The Erotic Countertransference: The Therapist's Sexual Attraction to the Client

In an earlier article, Psychotherapy and the Erotic Transference: Falling "In Love" With Your Psychotherapist, I discussed clients' erotic feelings (also known as transference) for the therapist, the struggle that clients often have with these feelings, and how these feelings can be worked through with the therapist in a way that furthers the work in therapy.  As mentioned in the earlier article, a client's erotic feelings for his therapist is a common issue in therapy.  In this article, I'm focusing on the therapist's erotic feelings (also known as countertransference) for the client.

The Erotic Countertransference: The Therapist's Sexual Attraction to the Client

Psychotherapists who have been trained psychoanalytically are aware that they can develop erotic feelings for some clients. Knowing in advance that this will occur at some point and being trained on how to deal with it in an ethical way helps therapists to be prepared for these encounters, and it allows them to handle these issues in a way that isn't harmful to the client or their work together.

Before I go any further, I want to make it clear that psychotherapists know that it would be a serious boundary violation to get sexually/romantically involved with the client whether that involvement occurred during their work together or even after the client terminated therapy.  Unfortunately, although the vast majority of therapists are ethical, there are some therapists who act unethically.  Fortunately, they are in the minority (see my article: Boundary Violations and Sexual Exploitation in Therapy).

A therapist who has in-depth psychoanalytic experience, knows how to attune to what's going on in her internal world, with the client, and in the intersubjective space between the client and therapist.

She is also able to  momentarily dip into her own subjective experience in a way that's useful for the therapy (see my article: Psychotherapy: A Unique Intersubjective Experience).

For instance, as an example having nothing to do with sexual attraction, while she is listening to the client, a particular song might pop into the therapist's head, and she would ask herself if this song has any relevance to the client or the therapy session. She would ask herself if this is a way for her unconscious mind to give her more information that she might not be picking up on consciously? (see my article: Making the Unconscious Conscious).

There can be many reasons why a therapist might feel sexually attracted to a client.  On the most basic level, some people, including clients in therapy, naturally exude a certain sexual magnetism.  Since part of the therapist's job is to be attuned to the client, she could be picking up on this magnetism.

Another common reason is that the client might be flirting with the therapist as part of a defense mechanism to divert the conversation from things that make him uncomfortable in the session. For an experienced therapist, this is usually easy to see and would need to be addressed by the therapist in a tactful way.

Another issue might be that the therapist might be at a point in her personal life where she is not romantically, sexually or emotionally fulfilled.  As a result, she might experience these unfulfilled needs in the therapy room with the client.  This is why it's so important for psychotherapists to be attuned to their own personal needs so that they don't make ethical mistakes.

The Erotic Countertransference:  The Therapist's Erotic Feelings For the Client
The following fictional vignette is based on many different clinical cases.  It illustrates how the therapist attunes to her own internal experience and how she uses this attunement to discover the meaning of her experience and how it relates to the work with the client.

Gina
Gina, who was an experienced psychotherapist, realized that she felt a sexual attraction for Jim, after their first session together.

As a seasoned psychotherapist whose original training was in psychoanalysis, Gina knew that it was common for both clients and therapists to have attractions for each other.

Not only had she learned about the erotic countertransference in her original analytic training and in her extensive supervision, she also experienced this occasionally with other male clients.  She and her colleagues also discussed this phenomenon in their peer supervision group.

Although she was clear that she wouldn't act on her attraction based on ethical and clinical reasons, there was something different about this experience as compared to other earlier experiences that concerned her.

So, rather than ignoring her sexual attraction, she paid attention to it, and after her second session with Jim, she thought about whether there was something familiar about him that might be triggering these feelings.

She also talked to her own psychotherapist about this sexual attraction in her next therapy session.  Since her therapist, Ruth, knew Gina well from having worked with her in her analysis for over 15 years, Ruth listened intently as Gina described the sexual feelings that came over her during the first two sessions with Jim.

As Ruth listened to Gina describe this attraction, she realized that Jim had similar characteristics to Gina's husband, who died several years before.  She knew that even though Gina had gone through a period of grief and mourning, she still missed her husband a lot.  She also knew that Gina had been unable to motivate herself to begin dating again even though several years had passed, which left Gina feeling lonely.

