This article presents preliminary findings on the characteristics of and predisposing factors in therapists engaging in sexual intimacies with patients. Data were derived from comprehensive evaluations, consultations, supervisions, or analytically oriented treatments. Particularly salient were frequent misunderstandings of, rationalizations about, or defensive transformations of love and hate in the countertransference. Common findings involved (a) long-standing and unresolved problems with self-esteem, (b) sexualization of pregenital needs, (c) restricted awareness of fantasy, (d) covert and sanctioned boundary transgressions by a parental figure, (e) unresolved anger toward authority figures, (f) intolerance of negative transference, and (g) defensive transformation of countertransference hate into countertransference love. Coexistence of multiple levels of reality within the psychotherapeutic dyad is discussed as an area in which misunderstandings and rationalizations frequently occurred.There is an undeniable curiosity about what may lead an analyst or therapist to engage in sexual relations with a patient. The fantasy that one
The causes of sexual misconduct by analysts are discussed, as is the viability of rehabilitation for different types of transgressors. Common misunderstandings about the transgressor (such as the assumption of psychopathy and the likelihood of multiple offenses) are countered with a summary of data derived from the evaluation and/or treatment of over two hundred cases, most of them one-time transgressors. The typical characteristics of the analyst or therapist who engages in sexual misconduct are presented and discussed as qualities that are to some extent present in analysts generally. The temptation to deny this universal vulnerability is viewed as effectively replicating the kind of vertical splitting or compartmentalization that makes one vulnerable to sexual misconduct in the first place.
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