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

Section 4
Relational Autonomy

CEU Question 4 | Ethics CEU Test | Table of Contents | Boundaries
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

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Although clients who are being sexually exploited by mental health professionals are not living with the professional or obviously not being physically restrained in their offices, there do seem to be some parallels with battered women, hostages, captives, and cult followers, in the sense that these victims have experienced a kind of "psychological transformation" with respect to the professional who is abusing them.

The intense entanglement, merging of identity, isolation, secrecy, loss of self, suspension of values and moral principles, compliance, and subordination cement the person to the abuser and continue to bend his or her reality after escape. Yet survivors do resist, fight back, try to reclaim their identity, and look for other ways to build their self-esteem. They thwart the professional's domination and numbness to their feelings, as well as their loss of energy and interest, and vivid memories or "flashbacks" of the abuse.

♦ The Inner Struggle of Battered Women
Herman disputes portrayals of battered women and other chronically traumatized people as apathetic or defeated. He depicts an inner struggle that is much livelier and more complex. While the victim has not given up, she tends to be extremely vigilant and careful, knowing that any action can have potentially dire consequences. If captivity is prolonged, the enforced relationship with the captor comes to monopolize the victim's inner life, and continues, even after release, to engross the victim's attention. Although perhaps fearful that her former captor will hunt her down, or re-imprison her, at the same time she may feel confused, empty, and worthless without him.

♦ "Robotization"
As you know, in abusive relationships, under extreme duress captives can be broken. A wife, for example, may enter a state of "robotization," experiencing a shutdown of thoughts, feelings, judgment, and initiative. In the movie, "American Beauty" starring Kevin Spacey, the wife of the husband living next door, totally depicts this robotization. Her husband, an ex-military man, is extraordinarily controlling and perfectionistic.

One scene depicts the couple sitting on the couch watching TV. The wife is so shut down that she is sitting stoically, robot-like, angled away from her husband, totally non-reactive to the program being "watched." In other scenes, she is so shut down that she stares robot-like often into space, totally disconnected to others around her, responding emotionlessly in a brief mechanical manner.

♦ Loss of Inner Autonomy
Inner autonomy, moral principles, world-view, and a sense of connection with others are also lost. A survivor of abuse, forced into pornography and prostitution, states "The very thought of escape was terrifying. I had been degraded in every possible way, stripped of all dignity, reduced to an animal and then to a vegetable. Whatever strength I had began to disappear. Simple survival took everything; making it all the way to tomorrow was a victory."

In this state of psychological degradation, which is still reversible, victims may alternate between complete submission and more active resistance. People in extreme situations, such as Nazi extermination camps, sometimes reached a second stage, which was one of total surrender, finally losing the will to live. Sometimes, on the verge of this surrender, captives reach a turning point and begin a fight for their lives.

"I decided that I would not die."
Patti Hearst, kept captive in a closet, describes growing steadily weaker, exhausted, drained, and tired. She wanted nothing more than to sleep, but realized that this could be fatal. Suddenly, aware of the danger, "My mind . . . was alive and alert to all this. I could see what was happening to me, as if I were outside myself. A silent battle was waged there in the closet, and my mind won. Deliberately and clearly, I decided that I would not die, not of my own accord. I would fight with everything in my power to survive."

Peer-Reviewed Journal Article References:
Girme, Y. U., Overall, N. C., & Hammond, M. D. (2019). Facilitating autonomy in interdependent relationships: Invisible support facilitates highly avoidant individuals’ autonomy. Journal of Family Psychology33(2), 154–165.

Kachanoff, F. J., & Taylor, D. M., Caouette, J., & Khullar, T. H., & Wohl, M. J. A. (January 2019). The chains on all my people are the chains on me: Restrictions to collective autonomy undermine the personal autonomy and psychological well-being of group members. Journal of Personality and Social Psychology, 116(1),141-165.

Levine, S. L., Holding, A. C., Milyavskaya, M., Powers, T. A., & Koestner, R. (2021). Collaborative autonomy: The dynamic relations between personal goal autonomy and perceived autonomy support in emerging adulthood results in positive affect and goal progress. Motivation Science, 7(2), 145–152.

Quill, T. E. (2002). Autonomy in a relational context: Balancing individual, family, cultural, and medical interests. Families, Systems, & Health, 20(3), 229–232.

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