When does sexual attraction turn into sexual misconduct?

Given that I’ve blogged about serious sexual misconduct cases in counselling and psychotherapy, @sameihuda on Twitter drew my attention to this article in BPS Research Digest. It deals with the tricky topic of when therapists develop a sense of sexual attraction to their clients.

The article refers only to when therapists have sexual feelings, not when this turns into actual sexual acts (fortunately, none of the therapists surveyed in the research cited had done this). I’ll give some thoughts on when this could happen.

Of those surveyed, 90 percent admitted to having felt attracted to a client on at least one occasion. I don’t think that’s particularly shameful. People feel attracted to other people all the time, including to people with whom it would be a seriously bad idea to actually try to take things further. Not just therapy clients; it could be your co-worker, or your best friend’s husband or wife. I’m sure there are far more occasions of it happening and people doing nothing than of times when people act on these thoughts. When this topic is discussed, professionals have a tendency to talk about transference and counter-transference, but for the life of me I can’t see why. It’s such an everyday, ordinary thing that it really doesn’t need any psychoanalytic concepts to explain it.

When this happens, I would hope that therapists would be honest with themselves about this, and in most cases they probably are. This is why psychotherapy training places so much emphasis on the therapist undergoing regular therapy and supervision – so you’re aware of what’s being brought from yourself into the room, and so you can learn to deal with what’s being brought in.

The research offers examples of both good and bad ways to respond.

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.

On the issue of clumsily reinforcing boundaries, this might be something to particularly consider if the therapist decides they need to pass the client on to a colleague. As a personal view, they should reflect on whether that actually needs to happen (which it doesn’t in all instances; and if it isn’t then it shouldn’t necessarily be rushed into as a decision). If it does need to happen, then it needs to be done in a careful, sensitive and non-rejecting way, so as not to harm the client.

Let’s move on to the question of when such thoughts and feelings (which, as I’ve said, I think are perfectly normal and not at all shameful), lead to actual actions, which by contrast would be the worst betrayal of a therapeutic relationship one could possibly commit. When does that happen?

I don’t have any research data to hand (if anyone knows of any, feel free to drop it into the comments section below) but anecdotal evidence seems to suggest that serious sexual misconduct doesn’t generally start with a perfectly normal session one week, and then the therapist and client having sex the next. More likely there’ll be other, lesser boundary breaches leading up to it.

The Professional Standards Authority’s Clear sexual boundaries between healthcare professionals and patients: responsibilities of healthcare professionals gives examples of such precursor breaches.

  • revealing intimate details to a patient during a professional consultation
  • giving or accepting social invitations
  • visiting a patient’s home unannounced and without a prior appointment
  • seeing patients outside of normal practice, for example when other staff are not there, appointments at unusual hours, not following normal patient appointment booking procedures or preferring a certain patient to have the last appointment of the day other than for clinical reasons
  • clinically unnecessary communications.

These are behaviours that both professionals and clients should keep a careful eye out for.

Now let’s have a look at the personalities of some of the people I’ve written about on this blog. There’s Palace Gate, struck off as a counselling service by the BACP after its director John Clapham was found to have groomed trainee and subordinate counsellors within his firm. The company responded to the allegations in a manner more befitting a cult than clinicians. They still have on their blog a long, rambling, paranoid article full of psychobabble and accusing the complainants of waging a “battle between therapists”.

Or there’s Ray Holland, who was struck off by the UK Council for Psychotherapy for serious sexual misconduct with an “evidently vulnerable client.” The UKCP found that he “threatened [the client] in order to prevent her from reporting the matter” and “spoke with the absence of empathy towards [the client] whom he said he believed was ‘a fantasist’.” After he was struck off, I found that he had rebranded himself and carried on practicing. He cited membership of various impressive-sounding but non-accredited therapy organisations, and renamed himself Ray Bott-Holland.

After I blogged about this, he sent me a legal threat, which I promptly sent viral on Twitter, and I referred RayBot to the answer given in Arkell v Pressdram. I never heard from his lawyer, if he ever had one in the first place.

