Wednesday, 4 January 2012

When therapists have the hots for their clients

The fictional Dr Weston
(played by Gabriel Byrne)
 experiences lust for a client
Clients go to psychotherapy seeking a mind massage, but all too often things turn physical. Cases of inappropriate sexual contact in psychotherapy average around 10 per cent prevalence, and a 2006 survey of hundreds of psychotherapists found that nearly 90 per cent reported having been sexually attracted to a client on at least one occasion. It's an issue dramatised artfully in the HBO series In Treatment, which follows the life and work of psychotherapist Dr Paul Weston.

A new paper by clinical psychologist Carol Martin and colleagues discusses how therapists deal with these awkward feelings. The researchers interviewed 13 psychotherapists (7 men), including 2 clinical psychologists and 2 psychoanalysts, in-depth about times they'd been attracted to a client but had stopped themselves acting on those urges.

The results can be broken down into three categories: the therapists' general views about being attracted to clients; the effective coping processes that therapists went through on realising they were attracted to a client; and harmful ways of coping.

The therapists were generally of the view that sexual attraction to clients was normal and not necessarily harmful. However, views differed on exactly where the boundaries should lie. For example, some therapists condoned fantasising about clients whereas others did not.

Effective ways of coping involved the following processes, though not always in order: noting the attraction, which was often accompanied by feelings of anxiety or unease; facing up to the feelings, which often involved managing shame and embarrassment; reflecting on the attraction, including the relevance of the therapist's own past; processing the feelings, including considering the implications of the situation; and finally formulating a way forward that would be to the client's benefit.

Harmful ways of coping included: clumsily reinforcing therapeutic boundaries, which often left the client feeling rejected and to premature ending of therapy; taking a moralising or omnipotent stance, including implying that the client had inappropriate feelings; feeling needy ("... it seems inevitable that being single ... you imagine those 'what if' questions, if we'd met elsewhere ...", said one male, middle-aged therapist); over-identifying with the client (one therapist talked of feelings of "yearning and anguish" after therapy ended; another spoke of being overwhelmed by a client's pain and extending therapy sessions to cope); and finally responding with over-protective anxiety, including offering support that they didn't usually offer, including allowing meetings between sessions, touch, hugging and sharing of personal information.

Martin and her team said that none of what they'd heard in the interviews constituted a boundary violation so severe that they had to blow the whistle on any of their participants (participants were warned that this would happen where appropriate). However, the researchers said the results showed that "even among experienced, accredited practitioners, sexuality and sexual feelings commonly intrude into the therapeutic encounter and required management for client benefit."

Every therapist may be vulnerable to practising in ways that they later regret, the researchers concluded, especially at times of personal stress or difficulty. "The framework and typology of common problematic reactions developed through this study has potential value in training and supervision for sensitising practitioners to the issues early on, and in maximising therapeutic benefit," they said.


Martin, C., Godfrey, M., Meekums, B., and Madill, A. (2011). Managing boundaries under pressure: A qualitative study of therapists’ experiences of sexual attraction in therapy. Counselling and Psychotherapy Research, 11 (4), 248-256 DOI: 10.1080/14733145.2010.519045

Post written by Christian Jarrett for the BPS Research Digest.


Dean Richardson said...

An interesting, brief, and somewhat misleading summary of sexualised feelings in the therapist during psychotherapy.

It would be interesting to hear which series of "In Treatment" this article refers to, as in series 3 Paul Weston (or at least, the words coming out of the writer's mind through Paul) experiences deeply sexual & emotional desires for his own therapist - albeit that Paul/The Writer surprisingly (for a psychoanalytically-orientated therapist) quickly dismisses them as couldn't-possibly-be-transference. Can't have successful self-reflection get in the way of drama ;)

The summary, here, of Martin's paper surprisingly refers to only one (slightly clumsy-worded) counter-transference interpretation of the sexualised, private feelings of the therapist to his patient. One. And added in the sub-category of "harmful ways", too.


Sexual feelings for the patient are not just be about an adult sexuality. They are a sexualised response too. Response *to* something ... and, in the context of psychotherapy, response to something from the patient. I was surprised to read no mention of this in this somewhat sensationalist-titled post. Nothing is mentioned here about child sexuality - and in this example I'm referring to the concept of the therapist's sexual feelings as being a counter-transference response to the patient's unconscious communication, potentially the child-like needs of the patient ('look after me', 'care for me', 'be drawn/attached to me'): the mother & child is a sexual relationship.

In other words, therapy is a sexually, intimate & seductive relationship. Who else in a patient's life will sit attentively actively listening to everything (we hope!) the patient says and, privately, working very hard not just to understand the patient's verbal communication but all the other forms of communications that we, as therapists, experience in order to assist the patient in understanding themselves.

Sexualised feelings in the therapist are not just about 'the hots'.

I'd suggest a sensible need for a four category in this article: the helpful ways a therapist interprets private feelings as a response to as-yet-not understood communication from his patient.

It worries me to be presented with a summary that may imply there are qualified psychotherapists (or at least a portion out of 13 chosen for Martin's study) who are not understanding or doing this.

It would be all interested readers responsibility - including mine - to gain access to the printed study to read it fully, just in case important matters were lost in translation for this post.

Unknown said...

Hi Dean

thanks for sharing your thoughts.

In series One of In Treatment Dr Weston falls in love with, and experiences lustful fantasises about, his client Laura.

I'm not able to grant you full access to the journal. But for your information, the word "transference" isn't mentioned once in the journal article.

plutishav said...

It is very interesting to observe how important and somehow, how negative is perceived the fact that therapist and client would touch or hug.