As they talked about the similarities, including appearance, between Jim and Gina's late husband, Gina felt a deep sadness come over her that she had not felt since Jim died unexpectedly.  Although she saw the striking similarities between Jim and her late husband, Gina also saw the differences, and as she began to differentiate the two men and her feelings towards them, she began to feel a little better.

These feelings for Jim were also a signal to Gina that she needed to take better care of herself and that her loneliness signaled that she might be ready to explore dating again--even though she had mixed feelings about it.

During her next several sessions with her therapist, Gina explored her ambivalence about dating.  Part of her hesitation was that she continued to feel loyal to her late husband, and she wasn't sure how she would feel dating someone new.

But she agreed with her therapist, Ruth, that she could take it one step at a time, and she was under no obligation to date anyone.  So, she thought of her foray into dating as a way to explore her own feelings and the next step in her mourning process, which included an acceptance that her husband would never come back.

This acceptance that her husband was gone forever brought a new and deeper wave of grief for Gina. She knew from her own training and clinical experience that this was a normal part of grief and mourning as time went on.  So, she continued to talk to her therapist to address her own emotional needs in her therapy and separate out these needs from her work with her client, Jim.

As Gina took care of herself emotionally by talking to her therapist about her emotions and to her friends, who were also colleagues, about her attraction to Jim, she noticed that her attraction began to diminish.  Her work with Jim continued without interruption to his clinical process in sessions, and the therapy was going well.

A few weeks after Gina started seeing Jim as a therapy client, she noticed that she no longer felt an attraction to him.  She could see the resemblance and similarities to her late husband, but she also saw Jim clearly for himself as an individual.

Four months later, Gina began dating again.  She met a man who was also a widower and who understood her mixed feelings about dating.  As she continued to see him, she realized that her feelings for her late husband would never change, and there was room in her heart for both her late husband and for the new man that she was beginning to really like (see my article: A New Relationship: Understanding the Loyalty Dilemma For Someone Whose Spouse Died).

As her emotional needs were met in her therapy, with friends and colleagues and with the new man that she was dating, Gina felt more emotionally fulfilled.  With time, her client, Jim no longer reminded her of her husband because, although there was a physical resemblance, she could now differentiate more clearly that they were two very different men.

She was glad that she took care of herself and used her resources in therapy and among friends and colleagues to deal with the countertransference issues related to her therapy with Jim.  She recognized that, in many ways, it was similar to what occurred occasionally with other clients in the past, but she also saw why her feelings were so heightened with the similarities to her husband.

Conclusion
Both clients and therapists can develop sexual attractions for each other.  It's usually related to transference for the client and countertransference for the therapist.

Therapists have an ethical responsibility to be aware of their feelings and, for the sake of the client and the integrity of the therapy, not to act on their feelings.

Occasionally it happens that a therapist, who sought help in her own therapy, in supervision and among colleagues, is still unable to handle the countertransference, she has a ethical responsibility to refer the client to another therapist rather than act on her feelings or continue to be in conflict about them.

It's of utmost importance that therapists have a strong sense of self awareness and engage in self care so that they don't compromise a client's therapy.  As in the fictional scenario above, this means that the therapist must have the necessary skills and training to self reflect on her own internal process and do what she needs to do to take care of herself.

Although it was not discussed in this article, there are times when both the therapist and the client have a sexual attraction for each other.  In those cases, even if the client behaves in a seductive way, it's the therapist's responsibility not to cross a boundary with a client.  She must analyze her own feelings as well as the clients to understand the root of the issue for each of them and then proceed in an ethical manner to do what's best for the client while taking care of herself.

Getting Help in Therapy
Most well-trained psychotherapists are aware that they will occasionally feel an attraction for a client.      This is a common experience.  Most of them will also know that this probably has less to do with the client than it does with whatever is or isn't going on in their life.

Although sexual boundary violations do occur from time to time, most therapists take their Code of Ethics, which states that therapists cannot be in a dual relationship with a client, seriously.  They know it would be devastating to the client, their work together and it would also jeopardize their professional license if they crossed this ethical boundary.

