The Prevention of Psychotherapist Sexual Misconduct: Avoiding the Slippery Slope

Abstract

Therapist sexual misconduct has its genesis in the therapeutic relationship. The mental health professions have long recognized the delicacy with which the therapist must handle the therapeutic relationship, with its power imbalance, inherent vulnerability of the patient, and transference and countertransference reactions. The prevention of sexual contact starts with the careful attention to boundary violations, which, though themselves perhaps not harmful, may escalate into sexualized behavior. Methods of preventing this behavior include the establishment of clear guidelines for practitioners and the expansion of the educational process for therapists, therapists' employers, patients, and other professionals. Last resorts lie in the legal and quasi-legal proceedings available to victims, such as civil suits for damages, criminal complaints, board of licensing complaints, and actions before professional associations. The best method of preventing sexual contact with patients involves respecting the boundaries of the professional relationship and avoidance of the slippery slope.

The Inner Life of Physicians and Care of the Seriously Ill

“…1,[45][46][47][48][49][50][51][52][53][54] Does improving self-awareness influence care outcomes, such as better medical decision-making or reduced physician impairment? 55 Although the available evidence is based largely on reports of experienced educators, 14,[45][46][47]56,57 these issues merit discussion because the impact of unexamined physician emotion on physicians and patients alike is selfevident, because it is consistent with limited data * and observations of case studies, [25][26][27][28] and because these issues are not part of routine medical training and are not commonly discussed among (nonpsychiatrist) physicians. 14,30,39,43,48,[60][61][62][63][64][65][66][67][68][69][70] …”

Sexual Excitement in Therapeutic Relationships

“…Patients may be lonely, not yet capable of developing intimate relationships outside of treatment, and very conflicted about being cared for and loved. Such developmental issues and conflicts may be expressed by demanding to have more of the therapist as a substitute for other relationships (Bridges, 1994;Gabbard, 1994b;Gabbard, 1996;Gabbard & Lester, 1995;Maroda, 1991;Schoener, Milgrom, Gonsiorek et al, 1989;Strasburger, Jorgenson & Sutherland, 1992). Chris's desperation comes about in part due to a lack of belief in his/her capacity to acquire these experiences, self-attributes, or confidence without help.…”

Sexuelle Übergriffe in therapeutischen Beziehungen: Risikofaktoren, Folgen und rechtliche Schritte

“…Diese Verfahrensweisen sind auch für Deutschland denkbar und sinnvoll. Einen weiteren Bei− trag können Medien leisten, die ein realistisches Bild zu professionellen Zielen wie auch zu Grenzen der Psycho− therapie vermitteln [50,51].…”