The client is there to be helped. In most of the cases, the client looks for HUMAN understanding and support.
Touch is part of (if not one of the most important) the ways we offer support to others.

Another aspect which seems very odd is how strong it is pointed out the fact that the therapist can feel attracted to the client: "the researchers said the results showed that "even among experienced, accredited practitioners, sexuality and sexual feelings commonly intrude into the therapeutic encounter and required management for client benefit."

It somehow seems that being a therapist means you are not human anymore.
We are first humans, and then anything else.
And sexual attraction is the very reason we are right here right now, reading and writing comments.

To deny that is to deny yourself.
There is one thing to recognize that there is desire, and another thing to make it sound bad!

Anonymous said...

Very interesting, indeed. However, I believe the fact that participants were told that they would be reported if their behaviour was deemed to be 'inappropriate' might have distorted some of the responses.

Peter Flowerdew said...

Hmm. "cases of ina propriate sexual contact avarage around 10%": the research I had through BACP read "10% of therapists admit to at least one instance of inapropriate behaviour" - not 10% of clients have experienced .. . If the second case is claimed, what happened to supervision, and why are the ethics commitees not overwhemed, and someone should inform the press; no?

Maybe reading
"Erotic Transference and Countertransference: Clinical practice in psychotherapy" and "Psychotherapy: an erotic relationship", both by David Mann, and "Erotic Transference"; Chapter 6 in Transactional Analysis; a relational perspective; by Helena Hargaden and Charlotte Sills might illuminat people who might be unaware that this is actually well trodden ground

Bonnie Meekums said...

I am delighted to see that our article has provoked some responses. Allow me to clarify one or two things, for those who have not had the chance to read our article in full:

1. We did, and do, acknowledge that sexual attraction to clients can provide some fruitful material for understanding the client, and for 'working through'.

2. It is, of course, to be acknowledged that our insistence on asking about successful management of sexual attraction could lead to some biased accounts - but that is what we were interested in. No-one had looked at the phenomenon from this angle previously, and attempts to identify what characterises an offender (i.e. someone who crosses the 'line') have been limited in terms of their usefulness to therapists in developing good practice. As a result of this research, we have written a set of guidelines for practice. These can be accessed via the BACP website, for members of that organisation (The research was BACP funded).

Bonnie Meekums

Jules Evans said...

10% of psychotherapy relationships involve inappropriate sexual contact?? Or did I read that wrong?

Anonymous said...

This sexualization of therapy (and sex) is rampant in the profession, but flies under the radar. I have experienced that and there are websites where people talk about what has happened.

The profession is unable to police their own.

Unless a client reports unethical behavior (or the clinician reports himself) there is no way to know how often this happens.......all done behind closed of my friends went to a therapist, they had sex and each left their husband/wife and are together now. I have a (shocking) list of how my therapy was "sexualize"....if anyone is interested, I will send it: e-mail me:

Anonymous said...

Psychoanalytic gobbledigook. You should know you're hurting your patients by refusing evidence based psychotherapy. Hopefully in treatment is not the only way you keep up.

Topsy Fair Do's said...

Even if you do report the therapist everything is stacked in his favour.

When I made a formal complaint I was pathologized as "delusional" (blame the victim) and he also fabricated stalking incidents to try to discredit me and evoke sympathy from his co workers. Sadly the head of psychology was incompetent and the NHS Trust was more than keen to brush it all under the carpet -they failed to hold him to account and he was never subjected to a disciplinary procedure.

I managed to put it all behind me and was doing OK until I found out he had attempted to clear his name by writing a chapter in a textbook about delusional clients who make false allegations.

I didnt know whether to laugh or cry.

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Nicky Paris said...

Good to see this response to one of our papers. The paper is currently free to access on the Taylor and Francis website if you click the link to the original post.

Anonymous said...

Same here, therapy with a female therapist necessarily has a sexual undertone. The whole business of transference could be exponentially speeded up if the female therapist slept with the male client when the time is right. Just imagine the analytical possibilities! Moreover Freud slept with a few of his female patients and as far as we know everything was okay. For gods sake it is just
sex not murder.

Anonymous said...

Fellow Anonymous - It is NOT just sex. It's rape. It's a total abuse of power. It's natural for a client to feel attracted to his/her therapist. This is called "transference." But it's immoral and abusive for the therapist to act on this. The harmful effects to the client are profound and long-lasting.

Anonymous said...

I agree, hugging clients is not taboo....smh.

Stella said...

My God! No matter how much the client thinks they want it or can 'handle' it (sex with the therapist), if you just think about it for a minute -- really think -- how can you not see how this most certainly will hurt the client? The odds of 1. the therapist and client living 'happily ever after' are probably astronomical, which can only send the client, who came in wanting help, on another course of confusion, sadness, loss and confusion. Adding more muck to already dirtied waters. It just CAN NOT BE GOOD, no matter HOW much it might feel good before and during. Eventually the honeymoon ends and then you are left with what you (the client) came in with PLUS the betrayal you feel when you realize you came in for treatment and ended up with even more baggage to be treated.... My God!

Topsy Fair Do's said...

He knew full well he had been abusive to me and didn’t feel good about anyone being under the impression that this is how he was.
He wanted to (re)secure his standing with fellow professionals he had 'zero' respect for me as a vulnerable woman and absolutely no concern about my wellbeing.

He couldn't care less...

I had an NHS referral to a therapist in the same healthcare trust as the male psychologist.

Unfortunately I found she automatically assumed that whatever I was trying to express was either a behavioural problem or a symptom of a psychological disorder.

She had ‘client is crazy’ as her default…she believed me in the end but it wasn’t really a good experience for me…it wasn’t healing.

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