If you're already in therapy and some of the issues in this article resonate with you, you would probably benefit from discussing them with your therapist or, if you're not comfortable with that, seeking a consultation with a different therapist to discuss what's going on in your therapy.  Most of the time these issues can be worked out, but if you tried and they can't be resolved, you can also seek help from another licensed therapist.

We all need help at some point in our lives.  If you're not in therapy and you're struggling with unresolved issues that are creating obstacles in your life, you deserve to get help from an experience licensed mental health professional.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, Somatic Experiencing and Emotionally Focused therapist, also known as EFT (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Is It Time to Reevaluate Your Therapy?

I've written many articles for this psychotherapy blog about how to find a psychotherapist that's right for you, and how you know if your therapy is working for you.

See my articles: 

How to Choose a Psychotherapist

Psychotherapy: Psychotherapists Listening and Learning From Clients

Psychotherapy: How Talking to a Psychotherapist is Different From Talking to a Frien

Being Honest With Your Psychotherapist  

In this article, I'm focusing on how you know if you need to reevaluate your therapy and recognizing some of the possible signs that your therapy might not be working for you.

Is It Time to Reevaluate Your Therapy?  Warning Sign:  Therapist Frequently  Falls Asleep in  Session

Consider Reevaluating Your Therapy Under the Following Circumstances:

• Your therapist misrepresented his or her skills, which you discover after you begin therapy.
• Your therapist lacks the professional skills to help you and is working outside the scope of his or her expertise.
• Your therapist lacks empathy for your problems.
• Your therapist doesn't respect your ethnic, religious, racial or cultural background.
• Your therapist talks too much about him or herself in your sessions.
• Your therapist hardly talks at all and you feel alone.
• Your therapist frequently falls asleep during your sessions.
• Your therapist can't remember basic information about you from one session to the next, and you have to keep repeating your story.
• Your therapist tries to be your friend instead of your therapist.
• Your therapist doesn't like that you're developing other sources of emotional support among healthy family members and friends.
• Your therapist frequently takes non-emergency calls during your sessions.
• Your therapist often misses appointments or shows up late.
• Your therapist has a belittling or dismissive attitude towards you.
• Your therapist uses your sessions to try to get advice from you during your sessions (e.g., you're a financial advisor and therapist tries to get financial advice).
• Your therapist thinks that his or her method of doing therapy is "the only way."
• Your therapist doesn't continue to develop his or her professional skills at seminars, workshops or online.
• Your therapist pressures you to confront family members when either you're not ready or you know it would be dangerous to do so.
• Your therapist promises you that you will be "cured" of your problem by seeing him or her.
• Your therapist breaks confidentiality by naming other clients.
• Your therapist breaks confidentiality by providing information about you without your permission or without a mandate.

Recognize even more serious "red flags" about your therapy under the following circumstances:

• Your therapist crosses boundaries by being seductive or trying to initiate a sexual relationship with you (see my article: Boundary Violations and Sexual Exploitation in Psychotherapy).
• Your therapist's license has been revoked.
• Your therapist has no license at all and never had one.
• Your therapist tries to borrow money from you.
• Your therapist appears to be emotionally unstable.
• Your therapist appears to be impaired on alcohol or drugs during your sessions.
• Your therapist attempts to push his or her religion on you.
• Your therapist becomes too emotional when you talk about your problems.
• Your therapist is frequently late or doesn't show up for your appointments.

Serious "Red Flags" in Your Therapy: Sexual Boundary Violations

Under the first category of items, if you've expressed your concern and your therapist hasn't changed his or her behavior or attitude, it's your right to tell your therapist that the therapy isn't working for you and you'll be seeking other help.

Under the second category of items, the "red flag" items, these problems in therapy are serious enough for you to discontinue therapy and look for someone else, especially in cases of serious boundary violations.

Conclusion
It's not always easy to recognize these problems, especially when you're in a vulnerable state, which is why I hope this article will be helpful to clients who aren't sure if they need to reevaluate or leave their therapy.

I have been a psychotherapist for over 20 years and I've known many therapists.  I believe that the vast majority of therapists are caring, qualified and ethical professionals.  Most therapists enter the field because they feel a calling to help clients and use their expertise in an appropriate and professional manner.

But, just as there are unethical people in any profession, there are cases where some therapists shouldn't be in the profession.

