Course excerpt from Ethics & Boundaries in Psychotherapy
According to Barnett (2014), it is widely accepted that psychotherapists experience feelings of sexual attraction toward clients and engage in sexual fantasies about clients (Pope, Tabachnick, & Keith-Spiegel, 1987; Pope, Sonne, & Greene, 2006). This is a naturally occurring phenomenon that exists whether or not it is acknowledged and appropriately addressed. In fact, Pope, Tabachnick, and Keith-Spiegel (1986) found that 87% of psychotherapists they surveyed acknowledged having been sexually attracted to one or more clients.
Sexual misconduct within the context of psychotherapy represents one of the most egregious forms of boundary violation. It consists of “explicitly adding a sexual component to the professional relationship, regardless of who might have initiated it” (Nagy, 2011, p. 38). It has a high risk of harming the client and is always prohibited within professional relationships.
The devastating effects to psychotherapy clients, who are, by definition, in a vulnerable position, have been widely documented. According to Pope and Vasquez (2011, p. 211), the consequences for clients who have been sexually involved with a therapist tend to cluster into 10 very general categories:
3. Emptiness and isolation
4. Sexual confusion
5. Impaired ability to trust
6. Confused roles and boundaries
7. Emotional lability
8. Suppressed rage
9. Increased suicide risk
10. Cognitive dysfunction, frequently in the areas of concentration and memory and often involving flashbacks, intrusive thoughts, unbidden images, and nightmares
In an earlier classic national survey of psychologists, Pope and Vetter (1991) studied the characteristics of patients who had engaged in sexual intimacies with a therapist. The following are selected statistics from that study:
• 32% of the patients had experienced incest or other child sex abuse
• 20% of the patients were seen pro bono or for a reduced fee
• 14% of the patients attempted suicide
• 1% (7 patients) committed suicide
• 11% of the patients required hospitalization considered to be at least partially a result of the intimacies
• 12% of the patients filed formal complaints, such as licensing board complaints or malpractice suits
These statistics bring to light the extensive damage that is done to patients by psychotherapists who engage in this form of boundary violation. Among the most notable are the observations that nearly one-third of the patients in this survey were among the most vulnerable of client groups: those who were victims of child sex abuse; a large number (134 patients) attempted suicide; only 12% eventually filed formal complaints.
In view of the documented damage sustained by clients, it is not surprising that nearly all professional organizations and at least half the states have legal prohibitions against sexual relationships in psychotherapy.
It is important that each therapist become familiar with the state statutes that cover violations of this well-known prohibition against patient-therapist sexual relationships.
Many states proclaim a blanket prohibition against sexual activity between therapist and patient in any of the three situations:
1. While in therapy
2. Within two years of a normal termination
3. By means of “therapeutic deception.” – Therapeutic deception means the use of coercion to coax a client into inappropriate sexual behavior (i.e., I can only help you if you let me massage you).
Ethics & Boundaries in Psychotherapy is a 3-hour online continuing education (CE/CEU) course intended to give psychotherapists the tools they need to resolve the common and not-so-common ethical and boundary issues and dilemmas that they may expect to encounter in their everyday professional practice in the 21st century. Among the topics discussed are definitions of boundaries; resolving conflicts between ethics and the law; boundary crossings vs. boundary violations; multiple relationships; sexual misconduct; privacy and confidentiality in the age of HIPAA and the Patriot Act; ethics issues with dangerous clients; boundary issues in clinical supervision; ethics and cultural competency; ethical boundaries in use of social media; ethical practice in teletherapy; fees and financial relationships; and a 17-step model for ethical decision making. * This course satisfies the ethics & boundaries requirement for license renewal of Florida counselors, social workers & MFTs. Course #30-77 | 2015 | 40 pages | 21 posttest questions
Professional Development Resources is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists; the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB #1046, ACE Program); the California Board of Behavioral Sciences (#PCE1625); the Florida Boards of Clinical Social Work, Marriage & Family Therapy, and Mental Health Counseling (#BAP346) and Psychology & School Psychology (#50-1635); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); and the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678).