pamphlets and lists have been produced for patients to help them detect when boundary
violations are occurring or may occur. For this reason, we feel the mental health
professional might be interested in the following information provided to consumers.
Warning signs of a possibility that the health professional could become sexually
exploitative include the following:
1. The health professional brings up
his personal problems.
2. Sex is brought up out of context, and discussion
of sex is emphasized in sessions. Sex may be put forward as the answer to the
3. Sessions are booked at odd hours or when there
are no other staff in the office.
4. Sessions are arranged outside the office,
or the patient is invited for a meal or other social occasion.
5. Forming a
close personal relationship with the professional is presented as part of the
6. The professional directs the patient on how to behave and what
to do in everyday life. This may include directions about engaging in certain
kinds of sexual behavior.
7. The professional presents himself as the expert
who has answers to every problem.
8. The patient is urged to become dependent
on the professional and to separate from family and close friends.
patients assertive behavior is criticized.
10. Touching, such as hand-holding
and hugging, is presented as a necessary or even central part of the treatment.
Alcohol or drugs, for use of the patient and professional, are made available
during office visits.
12. Gifts are given to the patient.
13. Personal letters
are written to the patient; unnecessary phone calls are made to the patient.
Fees, when applicable, are waived for treatment sessions.
15. The patient is
directed to alter her physical appearance or dress to become more sexually attractive.
The patient is not getting help for the problem that took her to the professional
in the first place. 17. The relationship feels uncomfortable, ambiguous,
or confusing to the patient.
18. With survivors of sexual abuse, the professional
seems to be titillated by details of the abuse.
Ethics - Ten
Scenarios That Lead to Personal Contact Boundary Violations
One way to
understand how abuse can be initiated by a professional is to examine the portrayals
of therapists characteristics or behavior that lead to sexual exploitation.
1. Role trading: Patient and therapist exchange roles, and the therapists
needs come first.
2. Sex therapy: The therapist manipulates the patient into
believing that sexual intimacy is a valid treatment technique.
3. As if . .
. : The therapist ignores the patients transference and assumes that their
intense and possibly erotic attachment is a sign that they are in love with the
4. Svengali: The therapist induces and takes advantage of an intense
dependency on the part of the patient.
5. Drugs: These are used to facilitate
6. Rape: Threats, intimidation, or physical force are used by
7. True love: The therapist conceptualizes the relationship
as a courtship or romance and tries to discount the formal professional nature
of the relationship.
8. It just got out of hand: The therapist does not give
sufficient attention, care, and respect to the emotional intimacy that develops
in the therapy.
9. Time out: The therapist considers that the principles and
expectations of the therapeutic relationship cease to exist between scheduled
sessions or outside the therapists office.
10. Hold me: The therapist
takes advantage of the patients need for physical contact and the possible
confusion between this and erotic contact.
Kenneth S. Pope
Sexual Boundary Violations by Health Professionals -
An Overview of the Published Empirical Literature
- Halter, M. Brown, H., and Stone, J. (2007). Sexual Boundary Violations by Health Professionals – an overview of the published empirical literature. The Council for Healthcare Regulatory Excellence.
Peer-Reviewed Journal Article References:
Kim, S., & Rutherford, A. (2015). From seduction to sexism: Feminists challenge the ethics of therapist–client sexual relations in 1970s america.History of Psychology, 18(3), 283–296.
Pizer, B. (2017). “Why can’t we be lovers?” When the price of love is loss of love: Boundary violations in a clinical context.Psychoanalytic Psychology, 34(2), 163–168.
Summers, F. (2017). Sexual relationships between patient and therapist: Boundary violation or collapse of the therapeutic space?Psychoanalytic Psychology, 34(2), 175–181. The article above contains foundational information. Articles below contain optional updates.
Ethics CEU QUESTION
18 What are potential clients warned about concerning boundaries and the
power dynamic in consumer information? To select and enter your answer go to Ethics CE Test.
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