Even if none of these circumstances apply, if you think you're not making progress in therapy after a reasonable time, you've discussed this with your therapist and you still don't know how your therapist is going to help you to overcome your problem, consider that you and your therapist just might not be a good fit or your therapist lacks the skills to help you.

Making a change in your therapy can feel daunting, but continuing to work with a therapist when the therapy isn't right for you is a waste of your time and money.

If you find yourself in one of these unfortunate circumstances in your therapy and you're not sure what to do, it might be wise to have a consultation with an experienced, objective therapist to talk over your concerns so you can make a decision about what to do.

Finding the Right Therapist Can Make All the Difference For Your Emotional Healing

Once you've found a psychotherapist that is the right therapist for you, it can make all the difference in your journey toward healing.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individuals and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Also, see my articles:
The Therapist's Empathic Attunement in Therapy

Asking For What You Need in Therapy

Empowering Clients in Therapy - Part 1

Empowering Clients in Therapy - Part 2: Clinical Issues

Beyond the "Band Aid" Approach in Therapy

Ruptures and Repairs in Therapy

Psychotherapy and the Erotic Transference: When You "Fall In Love" With Your Therapist
What is EMDR Therapy?

Boundary Violations and Sexual Exploitation in Psychotherapy

Boundary violations between psychotherapists and clients often begin on the "slippery slope" with inappropriate self-disclosure by the therapist. In this article, I will focus on when boundary violations occur where there is sexual exploitation of clients by their psychotherapists.

Boundary Violations and Sexual Exploitation in Psychotherapy

What Are "Boundaries" in Psychotherapy?
The term "boundaries" in psychotherapy is a metaphorical term that refers to the definition and professional structure of the psychotherapy relationship. It defines the psychotherapeutic relationship as being different from a personal relationship or a friendship. The boundaries of the psychotherapeutic relationship include, but are not limited to, the time that the psychotherapist and client spend together in a professional setting, the fee arrangement, the psychotherapist's self-disclosure, the type and frequency of between-session phone calls, the prohibitions with regard to physical touch, and other related issues.

The purpose of maintaining appropriate professional boundaries in psychotherapy is, first and foremost, to protect the client from inappropriate behavior by the therapist which can be psychologically harmful. Secondly, maintaining appropriate professional boundaries also protects the therapist with regard to accusations of unethical and illegal behavior which could result in malpractice lawsuits, professional sanctions and, in the worst cases, revocation of professional licenses and/or arrests.

As I mentioned in my prior article, it is always the therapist's responsibility to maintain appropriate professional boundaries in treatment, regardless of whatever the client might do or the type of therapy.

How Often Do Boundary Violations Occur in Psychotherapeutic Relationships?
It is difficult to come up with accurate numbers because many boundary violations, especially sexual exploitation, are not reported. Many clients feel ashamed and blame themselves for the boundary violations.

Most boundary violations occur with male therapists who are older, more established, and also well trained. This is not to say that boundary violations never occur with female psychotherapists. However, based on available data, it seems to be less prevalent. In the US, it is estimated that nearly half of all malpractice suits are related to psychotherapists' sexual exploitation of clients and most of these suits are against psychiatrists.

The good news is that these type of boundary violations seem to have decreased somewhat over the years, possibly due to stiffer penalties, professional sanctions, refusal of malpractice insurance companies to provide insurance to therapists who have transgressed with clients, and better training. While this is good news, even one boundary violation between a therapist and a client is one too many.

Non-Sexual Boundary Violations that Can Lead Down the "Slippery Slope" to Sexual Exploitation:

Excessive self-disclosure: See prior blog post

Dual relationships:
Most mental health professionals' codes of ethics prohibit dual relationships because it is recognized that this is usually harmful for the client. The psychotherapeutic relationship should be the only relationship between therapist and client. Even when the dual relationship is not sexual, it violates the professional boundary between therapist and client. For instance, if a therapist has a client who happens to be stock broker, the therapist should not ask the client for stock market advice and, it goes without saying, that the therapist shouldn't ask the client to handle his or her money for stock market transactions. Once the professional boundaries have been breached, the treatment is placed at risk for even greater boundary violations.

