Sexual intimacy between psychotherapists and patients.

Abstract

Information regarding the nature and effects of sexual intimacy between psychotherapist and patient is reported by 318 psychologists who treated 559 patients who had such prior involvement. Characteristics of the previous therapists, their patients, and their relationships are presented. Ninety percent of the patients were reported to have suffered ill effects. Historically, the health professions have assumed that effects of sexual intimacy between psychotherapist and patient are negative (American Psychological Association [APA], 1975; Boas, 1966; Holroyd & Brodsky, 1977; Kardener, Fuller, & Mensh, 1973; Keith-Spiegel, Note 1), and such intimacy has recently been proscribed in ethics codes (American Psychiatric Association, 1973; APA, 1979; National Association of Social Workers [NASW], 1980. A marked increase in the number of civil cases and ethics committee cases suggests growing public sensitivity to the problem. Attorneys defending therapists accused of sexual contact with patients sometimes have attempted to introduce evidence that the patients were seductive, that sexual intimacy during therapy is not below community standards of practice, and that sexual intimacy with patients may be beneficial rather than harmful. Expert witnesses have invalidated the first two arguments, but not the third. Seductiveness of the patient is irrelevant, as therapist-patient sexuality is analogous to parent-child sexuality. By that analogue, sexual intimacy between patient and therapist is not viewed as a consensual act between adults.1 Also, such behavior is not usual and customary by community standards, as only 5.6% of male therapists and .6% of female therapists have been involved in sexual intimacy with patients (Holroyd ,& Brodsky, 1977; Kardener et al., 1973; Perry, 1976). The third argument has not been refuted by strong evidence showing it to be harmful. The confidential nature of the therapeutic relationship makes psychotherapy patients unidentifiable and inaccessible to the researcher. Psychotherapists told by patients about instances of sexual intimacy with a former therapist are enjoined by ethical standards (APA, 1973; APA, 1979; NASW, 1980) against reporting such activity to authorities without the patients' approval. Butler (1975; Butler & Zelen, 1977) located eight patients through the therapists with whom they had been sexually intimate, and D'Addario (1977) located 60 patients through public advertisements. The need for more data on the effects of sexual intimacy between patients and psychotherapists is apparent. For this reason, despite possible/probable errors due to memory and secondhand reporting, obviously subjective inferences of causality on the part of the respondents, and a truncated sample that includes only those patients returning to therapy after sexual intimacy, these data aje still the best available and will suffice until a better net can be fashioned to collect a better sample.