Psychotherapists’ attitudes to intimate and informal behaviour towards clients

Abstract

Background To avoid harming or exploiting a client, sexual and non-sexual dual relationship is generally considered as unacceptable in the psychotherapeutic relationship. However, little is known about what therapists themselves constitute as (un)acceptable intimate and informal behaviour (IIB). Methods A survey among psychotherapists in Flanders (Belgium) was conducted. Opinions about the acceptability of IIB were asked. Based on these opinions attitude groups could be determined. Results In total, 786 therapists completed and returned the questionnaire (response rate: 39.8%). Therapists could be divided into three attitude groups. Almost half of the therapists belonged to the ‘rather restrictive group’, a third to the ‘rather socially permissive group’ and a fifth to the ‘rather sexually permissive group’. Being categorised as ‘rather sexually permissive’ is predominantly related to being male and non-heterosexual, whereas being ‘rather restrictive’ or ‘rather socially permissive’ is mainly due to the type of psychotherapy training. The ‘rather sexually permissive’ therapists more often found a client sexually attractive during the last year and fantasised more often about a romantic relationship with a client, but they did not more often started a sexual relationship. Conclusions Most therapists in Flanders are rather restrictive in their attitude to IIB, pointing to a high sense of morality. Having a rather sexually permissive attitude is predominantly related to more personal characteristics of the therapists, but these therapists did not start a sexual relationship more often.

Erotic Feelings Towards Patients in the Psychotherapy Session: Investigating Their Relationship With the Characteristics of the Therapist, the Patient, and the Treatment

“…It is important to note that even when flirtation does not continue into sexual contacts, it causes serious negative mental health effects in the patient (Hook and Devereux, 2018) and damages trust in the therapist and the therapeutic relationship. It is precisely to avoid harming or exploiting a patient that more than nine out of ten therapists agree that flirting with a patient, although without further ulterior motives (we would like to add "conscious"), is an unacceptable intimate and informal behavior (Vesentini, et al, 2021b).…”

Managing Romantic and Sexual Feelings Towards Clients in the Psychotherapy Room in Flanders (Belgium)

“…Concerning the referral of the client to a colleague when feelings become too intense, it was observed that this referral was a suggestion from therapists to each other rather than something they actually do (7%), when comparing the survey and focus group results. Although they are not in favor of continuing therapy when in love with the client (Vesentini, Van Overmeire, et al, 2021), they seem unprepared for referring clients when encountering strong romantic or sexual feelings (Marshall & Milton, 2014). Participants in the focus groups were unclear how to exactly manage the referral of the client.…”

Sexual Feelings Toward Clients in the Psychotherapeutic Relationship: The Taboo Revealed

“…One study found that experiencing sexual attraction (22%) and having sexual fantasies (33%) were perceived as unethical by a sizable minority of therapists (Pope et al, 1987). Another study found that the majority of therapists indicated that continuing therapy when being in love with a client (87.4%) and flirting with a client without ulterior motives (97.2%) is completely or rather unacceptable (Vesentini et al, 2020).…”