When therapists have the hots for their clients

The fictional Dr Weston
(played by Gabriel Byrne)
 experiences lust for a client

Clients go to psychotherapy seeking a mind massage, but all too often things turn physical. Cases of inappropriate sexual contact in psychotherapy average around 10 per cent prevalence, and a 2006 survey of hundreds of psychotherapists found that nearly 90 per cent reported having been sexually attracted to a client on at least one occasion. It's an issue dramatised artfully in the HBO series In Treatment, which follows the life and work of psychotherapist Dr Paul Weston.

A new paper by clinical psychologist Carol Martin and colleagues discusses how therapists deal with these awkward feelings. The researchers interviewed 13 psychotherapists (7 men), including 2 clinical psychologists and 2 psychoanalysts, in-depth about times they'd been attracted to a client but had stopped themselves acting on those urges.

The results can be broken down into three categories: the therapists' general views about being attracted to clients; the effective coping processes that therapists went through on realising they were attracted to a client; and harmful ways of coping.

The therapists were generally of the view that sexual attraction to clients was normal and not necessarily harmful. However, views differed on exactly where the boundaries should lie. For example, some therapists condoned fantasising about clients whereas others did not.

Effective ways of coping involved the following processes, though not always in order: noting the attraction, which was often accompanied by feelings of anxiety or unease; facing up to the feelings, which often involved managing shame and embarrassment; reflecting on the attraction, including the relevance of the therapist's own past; processing the feelings, including considering the implications of the situation; and finally formulating a way forward that would be to the client's benefit.

Harmful ways of coping included: clumsily reinforcing therapeutic boundaries, which often left the client feeling rejected and to premature ending of therapy; taking a moralising or omnipotent stance, including implying that the client had inappropriate feelings; feeling needy ("... it seems inevitable that being single ... you imagine those 'what if' questions, if we'd met elsewhere ...", said one male, middle-aged therapist); over-identifying with the client (one therapist talked of feelings of "yearning and anguish" after therapy ended; another spoke of being overwhelmed by a client's pain and extending therapy sessions to cope); and finally responding with over-protective anxiety, including offering support that they didn't usually offer, including allowing meetings between sessions, touch, hugging and sharing of personal information.

Martin and her team said that none of what they'd heard in the interviews constituted a boundary violation so severe that they had to blow the whistle on any of their participants (participants were warned that this would happen where appropriate). However, the researchers said the results showed that "even among experienced, accredited practitioners, sexuality and sexual feelings commonly intrude into the therapeutic encounter and required management for client benefit."

Every therapist may be vulnerable to practising in ways that they later regret, the researchers concluded, especially at times of personal stress or difficulty. "The framework and typology of common problematic reactions developed through this study has potential value in training and supervision for sensitising practitioners to the issues early on, and in maximising therapeutic benefit," they said.

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Martin, C., Godfrey, M., Meekums, B., and Madill, A. (2011). Managing boundaries under pressure: A qualitative study of therapists’ experiences of sexual attraction in therapy. Counselling and Psychotherapy Research, 11 (4), 248-256 DOI: 10.1080/14733145.2010.519045

Post written by Christian Jarrett for the BPS Research Digest.