Clients' sexually inappropriate behaviors directed toward clinicians: Conceptualization and management.

Abstract

Sexually inappropriate behaviors in clinical settings are relatively common occurrences that may negatively affect the therapeutic process. For example, more than half of female psychologists have reported at least 1 incident in which a client responded in a sexually inappropriate manner. Thus, it is important for clinicians to understand inappropriate behaviors and respond in a manner that is both personally satisfying and helpful to the client. A framework for conceptualizing these behaviors is proposed, as well as components for, and examples of, therapeutic responses. Recommendations are provided for preventive measures to decrease the likelihood of inappropriate behaviors and for systemic approaches to benefit professional training in regards to these issues. Our aim is to stimulate further discussion of sexually inappropriate behaviors specifically by facilitating psychotherapists' ability to address clients' within-session sexual behavior, facilitating speculation of the antecedents of and motivations behind such behaviors, and facilitating discussion of such behaviors within supervision and, more broadly, within training programs.

Clinical supervisors’ experiences with and barriers to supporting trainees who have experienced identity based harassment.

“…This is problematic as there are a number of reasons trainees may not do so. Specifically, several barriers identified in this study are consistent with existing literature, such as trainee beliefs that addressing harassment is not worthy of supervision time or is not important (Hartl et al, 2007;Ladany et al, 1996), concerns about not feeling supported (Morgan & Porter, 1999), concerns about negative evaluation (Ladany et al, 1996), or concerns about supervisor competency to address harassment (Bertsch et al, 2014). As such, it is imperative that supervisors take responsibility for broaching the topic with trainees, express its importance and place in supervision, and frame addressing harassment as an essential clinical skill for navigating many professional relationships.…”

“…Normalizing discussions of harassment as a valid topic for supervision and inviting trainees to share their experiences will allow avenues for discussion, especially when done early in the supervisory relationship. Supervisors should increase their comfort in addressing these concerns while recognizing that power differentials, trainee identity, and/or trainee discomfort may impact the discussion (Hartl et al, 2007). Acknowledging that harassment in healthcare settings is common and proactively asking how the trainee would like to handle it with the supervisor when (not if) it comes up will also increase the success of managing concerns as they arise (Goldenberg et al, 2019).…”

“…

The healthcare literature suggests that a majority of trainees experience some form of harassment based on an aspect of identity (Cencirulo et al, 2020;Fnais et al, 2014). However, there is very little research on the experiences of clinical supervisors who support trainees who experience harassment, and the existing literature tends to focus on sexual or gender-based harassment (deMayo, 2000;Hartl et al, 2007). The following study aimed to fill this gap by collecting information from clinical supervisors (N = 28) within a psychology training program located within a VA Medical Healthcare System in the Northeast.

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“…Though harassment of psychology trainees is likely a common occurrence, some trainees may experience barriers to discussing these experiences with clinical supervisors. These barriers may include trainee factors such as feeling uncertain that it was worthy of supervision time, an expectation that they will be judged (Hartl et al, 2007), perceiving the topic as unimportant (Ladany et al, 1996), reluctance to be viewed as a victim, and/or a fear that one is being "too sensitive" (Wear et al, 2007). Barriers may also include trainee perceptions surrounding safety in making such disclosures.…”

“…There is, however, a surprising lack of data and scholarship on the specific experiences of psychology trainees witnessing or experiencing harassment in mental health settings. The limited literature that exists highlights that psychology trainees commonly report experiences of sexism and sexual harassment, racism, and/or heterosexism from both clients (Bertsch et al, 2014; Cencirulo et al, 2020; deMayo, 2000; Hartl et al, 2007) and clinical supervisors (Bertsch et al, 2014) during their clinical training.…”