factors, or the environment, may play a part in facilitating the onset of an
abusive relationship. In pointing this out, I remove no responsibility from
the therapist. The responsibility of the abuse lies with the therapist because
the removal of constraints is planned by this professional.
3 Situational Factors of an Abusive Relationship
are three examples of situational factors being manipulated by the therapists to remove constraints.
-- 1. First, Mary's therapist told her to make a late appointment,
after the secretary had left.
-- 2. Second, he knew that her husband had
moved out following the divorce. He invited himself to her home for a "cup
-- 3. Third, he invited her to his house to read a copy
of the play he had written on a weekend, when his wife and two children were in
another city visiting relatives.
the situational factors, it might be interesting to note at this time that the
literature suggests the lower incidence of client abuse by social workers as opposed
to psychiatrists and other mental health professionals might be attributable to
their work situations. The work situation of a social worker working for an agency
is often the setting of a busy public office.
Intense Feelings Bound up in the Relationship
second warning sign, as mentioned earlier, is client vulnerability. Attachment
Theory plays a major role here. As you know, children develop attachments to their
parents, siblings, and other family members. The quality of these attachments
depends on a number of factors, including the consistency and availability of
the main parent figure, or "primary caretaker."
As was the case with
Mary, during her first three years, she was exposed to repeated parental absence,
emotional unavailability, and abuse. She thus developed a tendency for "anxious attachments," with clinging behavior and fears of being separated from significant
others. She learned about this abuse from an aunt. This abuse led to her tendency
to cling to important others, be possessive, and fear abandonment. As you know,
relationships based on such characteristics are sometimes called "symbiotic",
meaning that there is a psychological fusion of two people. The symbiotic relationship,
or in some cases codependent relationship, allows the person to avoid re-experiencing
the vulnerabilities and anxieties of childhood, thus causing a power imbalance
Idealizing the Professional
person is more likely to form a symbiotic relationship with a mental health professional.
As a result, they end up idealizing the professional clinging to them and fearing
abandonment. Specifically in the case of Mary, she was unable to leave the relationship,
even though it was damaging and exploitative. Kenneth Pope who wrote "Sexual
Involvement with Therapists" indicates connections between childhood abuse
and symbiotic or codependent relationships with an abusive therapist almost seems
to orchestrate the client's enslavement.
The Wish for an Omnipotent Rescuer - A Life and Death Matter
many of the clients we treat have had abusive childhoods. What was different in
the case of the abused client? The literature seems to incite a traumatic transference
often occurs at a certain level. I define a traumatic transference, as an intense,
life-or-death quality of the reaction by a survivor of childhood trauma to a person
in authority. The survivor's emotional responses have been changed by experiences
of terror and helplessness. Abused clients cast the mental health professional
in the role of omnipotent rescuer. However, at the same time, they state their
mistrust of them. Mary stated many doubts, suspicions, and feelings that she had
to try to control the therapist by giving into his sexual advances
4 Warning Signs
doubt, with Mary, the four warning signs indicated by Pope came in to play:
-- 1. First, Mary's idealization of the professional;
-- 2. Second, her wish for an omnipotent
-- 3. Third, her intense feelings bound up in the relationship;
-- 4. Fourth, her
impression that the survival of the treatment relationship was a life-and-death
All four of these factors lead to the power entrapment of a childhood
trauma victim with an abusive professional.
- Pope, Kenneth PhD and Bouhoutsos, Jacqueline. Sexual Intimacy Between Therapists and Patients. Praeger, New York, 1997.
Peer-Reviewed Journal Article References:
Bachelor, A., Meunier, G., Laverdiére, O., & Gamache, D. (2010). Client attachment to therapist: Relation to client personality and symptomatology, and their contributions to the therapeutic alliance. Psychotherapy: Theory, Research, Practice, Training, 47(4), 454–468.
Mallinckrodt, B., & Jeong, J. (2015). Meta-analysis of client attachment to therapist: Associations with working alliance and client pretherapy attachment. Psychotherapy, 52(1), 134–139.
O'Connor, S., Kivlighan, D. M., Jr., Hill, C. E., & Gelso, C. J. (2019). Therapist–client agreement about their working alliance: Associations with attachment styles. Journal of Counseling Psychology, 66(1), 83–93.
What are four warning signs that a client may be vulnerable to an abusive
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