There’s other cases, and by no means do I post online everything I’ve heard about every case. Some of what I’ve heard has been absolutely horrific. I remember receiving one account from a traumatised client, and not being able to get to sleep that night.

So, does this sound like the behaviour of ordinary professionals who behaved foolishly and got themselves out of their depth? No, it doesn’t. It sounds like the actions of highly dangerous and manipulative predators.

To conclude, I think it’s a normal thing for professionals to feel attracted to a client. However, if you’re a properly-trained, ethical therapist with good boundaries, it really isn’t difficult to not have sex with your clients.

On the other hand, psychotherapy is a profession where people sit in a room and hand over their darkest secrets and fears to another person. That gives the professional an enormous amount of power. With that in mind, one has consider the possibility that psychotherapy may be a very attractive career option to a psychopath.

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11 thoughts on “When does sexual attraction turn into sexual misconduct?

  1. It’s worth noting that different modalities of therapy have very different ideas about when revealing intimate details to a client during a professional consultation is and is not appropriate. There has been lots written on the subject and the boundary is not by any means rigid. It shouldn’t be assumed that every action of self-revelation is untherapeutic or abusive.

  2. The question of countertransference is interesting too.

    Those whose modalities include consideration of the transference and countertransference might report that erotic feelings can arise more strongly than in ordinary life and between client and therapist in a way that they would not were the same two people were not in a therapeutic relationship. This seems to me to be why it is not just ‘an ordinary thing’ and why so much emphasis is put on the meaning of the countertransference in those modalities and also why it is so important to be aware of it and not to act out when it arises.

    I wonder about modalities that don’t recognise these concepts. Do these unusual erotic feelings not occur in therapy under those modalities? Are they denied or suppressed? If they do occur, how are they understood? Is there more danger of acting out if such feelings are not seen as being a product of the unusual nature of therapeutic relationships rather than experienced as just ‘a normal thing’?

    I can understand why this might not be an issue in low impact modalities such as CBT, but I would have thought in any work with any depth, this is going to come up. It would seem to me to be wrong to hold a space for a client where these feelings are seen as unwelcome or ‘wrong’. They might be exactly where the client needs to go. Holding the therapeutic container firmly without acting out while being fully present to anything that arises, however difficult, seems to me to be the essential art of it. It is far from ordinary, but equally the further from ordinary it is, the more essential that the trust is not abused.

    • Not all abuse is premeditated, ultimately the only thing stopping you inadvertently becoming an abuser is your own judgement; so you have to balance the therapeutic benefit of your actions against the risk of misjudging. When you engage in the sorts of behaviour listed above you are working at the limits of the relationship’s boundaries, you’ve got a greatly reduced margin of error for misjudgement so you have to take extra care to make sure you stay within those boundaries.

      The tricky thing about expressing countertransferencal erotic feelings is that one way of acting them out is to express them, so whatever your modality you have to make sure that that is not the case before you do so. It’s not that some modalities don’t recognise these concepts, but rather they tend to focus sessions elsewhere; the feelings are not denied or suppressed, they are just not particularly relevant to the client’s situation. If needed they are addressed outside the counselling session in supervision and the counsellor’s personal therapy.

      • It’s interesting what you say about reduced margin of error for misjudgement. There seems to be an assumption that those who fall foul of this are monsters and psychopaths and doubtless some are. Perhaps there are also those who just make mistakes. That’s not to say that those mistakes are forgiveable or that suitable sanctions should not be applied, just to warn against rushng to demonise people.

  3. So is some abuse accidental then? I think there’s a real danger of painting sexual abusers as just ordinary folk who have made forgivable mistakes. We are not talking about one equal sexually attracting another equal; we are talking about someone, be they male or female, being vulnerable enough to enter an unusually intimate and also secret relationship where no other exists, with a trusted professional, be they male or female, who is expected to be aware of the power imbalance that exists between them and trained to be ethical within it. Acting on sexual feelings in that place where the relationship is not equal is an abuse, and I fail to see how the sexual abuse of a client could be anything other than premeditated given the amount of importance counselling training puts into self-awareness and reflection. Perhaps therapists who have given in to erotic countertransference (although let’s just be clear here, that’s just therapy jargon for sexual attraction) don’t like the label ‘sexual abuser’ but if the cap fits, as they say.