Too Many Unnecessary Phone Calls Between Sessions:
While most therapists recognize the necessity of some phone calls between sessions to reschedule appointments or to help clients who are in a particular crisis, most therapists also know that too many unnecessary phone calls between sessions should be explored during in-person sessions with the client. Needless to say, I'm not talking about clients who are home bound or sick and have phone sessions with their therapists. Rather, I'm referring to clients who might not understand the professional treatment frame and who want to treat their therapist like a friend. As in all of these examples, it's up to the therapist to address the issue and set appropriate limits.

Therapist's Failure to Maintain the Treatment Frame:
While it is understood that there are times when certain clients might need extra time in a therapy session due to a crisis or they might need a temporary fee agreement due to financial necessity, when the therapist fails to maintain the treatment frame on a frequent basis with a particular client, this is usually indicative of the therapist's boundary violation in the treatment, which might be conscious or unconscious on the therapist's part.

I often work with clients on a sliding scale basis, when I have available open slots to do so. I have also extended my services to longstanding clients on a pro bono basis for a limited amount of time when they've lost their jobs. However, in all these instances, I've carefully considered the particular circumstances of the client and the nature of our professional relationship to make sure that I'm not enacting a boundary violation by giving "special treatment" to certain clients. If it's clear that a client can afford to pay the full fee, I see no reason to provide a sliding scale fee and I would see this as an unprofessional enactment with the client.

Touching or Frequent Hugs:
As a matter of course, I do not touch my clients. I am very aware that, for many clients, touching has particular inappropriate implications, especially for clients who were sexually abused, and even more so in cases of incest. The therapeutic relationship can often take on the appearance and feeling of a parent-child relationship. It's very important for the client to feel that he or she can trust the therapist. No matter how non-hierarchical or egalitarian a therapist might try to be, the client-therapist relationship is, by definition, an unequal relationship where the therapist has more power than the client--even in therapy relationships where the client is a therapist.

Like most examples, there are some limited exceptions. At the conclusion of a long-term therapy relationship, many clients spontaneously hug their therapists. This is usually an expression of their gratitude and caring for the therapist. While I don't initiate these hugs, I would not hurt a client's feelings by trying to ward off a hug under these circumstances.

The problems with touching and frequent hugs is that they can easily develop into more inappropriate seductive touching of an intimate or sexual nature, once again, crossing the therapeutic boundaries of treatment.

The above list is certainly not exhaustive, but it represents some of the more common non-sexual boundary violations that often lead to sexual boundary violations.

To illustrate the points that I have made above, the following fictionalized account is an example of a sexual boundary violation between a psychotherapist and his client:

Betty began attending psychotherapy sessions with Dr. Smith after she lost the third job in a row for getting sexually involved with her supervisor. Dr. Smith was highly recommended to her by a friend as a psychiatrist who was both a psychotherapist and psychopharmacologist.

Betty, who was in her mid-20s, had never been in therapy before, so she didn't know what to expect. Dr. Smith talked to her about what would be expected of her with regard to the treatment frame (i.e., coming to sessions regularly and on time, paying fees in a timely manner, the length of treatment sessions, and other related issues). He also talked to her about his professional obligations with her.

After several sessions, Betty began to have erotic feelings for Dr. Smith, which is not unusual in psychotherapy. This is often part of clients' transferential feelings for their therapist. Most of the time, these tranferential feelings have little to do with the therapist and more to do with the client's underlying, unconscious issues.

Betty tended to be seductive in her relationships with most people, including her professors, work supervisors and other authority figures in her life. At that point in the therapy, she was unaware of how she attempted to sexualize her relationships. So, it was not surprising when she began to come to therapy with revealing, low-cut blouses and short skirts.

When Dr. Smith addressed and explored this seductive behavior in therapy, Betty wasn't sure how to respond to this. In the past, due to her seductive nature and the fact that she was extremely attractive, most people responded to her seduction by engaging in sex with her. Although she usually felt powerful at first, these sexual encounters ended up being emotional disasters for her. It was the cause of many problems for her in college as well as in her work relationships with supervisors.

As the therapy progressed, it came to light that Betty had been sexually abused by her maternal uncle from the time that she was 10 until she was in her late teens. According to Betty, it began with inappropriate touching and progressed to sexual intercourse when she was in her teens. As an only child of a single, alcoholic mother, Betty craved attention and she was easy prey for her uncle, who lived with Betty and her mother.

