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image_nav_button_3When Professionals Exploit Their Clients/Patients/Students

Professionals in mental health-related services, psychologists, psychiatrists, counselors, therapists, ministers, as well as doctors, nurses, attorneys, professors, educators, social workers, emergency / crisis / victim services, and law enforcement officers are entrusted and empowered by society to have authority and power in people’s lives.

“I was hurting deeply when I made my first appointment with him. It seemed like I couldn’t cope with life anymore. I was deeply depressed and I trusted him to help me. He convinced me he knew what was best for me. Somehow we became sexually involved. Now, a year later, I hurt a thousand times worse than I ever imagined. I feel used, exploited, violated, and shattered. To think, I paid for him to do this to me! I don’t think I’ll be able to trust anyone ever again.”

This power gives them the opportunity, by virtue of their professional role, to serve and help others. If this power is abused; if a client’s dependence on a professional is exploited, the client is almost always injured and the professional has betrayed the client’s and society’s trust. When a client is sexually exploited, the wounds can be particularly deep. It is a violation that goes beyond physical violation. It is an emotional, psychological, and sometimes spiritual violation. It is the most intimate way a person can be abused.

Professional standards and codes of ethics emphatically state that having a sexual relationship with a client is highly unethical and unprofessional behavior, and is forbidden. In fact, it is illegal in many states.

“At first, my counselor really helped me through a difficult part of my life. I felt like he really cared. I shared my deepest innermost self with him. Over time, he began telling me how hard his life was and how unhappy he was in his marriage. One day, he leaned forward and kissed me, the next thing I knew, we were making love right there in his office. I knew it was wrong, but for some reason, I just couldn’t tell him NO. That was the beginning of what later became a nightmare in my life.”

Why such high standards? Because people can be deeply injured by professionals who exploit them. Therefore, it is not considered permissible behavior. Also, in order for a professional to possess the power and authority and trust they require to carry out their role in helping clients, they have to be trustworthy as professionals to not abuse their clients. If counselors or doctors had a reputation of abusing their clients, clients would never allow themselves to be vulnerable to the degree necessary in psychotherapy or medicine. Thus when professionals abuse their power and position, they not only injure the client and violate society’s trust, they also damage their entire profession. This is why the standards of professional conduct and codes of ethics and laws make it clear. Sexual exploitation of clients is not to be tolerated, and it is the professional’s responsibility to ensure this does not happen.

For someone who has been sexually exploited by a professional, reactions are unique and individual, but the consequences sometimes can be devastating, with many resultant problems, symptoms, and emotions:1

The Impact of Sexual Exploitation of Clients

depressionanxiety disordersdissociation
dysthymiapost traumatic stress disorderchronic fatigue
intense psychological distress at exposure to internal or external cuesphysiological reactivity upon exposure to internal cuesincreased risk of suicide
psychiatric hospitalizationsfeelings of betrayal & abandonmentisolation and sense of profound & pervasive emptiness
nightmaresdivorceinsomnia
sexual dysfunctionintrusive thoughts & imagesdisruption of significant relationships
alienation from familyemotional withdrawalmistrust of others, especially authorities
faith & spiritual crisesconflicting emotionssense of despair / hopelessness
changes in appetitesubstance abusedifficulty with memory
self devaluationlowered self-esteemspontaneous crying
intense guilt / shameintense anger / ragehatred
confusionnauseaextreme fear
humiliationembarrassmentirritability
griefremorse

This is some of the harm that can be caused by professionals who exploit the emotional vulnerability of their clients by pursuing a sexual relationship with them. This can be a very deep and complex violation of the client, betraying the intimate vulnerability and trust imparted on the professional by the client. The emotional and psychological injury might not be due to just sexual contact, but may also be a result of the broader boundary violations or other forms of exploitation that may have taken place. Ironically this harm is being caused by professionals originally entrusted by clients to help them, not harm them. Not only do clients not get the help they needed, but instead, the original reasons for seeking help may be greatly exacerbated.

“My husband was the one who encouraged me to make an appointment to see this counselor. Now, four months later, how do I tell my husband that I am having an affair with my counselor? My God, I can’t believe this is happening!”

Sexual exploitation by professionals is a serious societal problem with an alarming prevalence. Current estimates are that one-third2 of all money awarded for medical malpractice is for damages for sexual misconduct. (In some specific professions, such as psychology, this monetary figure is estimated at greater than fifty percent!3) Sexual exploitation by professionals has come to be recognized as a problem of great magnitude in recent years. A PRNewswire report4 states:

“According to a survey reported in the Journal of the American Medical Association (JAMA), 1O% of psychiatrists admitted to having sexual relations with their patients. However, in a survey reported by the American Journal of Ortho Psychiatry, 65% of the psychiatrists who were asked stated they knew of a colleague having or having had sexual relations with their patients or with a patient. In a July 1997 report, published by the Public Citizen Health Research Group, 28% of psychiatrists were disciplined for sex-related offenses, which is a figure far higher than any of the other medical specialty groups. A 1973 report found an incredible 51% of psychiatrists involved in sexual crimes or relations with patients. Overall, psychiatrists rise far above the national scale on sexual offenses.”

Studies indicate that as many as 10 to 12 percent of male therapists sexually exploit clients at some point in their career. For many, this is not a single incident, but instead is a repeated behavior. For clients abused in this way, as many as 90 percent suffer serious consequences. Tremendous harm can result from this prevalent form of abuse.