    To look at it another way….countertransference is just the counsellor’s reaction to the client. What if the countertransference was something darker than sexual attraction…for example, racist feelings towards a client, or feelings of disgust towards an obese client. Would we be talking about modalities and how to share these feelings with the client? I think we’d be talking about the therapist using supervision and perhaps their own therapy to ensure those feelings were not projected onto the client and thus risk being abusive or contaminating the therapeutic process in any way.

    • No abuse is not accidental. I hope nobody is being excused. I specifically said that such mistakes are unforgivable and require sanction. Abuse is abuse and needs calling out and naming. However, if we consider that some of these people might be ‘ordinary folk’ who have made unforgivable and disastrous mistakes rather than monsters then it’s clear that all therapists need to be constantly vigilent of their own behaviour. Everyone should be aware of the potential for harm in the power dynamics of the therapeutic relationship and very careful to avoid such mistakes and not just assume that there is no risk because they believe themselves to not be the monstrous type. Doubtless there are monsters around, also, but let nobody ignore their own potential capacity for harm and their responsibility for avoiding it. One of things about working with vulnerable people is that what might seem like a small error to the therapist might have huge consequences for the client, and it is the consequences by which actions should be judged.

      I am not aware of any modality that suggests that countertransference must be shared, but some suggest that a therapist should stay very aware of it and think about it carefully. Of course, supervision is where such things are best explored.

      • Trouble is, in all the cases of sexual misconduct involving therapists that I’ve written about, I can tell you exactly how many of them seemed like ordinary people who got out of their depth – none of them.

        In every case I’ve engaged with – Holland, Clapham etc, it became clear that I was dealing with dangerous predators. I know it sounds simplistic to say “they’re all monsters” but that’s exactly what these people are. That’s not a slur on psychotherapy as a profession, because I know there are plenty of decent people in the field, but looking at the evidence I’ve gathered, the conclusion I’ve come to is that psychopaths flock to psychotherapy because of the opportunities it provides to manipulate people.

    • The danger of characterising abuse as always being something that is carried out by monsters who set out to establish an abusive relationship is that it ignores the inherent risk that is in every therapeutic relationship regardless of the intention of the therapist.

      “Acting on sexual feelings” doesn’t just mean initiating sexual contact. You can act on a sexual feelings by smiling at a particular attractive client slightly more brightly than would normally do, is that abuse? As a therapist, basing your choices solely on your own sexual feelings and gratification is always wrong, and is always abusive; but sexual feeling can also influence choices that are justifiable on other grounds, and it’s sometimes hard to tell how much they are affecting your judgement.

      In any occupation that deals directly the wellbeing of others working beyond your competence is a form of abuse. If a carpenter doesn’t know his own limits and tries to build a cabinet that’s too complex then the result is badly made piece of furniture but nobody gets hurt, if a surgeon doesn’t know his own limits and tries to perform an operation that’s too complex then the result is harm to the patient. If you don’t handle your own emotions competently, whether they be sexual attraction, bigoted repulsion, compassion or anything else, then you run the risk of forming an abusive relationship with your client whether you want to or not.

      There are monsters who are attracted to counselling because of the opportunities for abuse the unequal relationship gives them, and the better they understand the boundaries of their relationships the more effective they are at establishing abusive relationships. There are also people who attracted to counselling to help others (hopefully the majority), and the better they understand the boundaries of their relationships the less likely they are to ever find themselves in the role of abuser.

  4. What do such people think about themselves? Are they really deliberately targeting therapy as a source of prey? Do they imagine that they are above basic human good conduct? Do they think if themselves as monsters?

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