Although she felt that her uncle's sexual attention was wrong, she was vulnerable to him because she was an emotionally neglected child. She also told herself that she must be "special" for her uncle to want to spend time with her in this way, so she never told anyone about it. The only reason that the incest stopped was because as Betty got older, her uncle, who turned out to be a pedophile with other children too, no longer found her sexually exciting. As is often the case with pedophiles, he needed to enact his sexual transgressions with children so he stopped approaching Betty in a sexual manner. And, even though she attempted to seduce him back into their incestuous relationship to get his attention, he "abandoned" her, presumably, for a younger child.

Having been sexually violated at such a young age, Betty learned to sexualize most of her relationships with men when she wanted attention. As a result, she continued to enact the sexual transgressions as an adult but, instead of being the one who was seduced, she took on the role of the sexual aggressor, albeit with adults and not children, to continue to get attention and gratify her emotional needs.

When Dr. Smith did not respond to her sexually provocative clothing in session, she began calling him between sessions "to chat." Dr. Smith responded to her calls by telling her that, unless she had an urgent matter or she needed to change an appointment time, she should wait for their next therapy session to talk to him. Undeterred, Betty began leaving frequent voicemail messages for Dr. Smith late at night, letting him know that she was thinking of him and couldn't wait to see him again.

At that point, Dr. Smith consulted with his former, more experienced clinical supervisor to get clinical advice on how to handle this client. His supervisor knew Dr. Smith well and knew him to be an ethical psychiatrist. However, he also knew that Dr. Smith was going through a tumultuous divorce, he was lonely, and he could be vulnerable to Betty's seduction. He reminded Dr. Smith of his professional and ethical obligations under their professional code of conduct. Then, he asked Dr. Smith about his countertransferential feelings for Betty. Dr. Smith admitted to his supervisor that he found Betty very attractive and sexually tantalizing, as most men probably would. However, he told his supervisor that he didn't want to cross the professional boundary with this client.

Dr. Smith's supervisor told him that if he could work out this issue with Betty, it could be an important breakthrough in her treatment and she could deal with the original incest rather than continuing to engage in sexual enactments. However, he also told him that if he thought that he might violate the therapist-client professional boundaries with Betty, he should refer her to another therapist, preferably a woman. Dr. Smith's supervisor knew that Dr. Smith had a narcissistic streak to his personality, and he assured him that referring the client to another therapist would not be considered a professional failure. Rather, it would be a wise move to protect the client and to protect himself from crossing the professional boundary, especially at a time when Dr. Smith was in so much emotional turmoil himself and he was feeling lonely.

Dr. Smith agreed to consider the wise advice of his clinical supervisor. He knew that he actually felt more tempted than he admitted to his supervisor to breach the professional boundaries of the relationship, but he also knew that he would perceive himself as a failure in this case if he referred Betty to a colleague, and he was determined to work through the transferential and countertransferential issues in this case.

As treatment continued, Betty continued to be seductive with Dr. Smith. The more he attempted to maintain the treatment frame, the more determined she appeared to be to violate it. He attempted to talk to Betty about her uncle's sexual abuse, but she would find ways to bring the conversation back to her erotic feelings for Dr. Smith.

During that same time, Dr. Smith was feeling increasing emotional pressure from his divorce proceedings, which became nasty and heated. He was receiving email messages from his wife telling him that she thought he was "less than a man" and he was "spineless." His lawyer encouraged him to settle on his wife's demands and put the whole thing behind him, but Dr. Smith didn't want to give up the battle.

This resulted in many sleepless nights, poor appetite, and the beginning of his isolation from friends, family and colleagues. Within a few months, he felt like an emotional wreck. He knew that he should probably take a short sabbatical from his private practice, but he didn't want to admit that he needed a rest, so he continued to see clients, including Betty.

