Sexual Exploitation of Clients by Professionals
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When 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.  

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.

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

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.

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 indicate⁵ 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 victim^6,7 such a spouse or family or friends.

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.

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.  With this Web site (http://www.advocateweb.org/hope), we hope to provide survivors of this form of abuse with some resources to help them in their recovery, and we hope these resources are also helpful for professionals in reducing the prevalence of this problem.

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