Sexual Transference and Countertransference in Counseling

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1 Sexual Transference and Countertransference in Counseling Frances Clark-Patterson, PhD, MAC, BCPC, CCJAS, QSAP, QCS Footprints Consulting Services, LLC (615)

2 Values Clarification 1. What we believe 2. Our behaviors 3. Our attitudes We prize and cherish Affirm publicly Chosen from alternatives Chosen freely after consideration of consequences We take action on with a pattern of consistency and repetition Where do Values Come From? 1. Parents/family 2. Peers/friends 3. Teachers/schools/education 4. Politicians/government 5. Church/religious beliefs 6. Media 7. Literature 8. Personal experience (primary source) Consequences of Sexual Dynamics Between Professional and Client 1. Diversion of time and energy from the professional relationship to the fulfillment of personal needs and desires. 2. Loss of therapeutic effectiveness and of therapeutic benefits for the patient. 3. Self-doubt, frustration, and reduced job satisfaction for the professional. 4. Potentially damaging experiences for the patient, ranging from double messages to overt exploitation. 5. Personally or professionally compromising situation for the professional, resulting in some cases, in job loss, livelihood, and career, civil liability, and/or criminal prosecution. 6. Additional civil liability for supervisors, consultants, and employing agencies.

3 How Clients Seduce 1. Fantasy 2. Preference for therapists of one sex or the other 3. Edited self-presentation 4. Voyeurism 5. Extracurricular contacts 6. Verbal exhibitionism 7. Body language 8. Spoken invitations Why Clients Seduce 1. To gratify sexual desire 2. To divert attention from treatment issues 3. To bribe or manipulate 4. To establish an unholy alliance in conjoint therapy 5. To compromise the therapist's position 6. To gain strength through bonding with a stronger person 7. To gain attention and gratification through the use of learned behaviors Research Facts Pope, Keith-Spiegel, and Tabachnick 1986) 87% of therapists have been sexually attracted to clients 63% feel guilty, anxious or confused about the attraction 27% report experiencing some type of sexual involvement in therapy Overall complaints against therapists who reported sexual involvement is less than 10% 17% male, 6% female therapists had a least one complaint filed against them Almost 58% report experiencing sexual arousal while in the presence of a client 87% report at least some sexual attraction to clients Higher percentage of female clients than males are noticed by their therapists as physically attractive, are hugged by the therapists and are cradled or held in their therapists laps How the therapist plays the game of seduction 1. Attraction to clients 2. Wishful thinking and self-seduction 3. Ambiguous communications 4. Voyeurism 5. Over-identification

4 Power in Therapeutic Relationships In therapeutic relationships, there is a struggle for power between client and therapist. The client's power - be it the power to attract or the power to coerce - is personal and physical. The therapist's power is personal, social, and institutional; it is the power to observe, to know, to teach, to judge, to open and close doors. Client Power People in therapy, however seriously motivated to change, put up conscious and unconscious resistance. One way people seek reassurances is by exploiting what power they have in a situation of relative powerlessness. Sex is power. Client Power Before the Fact Limit-testing as well as a continuation of the (usually dysfunctional) methods of coping that the client has learned in the outside world. Seduction as a power play, an acting out of deep-seated conflicts in the therapeutic arena. Display of physical strength. Client Power after the Fact A former can client influence the therapist's reputation, at least among a limited number of people. In most cases, about all the client can do is say, He/she didn't do a damn thing for me," to whoever will listen. If the therapeutic relationship escalates into personal intimacy, then the client's power to divulge damaging information becomes something to be reckoned with. A sexual relationship with a client compromises a therapist's ability to confront or be objective.

5 Clinician Power Privileged information Appearance of being above reproach Perceived by the client as a strong, successful person who "has it made" and has as a repository of the "answers" that will bring fulfillment All can lead to abuse of the client- intentional or unintentional Legitimate Uses of Power To elicit constructive behavior and encourage openness to growth Knowing when to be seductive, and when to be manipulative Illegitimate Uses of Power Exploitation of clients for sexual gratification Power seduction carried on continuously with the same client can be used to create and maintain an unhealthy dependency on the therapist Supporting the idea that they (the therapist) has all the answers Pope and Vetter Study 90% of patients are harmed by sex with therapist 80% are harmed when the sexual involvement begins only after termination of therapy 11% required hospitalization 14% attempted suicide 1% committed suicide 10% had prior rape 1/3 had history of incest or child sex abuse 5% were minors 17% fully recovered

6 10 Common Reactions Associated with Therapist-Client Sex 1. Ambivalence 2. Cognitive dysfunction 3. Emotional lability 4. Emptiness and Isolation 5. Impaired ability to trust 6. Guilt 7. Increased suicidal risk 8. Role reversal and boundary confusion 9. Sexual confusion 10. Suppressed anger THE Limits of Involvement: Boundary Violations Most sexual misconduct in therapy begins with other boundary violations. Boundary violations do not in themselves prove sexual misconduct. More credence is given to allegations of sexual misconduct in the presence of boundary violations. The following guidelines show how clinicians can be responsible without being unnecessarily harsh or remote Physical contact Social contact Extracurricular therapy Money and employment Follow-up with former clients Self-disclosure Ethical Responses to Feelings of Attraction and Seductive Behavior DO acknowledge your own feelings. DO separate your personal feelings from dealings with the client. DON'T make the client's problems your own. DON'T give your problems to the client. DO confide in your supervisor, peers, or professional consultant. DO set limits while giving the client a safe space for self-expression. DON'T be rejecting. DO express nonsexual caring. DON'T be drawn into answering personal questions or giving the client other "double messages." DO confront the issue straightforwardly. DO explore the client's behavior therapeutically. DON'T "refer out."

7 Acknowledgements/Resources Sexual Dilemmas for the Helping Professional by J. Edelwich and A. Brodsky, 1991 Sex Between Therapists and Clients by Kenneth S. Pope, 2001 Transference: Are you a biological time machine? by M. G. Connor, PsyD, 2007 Therapists Anger, Hate, and Sexual Feelings: National Survey of Therapists Responses, Client Characteristics, Critical Events, Formal Complaints, and Training K. Pope and B. Tabachnick, 1993 Psychotherapists' Sexual Involvement With Clients-Intervention and Prevention Schoener and Gonsiorek, 1989 Additional References: It s Never OK: A Handbook for Professionals on Sexual Exploitation by Counselors and Therapists B. E. Sanders Sex in the Forbidden Zone: When Men in Power Therapists, Doctors, Clergy, Teachers, and Others Betray Women s Trust P. Rutter Sexual Exploitation by Health Care Professionals J.T. Smith and S.B. Bisbing Sexual Exploitation in Professional Relationships G. Gabbard Transference: Are you a biological time machine? M.G. Conner Sexual Attraction to Clients: The Human Therapist and the (Sometimes) Inhuman Training System K. S. Pope, B. G. Tabachnick, P Keith-Spiege.

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