At the end of a particularly difficult week where he had gotten very little sleep and he was emotionally and physically exhausted, Dr. Smith saw Betty for her usual weekly session. As usual, she was wearing a sexually provocative outfit and she talked to him about her erotic feelings for him. Whereas in the past, she limited herself to telling him that she was "turned on" by him and would like to have sex with him, this time, she was more sexually explicit. Dr. Smith felt himself getting sexually aroused, but he maintained his professional demeanor. However, by the end of the session, when Dr. Smith and Betty stood up for her to leave, she locked the door and began kissing him on the mouth. Emotionally depleted by his personal problems, Dr. Smith gave in to Betty's sexual advances during that session.

By the time Betty left, Dr. Smith began to panic and he called his clinical supervisor for an emergency session. His clinical supervisor met with Dr. Smith, reprimanded him for violating the client-therapist boundary, and told him that he needed to apologize to Betty and tell her that he could no longer see her and he would refer her to a female therapist. He told him take a sabbatical from his private practice, seek his own personal therapy to deal with this transgression and with his overwhelming personal problems, and consult with a malpractice attorney in case Betty took action against him.

He also told Dr. Smith that he was obligated to report this sexual exploitation to their ethics board who would investigate the case. In addition, he told Dr. Smith that if he did not agree to follow all of these recommendations, he would also report that to their professional ethics board immediately and advocate for his license to be suspended.

Dr. Smith felt a lot of remorse for crossing the client-therapist boundary. He knew that, regardless of his personal problems and regardless of how seductive Betty was, as a mental health professional, he was responsible for maintaining the professional boundary between them.
When he apologized to Betty and told her that he could not see her again, she was crushed. This boundary violation and termination of treatment represented a repetition of her earlier problems with her uncle. Dr. Smith referred Betty to a seasoned female colleague, admitting that he had violated the therapeutic relationship and expressing his remorse.

Over time, Betty was able to work through the sexual exploitation in her therapeutic relationship with Dr. Smith as well as the original incest with her uncle. It was not easy or quick, and Betty also tested the professional boundaries with the new therapist. However, ultimately, her therapy was a success.

Dr. Smith took a sabbatical from his private practice. He entered into his own personal therapy to deal with the boundary violation as well as his divorce and loneliness. He also consulted with a malpractice attorney. After long and careful consideration, he decided to change his career focus from his psychotherapy private practice to psychotherapy research.

As this fictionalized scenario demonstrates, even when the psychotherapist is determined to maintain professional boundaries and seeks out clinical supervision to deal with the erotic transference and countertransference, there are so many personal and professional factors that can jeopardize a treatment.

Psychotherapists need to be emotionally attuned to their own professional and personal vulnerabilities before they slide down the "slippery slope" of crossing boundaries with a client.

Although the fictionalized account that I presented was between a heterosexual therapist and client, these boundary violations also occur among gay and lesbian therapists and clients.

In most cases, sexual exploitation in psychotherapy doesn't occur immediately. It usually follows after minor boundary violations turn into larger violations, culminating in the most egregious violation of sexual exploitation.

Also, in many cases where there is sexual exploitation in therapy, the psychotherapist, and not the client, is the aggressor. So, it goes both ways.

I intentionally presented a fictionalized account where the client is seductive and has a history of seducing authority figures due to childhood incest because this is a common scenario. Also, I wanted to demonstrate that even if cases where clients are extremely seductive, the therapist is the one who is still accountable for maintainng profesional boundaries.

If you are a psychotherapist who has crossed professional boundaries with your client, it is very important that you seek clinical supervision, no matter how long youve been practicing or how experienced you are. In most cases, therapists who have violated clients' boundaries should also seek their own personal therapy to work through these issues and do some soul searching as to whether they are in the right profession.

If you are a client who has been sexually exploited in therapy, don't suffer in shame alone. Although it might be hard for you to trust another therapist again, first, seek out a psychotherapy recommendation from your doctor or a trusted friend to work through this abuse.

Second, if you should decide to take legal action against this therapist for what he or she did to you and because you suspect that the therapist might be perpetrating this inappropriate behavior with other clients, seek out the advice of the ethnics board for the professional organization with whom the therapist is affiliated. So, it would be the American Psychiatric Association for psychiatrists, the American Psychological Association for psychologists, and the National Association of Social Workers for clinical social workers. You can also seek out the advice of the ethnics department for the State licensing board, who provides licensure for that particular profession. You can find this information online for your particular State.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist.  

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.