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Clinical Supervision: Models, Role, Legal & Ethical, & Transference
On the last track, we discussed discuss training supervisees in ten steps that can help a therapist cope with a client who might be at risk for suicide.
On this track, we will discuss sexual attraction to clients, and determining appropriate levels of nonsexual physical contact with clients. You might consider playing this track for your clinical supervisee early in your supervisor relationship, as a means to open the discussion, should issues arise later.
I find it beneficial to provide my supervisees with the following statistics regarding sexual attraction towards clients. You might consider playing this track during one of your sessions.
As you may be aware, sexual attraction to clients is a common occurrence. A national study by Pope found that 87% of therapists reported that they had experienced attraction towards a client during their practice. The study found that this was more commonly experienced by male therapists, 95% of whom experienced attraction to a client. Attraction to clients was also common among female therapists, 76 percent of whom had at one time felt attracted to a client.
However, 82% of these therapists reporting an experience of attraction noted that they had never seriously considered engaging in sex with that client. I find by providing this information up front, at the beginning of the supervisor relationship, the topic becomes less taboo and the door has been opened for future discussion.
Pope’s study also found that 63% of therapists surveyed who felt attraction to a client felt guilty, anxious, and confused because of the attraction. Because of this, one fifth of the therapist kept the attraction a complete secret, and did not mention the attraction to the client, to their supervisor, or to their own therapists. However, over one fourth of these same therapists reported having sexual fantasies about the client while engaging in sex with someone else.
Helping Supervisees Deal with Sexual Attraction to Clients
I feel that it is an ethical responsibility of supervisors to provide training regarding attraction to clients. To enhance training regarding attraction to clients, I try to ensure that the supervisory relationship is a safe and supportive environment in which these issues can be disclosed and discussed. I also feel that it is important to tell my supervisees that it is not unethical to feel attracted to a client, and is in fact a common experience. What is an important ethical responsibility is to acknowledge and address the attraction right away, to act carefully, and to take appropriate action to address the issue thoroughly.
3 Mechanisms for Helping Supervisees Deal with Sexual Attraction
I also feel that it is necessary to discuss the issue of, physical-contact with-clients, with my supervisees. As you know, many therapists go to great lengths to ensure a complete absence of physical contact with their clients, in case a physical touch might be misinterpreted. Take a few seconds to assess where you are at regarding physical contact with your clients.
Appropriate Physical Contact
I also feel that it is important to discuss openly with my supervisees what may be considered appropriate physical contact with clients. Of course, it is important first to become familiar with state or organizational regulations regarding physical contact. Outside of these guidelines, I explain to my supervisees that there are three conditions for determining whether therapist-client physical contact is appropriate.
3 Conditions for Determining if Physical Contact is Appropriate
Obviously, when not based upon clinical needs, even nonsexual touch can be experienced by the client as intrusive, demeaning, or even frightening. However, I realize many agencies have a no-touch policy, which may have legal precedence in your state due to specific client-therapist sexual harassment litigation.
I have found that many clinical supervisees who have in the past not had a chance to discuss and explore the issues of nonsexual touch and sexual attraction to clients react in two distinct ways. Here’s an example. My supervisee Danielle’s unresolved concerns over client-therapist sexual intimacies resulted in her avoiding any contact or physical closeness or proximity with her clients, often in an exaggerated manner.
Via a two-way mirror observation, I noted Danielle’s unusual distance from the client as she would clearly step far away in seeing her to the door, so as to stay greater than an arm’s-length away from her client. You might even say Danielle reacted in a phobic sort of fear.
However, my supervisee Trisha reacted counterphobically. By that I mean Trisha overcompensated for her fear of client contact. I observed that Trisha engaged in handshaking and nonsexual hugs excessively. Trisha stated, "by hugging my clients, they can see that I’m comfortable with physical touching, and I don’t have any sexual impulses towards them!"
In addition to phobic avoidance of client contact and counterphobic overcompensation; I have observed that if supervisees have unresolved concerns regarding sexual attraction and physical intimacy, these concerns may result in the supervisee’s focusing on sexual issues within sessions with their clients to an extent that is not based on the client’s clinical needs.
Think of a supervisee you are currently supervising, or perhaps one you have supervised in the past. Would a discussion early in your supervision relationship have been beneficial regarding the potential for over avoidance of physical contact; overuse of physical contact; or inappropriate over emphasis of sexual issues during a session? For me, I find it is necessary to create an open place for discussion about these issues with my supervisees in order to ethically, authentically, and therapeutically respond to unresolved feelings and fears of sexual attraction to clients.
On this track, we have discussed sexual attraction to clients, determining appropriate levels of nonsexual physical contact with clients, and ways supervisees might react to feelings or fears of sexual attraction towards a client. These three reactions were over avoidance of physical contact, overuse of physical contact, or inappropriate emphasis of sexual issues during a session.
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