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Litigating Sexual
Misconduct Cases -- A Plaintiffs' Attorney's Perspective
C. Characteristics of Perpetrator/Victim
Sexual exploitation of patients happens due to characteristics of the psychotherapeutic
relationship and characteristics of the individual psychotherapists. Patients enter the
relationship vulnerable and trusting of the therapist to make them better.[23]
The intimacy present in the therapeutic relationship lends itself to sexual acting out.
The American Psychiatric Association has warned: "[T]he necessary intensity of the
therapeutic relationship may tend to activate sexual and other needs and fantasies on the
part of both patient and therapist, while weakening the objectivity necessary for
control."[24]
Transference also plays a role in the sexualization of therapy. Transference describes
the phenomenon in which the patient ascribes both positive and negative feelings the
patient has about others in the patient's past and present life to the therapist. One
court noted the difficulty this presents for the treating therapist:
The therapist must encourage the patient to express her transferred feelings, while
rejecting her erotic advances; at the same time, he must explain to the patient that her
feelings are not really for him, but that she is using him in a symbolic role to react to
some other significant person in her life. Inshort, the therapist must both encourage
transference and discourage certainaspects of it. This may be difficult to do and presents
an occupational risk. The therapeutic alliance in this situation gives rise to a duty,
imposed by professional standards of care as well as ethical standards of behavior, to
refrain from a personal relationship with the patient, whether during or outside therapy
sessions. This is because the personal relationship infects the therapy treatment,
rendering it ineffective and even harmful.[25]
There appear to be no common traits among the patients who are sexually exploited by
their therapists, other than that they are vulnerable,[26]
they tend to be female[27] and they tend to be
substantially younger than their therapist.[28] The
Minnesota Walk-In Counseling Center reports that with the more than 2000 victims of
therapist sexual abuse, little else is "standard."
Therapists who exploit their patients are usually male[29]
and are, correspondingly, substantially older than their victims.[30] Studies show that therapists who sexually exploit
do so more than once.[31] These therapists may run
the gamut in personal characteristics from the psychotic to the psychopathic "repeat
offender" to the "lovesick" therapist.[32]
The lovesick therapist has been most commonly identified as an older, narcissistic male in
the midst of marital difficulties.[33] The most
common scenario involving the lovesick therapist finds the therapist feeling lonely and
vulnerable, and gradually beginning to become overinvolved with a certain patient. This
overinvolvement starts with "slippery slope" boundary violations of a non-sexual
nature, which then escalates into sexual contact with the patient.
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Disclaimer
Exploitation
