Speiser, Nili, Elizur, Avner, The Israel Journal of Psychiatry and Related Sciences
Abstract: Background: Studies focusing on Patient-Therapist sexual relations have been carried out mainly in the U.S. This study comes to broadly explore this phenomenon in Israel. Method: An indirect questionnaire was sent to all 1,817 psychiatrists, psychologists and social workers who are members of the Israeli Psychiatric Association, Psychologists Association and Psychotherapy Association, respectively. Results: 29% of the responding therapists reported that at least one of their patients had experienced sexual relations with the most recent, former therapist. Limitation: The design of our survey made it impossible for us to conduct a follow-up after termination of therapy and to differentiate intercourse from nonintercourse sexual exploitation. Conclusions: Similar numbers of the gender of the exploiting therapist and exploited patients were obtained for both the indirect current Israeli study and previous U.S. studies. This may suggest that such parameters are influenced by common norms regarding the relationships between men and women of both societies, and from the psychotherapeutic dyadic situation.
Over the past two decades the public, as well as mental health professional organizations, have become increasingly aware of the issue of patient-psychotherapist sexual relations. A consensus in the professional psychotherapist community indicates that while sexual fantasies expressed within the realm of transference are part of the therapeutic process, the actual acting out of such fantasies is deleterious and prohibited.
Gabbard and Lester (1) maintain that although discussion of sexual boundary violations generally implies that interpersonal boundaries are being crossed, earlier in the process inner boundaries between self and object representation is eroded. Long before the first physical contact between the therapist and the patient, the therapist generally begins to feel a special kinship with the patient. There is a common tendency among mental health professionals to claim that therapists who violate sexual boundaries are a small handful of "impaired professionals." The fact is that every therapist is potentially vulnerable to various kinds of boundary violations, including sexual ones. The above distinction between "us" and "them" implies that there is no problem of poor training or bad techniques that are relevant to sexual misconduct in psychotherapy, resulting in ignoring the origins of this very problematic phenomenon (2).
Psychiatric training about boundary issues has continued to be ineffective despite today's wider awareness of this serious problem. Norris et al. (3) believe that the denial - "this couldn't happen to me" - plays a significant role in the persistence of the problem. They also count a number of risk factors which could lead a therapist to violate boundaries, among them: life crises, illnesses, loneliness and impulse to confide, idealization of the patient and so forth. Although some risk factors may also be found in the patient, it is always the therapist's responsibility to set the limits and to maintain the boundaries of the therapeutic situation.
Comparison of patient-therapist sexual relationship and incest within the family has been reviewed in the literature (4, 5). Witztum et al. detail what Pope named "therapist-patient sex syndrome" to emphasize the serious damage that such relationships might bring about for the patients (6, 7). The extent of such behavior among mental health professionals was found to be from 5% to 12% for male psychotherapists, and from 0.6% to 3% for female psychotherapists (8-13). The overall percentage for exploitation by psychotherapists seems to be 5% to 7% of all therapeutic situations (8, 14-16).
The numbers mentioned above, and the potential deleterious effects of such phenomena stress the importance of studying therapists' sexual exploitation of patients for future prevention. Most of the studies surveying the extent and characteristics of the phenomena have been conducted in the U. …