This is tragic, considering clients run the risk of being exploited and abused, when what they were seeking was help, not abuse. As authors Friedman and Boumil state in their book, “Betrayal of Trust: Sex and Power in Professional Relationships“:

“there is absolutely nothing romantic about it. It is not about love; it is really not even about sex. It is about power and exploitation. It is about what happens when an unethical professional encounters a psychologically vulnerable patient, client, student, or other and decides to use her trust in him, primarily engendered by his power and position, to his own advantage – with little regard to the consequences for her.”

The consequences are far-reaching, and can cause a damaging or harmful impact on persons close to the victim6,7 such a spouse or family or friends.

“I admired him so much and I was flattered when he admitted that he found me attractive. At first it seemed so romantic. I don’t know what happened. I feel like I lost touch with who I am and all that I believed about myself. This has hurt me so bad. I can’t trust anyone anymore. I feel so alone in my pain. Each day, it hurts to even wake up.”

“I admired him so much and I was flattered when he admitted that he found me attractive.  At first it seemed so romantic.  I don’t know what happened.  I feel like I lost touch with who I am and all that I believed about myself.  This has hurt me so bad.  I can’t trust anyone anymore.  I feel so alone in my pain.  Each day, it hurts to even wake up.”

Victims often find themselves feeling very isolated in this form of abuse. They often do not know where to turn for help. People who do not understand the real issues involved in this form of exploitation, sometimes do not even realize this is abuse, especially when they consider the sexual relationship appears to be “consensual”. The client herself/himself, might initially feel they are somehow responsible for the abuse because they consented. The truth is that there is often such a severe imbalance of “power” in the relationship that the possibility of true consent does not exist8. The vulnerable client can be unfairly influenced and exploited through this power imbalance, especially in relationships where a psychological phenomena called “transference”9 frequently occurs, or where the client is very emotionally dependent on the professional.

Because of the prevalence of this problem in the mental health community, numerous states have created “Sexual Exploitation” laws which strictly prohibit professionals in the mental health community, or anyone who purports to provide mental health services, licensed or unlicensed, from sexually exploiting their clients or even former clients. Concerning the question of the client’s “consent” in the sexual relationship, the imbalance of power and the potential for abusing a client’s vulnerability is so strong in these cases, that civil statutes explicitly prohibit the fact that the client may have “consented” from being considered in the case. In some states, penal codes consider this form of abuse to be a second degree felony, defining it as a form of sexual assault.

“My wife had an affair with our minister. He counseled us many times on marital issues, and I was shocked beyond belief when I found out about the affair. I feel so doubly betrayed. I even feel betrayed by God. During their affair, I began to sense that something was wrong. My wife became increasingly depressed and ultimately suicidal. After one of her suicide attempts nearly succeeded, I learned what had been happening. A subsequent counselor has helped us work through this, but it is a slow and painful process. The issues are different than in a “normal affair.” In fact, our present counselor insists we should not refer to this as an ‘affair’. This was abuse.”

Despite the existence of these laws, most cases of this abuse are not reported, and the process of going through legal channels sometimes further traumatizes and discourages victims. Thus, most victims suffer in silence. Tragically, some even attempt suicide. But the good news is that there is hope, and there is help available.

“Sexual harassment” gets a lot of media coverage, yet differs from “sexual exploitation” by professionals. Of course, sexual harassment is indeed degrading, violating, abusive, and harmful but sometimes the harm from sexual exploitation can be much greater, leaving much deeper wounds.

Sources:

1. Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (1994) and Pamela K. Sutherland, “Sexual Abuse by Therapists, Physicians, Attorneys, and Other Professionals” and Joel Friedman and Marcia Mobilia Boumil, “Betrayal of Trust: Sex and Power in Professional Relationships”, p. 109-113 and Signe L. Nestingen, “Breach of Trust – Sexual Exploitation by Health Care Professionals and Clergy” (John Gonsiorek, Editor), “Transforming Power – Women Who Have Been Exploited by a Professional”, p. 82

2. Joel Friedman and Marcia Mobilia Boumil, “Betrayal of Trust: Sex and Power in Professional Relationships”, Introduction

3. Gary Richard Schoener, “Assessment & Rehabilitation of Psychotherapists Who Violate Boundaries With Clients”

4. PRNewswire, Pinellas, Fla., 09/14/97

5. Joel Friedman and Marcia Mobilia Boumil, “Betrayal of Trust: Sex and Power in Professional Relationships”, p. 10

6. Steven B. Bisbing, Linda M. Jorgenson, Pamela K. Sutherland, “Sexual Abuse by Professionals: A Legal Guide”, section 6-6(b) “Third Parties as Secondary Victims”, which references: Jeanette Milgrom, “Secondary Victim of Sexual Exploitation by Counselors and Therapists: Some Observations”

7. Ellen Thompson Luepker, “Breach of Trust – Sexual Exploitation by Health Care Professionals and Clergy” (John Gonsiorek, Editor), “Helping Direct and Associate Victims to Restore Connections After Practitioner Sexual Misconduct”, p. 112

8. Marilyn R. Peterson, “At Personal Risk – Boundary Violations in Professional-Client Relationships”, p. 122-125 Joel Friedman and Marcia Mobilia Boumil, “Betrayal of Trust: Sex and Power in Professional Relationships”, p. 3-4

9. Joel Friedman and Marcia Mobilia Boumil, “Betrayal of Trust: Sex and Power in Professional Relationships”, p. 20-22

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