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Ethical Boundaries in Balancing the Power Dynamic in the Therapeutic Relationship
Ethics Boundaries continuing education MFT CEUs

Section 7
Mental Health Professionals with Mental Illness

Ethics CEU Question 7 | Ethics CE Test | Table of Contents | Boundaries
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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Phyllis Chesler, in her book "Women and Madness," indicates victims report that the professionals who abused them were going through life crises or changes. If you recall Russ, the therapist that treated Mary, indicated he was unhappy with his marriage.

Chesler indicated one victim, who felt that her psychiatrist was too familiar during her first session with him, reported that "he kissed me, and asked if he could visit me on his way home." She cancelled any follow-up sessions and later discovered "the psychiatrist was in the process of a divorce."

Josephine, whose female psychologist had recently gone through a marriage breakdown, confided, "She kept telling me that I was uptight about my body. So she suggested that we go to the nude swimming session at the YWCA together. Afterwards, she asked me back to her apartment."

Perfunctory sex was a common experience with abusive professionals, as described by the nine women abused by therapists in the Chesler study. The professional appeared to be interested only in his or her own sexual needs, and had no interest in the emotional or sexual gratification of their patients or clients.

♦ Incest Victims
Chesler states there is a tendency for professionals to abuse incest victims shortly after they disclose their abuse. This could be linked to a perception of the incest victim as having been "publicly deflowered" and therefore no longer deserving of protection or respect. Thus the mental health professional may view the incest victim as "fair game," and may excuse his or her seduction of the client by telling themselves that they cannot do the client any further harm.

The abused child, trained to please men, may engage in a kind of ritualized seductive behavior that arouses the professional and permits him to believe that the child has an adult desire for sex with him. Because the victim has low self-esteem and may believe that no man will care for him/her without a sexual relationship, the victim may feel that sexual involvement with the professional is a necessary price to pay for his attention.

♦ Stone's 6 Types of Sexually Abusive Mental Health Professionals
Based on his clinical experience, Alan Stone proposed a typology of sexually abusive mental health professionals. Interestingly, Stone makes no mention of female therapists. We'll discuss his focus on male therapists later. The six types of therapists are as follows:
1. The therapist who is middle-aged, depressed, and has problems in his own marriage. He usually gets involved with a younger female client, to whom he tells his troubles. Sometimes the client is led to believe that the therapist is contemplating divorcing his wife and marrying the client.
2. The manipulative and sociopathic therapist is exploiting his position and its opportunities with a goal of self-gratification.
3. The therapist who uses patients to satisfy perverse instincts. This group includes therapists who drug their patients into unconsciousness and then have sex with them. Unlike the other examples, this does not involve an exploitation of transference, of the patient's view of the therapist as a parent- like figure.
4. The charming, expansive, grandiose therapist who wants to be loved by his female patients, particularly if they are young and attractive. He initiates hugging and kissing early in the therapy, and goes on from there.
5. The therapist who sees himself as "progressive" and believes that this includes sexual contact with his patients.
6. The introverted and withdrawn therapist who is very uncomfortable with interpersonal intimacy. If a patient appears to be intensely sexually attracted to him, he succumbs. He may contend that the patient seduced him, but is likely to feel guilty and will probably confess.

♦ Schoener's 6 Types of Sexually Exploitative Therapists
Another typology of sexually exploitative therapists, again with six categories, has been developed by Schoener and his associates at the Minnesota Walk-In Counseling Center. The clusters are as follows:
1. Naive and uninformed: This group includes trainees and poorly trained therapists who may lack knowledge of professional standards and the importance of boundaries.
2. Healthy or mildly neurotic: Minimal sexual contact or comprises in a single episode leading to remorse and requests for help are common.
3. Severely neurotic: This group has severe, long-standing emotional problems and focus on getting their personal needs met in the work setting. As intimacy grows in a therapeutic relationship, these therapists play seductive games, talk about themselves, use touch excessively, and arrange business or social involvements outside counseling.
4. Character disorders with impulse control problems: These therapists have a variety of problems which may include legal difficulties; they have little or no appreciation of the effect of their impulsive and inappropriate behavior on others, and tend to deny or minimize any harm they have caused.
5. Sociopathic or narcissistic character disorders: These therapists are adept in manipulating clients and professional colleagues; they are cool and calculating, able to cunningly seduce a variety of clients and cover their tracks.
6. Psychotic or borderline personality disorders: These therapists are more obviously mentally ill, with poor judgment and a tenuous grasp on reality.

How do you feel after hearing this list of Stone's typology of sexually abusive mental health professionals? Do you feel a knot in your stomach right now? Is this material difficult for you to hear? I know for me it is because the thought of this existing in our profession is unthinkable. However, as stated at the beginning of this course, it is hoped that by bringing these "uncomfortable" professional imbalances to light, the veil of secrecy will be somewhat lifted from this emotionally charged area, which most have felt is not an actual issue to be considered for discussion today.

Peer-Reviewed Journal Article References:
Boyd, J. E., Zeiss, A., Reddy, S., & Skinner, S. (2016). Accomplishments of 77 VA mental health professionals with a lived experience of mental illness. American Journal of Orthopsychiatry86(6), 610–619.

Elliott, M., & Ragsdale, J. M. (2020). Mental health professionals with mental illnesses: A qualitative interview study. American Journal of Orthopsychiatry90(6), 677–686.

Moody, K. J., Pomerantz, A. M., Ro, E., & Segrist, D. J. (2021). “Me too, a long time ago”: Therapist self-disclosure of past or present psychological problems similar to those of the client. Practice Innovations. Advance online publication.

Spaulding, W. (2016). Introduction to the special section: Mental health professionals with mental illness. American Journal of Orthopsychiatry, 86(6), 603.

Whitten, L. (2020). Stigma matters: An African American psychology professor comes out of the mental illness closet. Psychological Services. Advance online publication.

What are the six categories listed in Schoener's typology of abuse (as referenced in - Schoener, GR, Ph.D. "Boundaries in Group Therapy: Ethical and Practice Issues." Women and Group Psychotherapy, New York, Builford Press, 2001)? To select and enter your answer go to Ethics CE Test.

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