Around ten percent of male psychotherapists admit to having sex with at least one patient. Between 22 and 26% of patients report having been sexually involved with a previous therapist to another practitioner (Professional Standards Authority, 2007).
All studies that are available to date show very negative consequences for the clients. They exhibit symptoms such as trust issues, isolation, feelings of shame and guilt, fear, depression, suicidal tendencies, and symptoms of posttraumatic stress disorder.
Perhaps one of the most difficult emotions for a client to deal with in the midst of a boundary violation is confusion. It’s only natural that these patients felt a great deal of respect and admiration for their therapists to begin with. Who wouldn’t be charmed by a kind, patient and attentive human being who showed them unconditional love and acceptance? So when the reality of abuse dawns on these patients, they are left with so many questions.
Who was my therapist really? Why did he do it? How did this happen?
The British Association of Counselling and Psychotherapy interviewed a group of therapy clients that contacted them following difficult experiences with adverse idealising transference (AIT). Adapted from their findings, here are three types of therapist likely to be involved in sexual boundary violations. These types exist on a spectrum or a continuum, and are not necessarily independent of one another.
1) The Psychopath
This is the therapist who sets out to use transference to create dependency and then intentionally exploits the client for emotional, financial or sexual advantage, for years or even decades. Clients of such therapists often describe being drawn into cold, humiliating sexual activity, and/or financial and emotional exploitation, where they are coerced into making self-defeating choices. These therapists frequently exploit their knowledge of the client’s developmental vulnerabilities in order to exert maximum power and control.
2) The Opportunist (narcissist)
This therapist may not set out to exploit the transference but cannot resist doing so when it emerges. They reap the emotional, financial and/or sexual rewards, and often convince themselves that the client’s feelings are ‘real’ and that sexual exploitation is ‘an affair’. They typically have poor professional boundaries, operate from a narcissistic position and often have relationship problems themselves, so the client becomes a source of comfort and validation. Clients of therapists in this category frequently describe getting into role-reversal situations with them.
3) The Over-compensator
The third category comprises therapists who offer love in the belief that they can compensate for their client’s history of poor parenting. Clients often respond with appreciation and idealisation, which encourages the therapist to continue practising in this way. Some therapists in this category do not set out to offer love but respond to the client’s demand that they prove that they care, and find themselves breaching boundaries if the client’s demands then escalate and cannot be satisfied.
If you are interested in reading more about boundary violations in psychotherapy, check out my previous post, 10 Warning Signs of Bad Therapy.