19 May 2015

When does sexual attraction turn into sexual misconduct? by Phil Doré

This post is reblogged from The Not So Big Society Blog, written by Phil Doré, a mental health nurse with a niche interest in abuse by counsellors and psychotherapists.


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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