Microentorno

"The disillusionment I experienced, necessary though it was, and too long in coming, also brought me grief. I was only beginning to realise the implications of my neediness. I had settled for an abusive form of contact rather than risking no contact at all. 1 was ashamed of myself... he had methodically sabotaged my self-trust. He had disabled my sense of direction and my judgment. I had lost any chance of resolving the problems I brought to him initially. I had lost the opportunity to deal with the additional conflicts that had emerged in the course of therapy. And I had lost another father ... within a mere two months the combined effects of the sexual abuse and the unresolved problems that had originally prompted me to enter psychotherapy made life seem unbearable. I was burdened with an unending depression, and my thoughts progressed from occasional ideas about suicide to a studied contemplation of it. I experienced a pervasive sense of having no control over my life. I felt helpless to affect the world around me, helpless to affect my inner world. I was tom between caring for the once-trusted Dr X and hating the therapist who had used me sexually. My confusion emerged in the form of violent dreams that brought me screaming into wakefulness".

(Patient’s account of the effects of sexual contact with her therapist, Bates and Brodsky, 1989, p.40)

C hapter Critical Review of the Literature 74

"I've seen too many patients badly damaged by therapists using them sexually. It's always damaging to a patient"

(Yalom, 1989, p.2) (original emphasis)

The above descriptions of the destructive effects of therapist-patient sexual contact are typical and illustrative of the accounts reported in the literature by patients and subsequent treating therapists.

Systematically gathered empirical data regarding the effects of therapist-patient sexual contact have only relatively recently become available. Traditionally, these relationships have been assumed to be harmful to patients (Marmor, 1972) but some writers have argued that such contact may be beneficial (e.g. McCartney, 1966). There is no evidence to suggest that sexual intercourse between a therapist and a patient is any more harmful than other forms of sexualized behaviour, such a provocative statements or fondling (Keith-Spiegel and Koocher, 1985). Thus, all forms of behaviour with sexual intent must be considered.

A review of every available case (34 in all) in the literature of therapist-patient sexual contact, some reported by therapists, carried out by Taylor and Wagner (1976) showed that the majority had negative or mixed effects on the patient, but 21% reportedly had positive effects'. However, this conclusion must be interpreted in the light of the empirical finding (Holroyd and Bouhoutsos, 1985) that psychologists who reported that

1 The effects of sexual contact upon the patient were established by Taylor and Wagner (1976) by rating "material presented in the case history, or by the patient's rating of the involvement" (p 594).

Chapter 1 Critical Review o f the Literature 75 no harm occurred to patients as a result of sexual encounters with their therapists are twice as likely themselves to have had sexual contact with a patient as psychologists generally. Further, psychologists who have been sexually intimate with patients are less likely to report adverse effects of sexual intimacy, either for patients or for therapy (Holroyd and Bouhoutsos, 1985).

In a survey of psychologists who had treated patients who had been sexually intimate with a previous therapist, Pope and Vetter (1991) found that harm had occurred in 90%

of cases overall. Butler and Zelen (1977) conclude on the basis of interviews with therapists who had had sexual contact with their patients, that "it was not a therapeutic experience for either patient or therapist" (pl45). A similar conclusion was reached by Chesler (1972) who interviewed eleven women who had experienced sexual contact with their psychotherapist: "none of them was helped by their seductive therapists" (p 144).

Feldman-Summers and Jones (1984) compared women who had had sexual contact with therapists, women who had had sexual contact with other health care practitioners and women who had not had sexual contact with a professional. The first group had a greater mistrust of and anger towards men and therapists, and a greater number of psychological and psychosomatic symptoms than the third group. The First two groups did not differ in terms of the psychological impact of the sexual contacts. The greater the reported prior sexual victimisation (e.g. childhood sexual abuse or adulthood sexual coercion), the greater the impact of sexual contact with the professional. Mistrust of and anger towards men in general were greater when the abusive professional was married than when he

Chapter 1 Critical Review of the Literature 76 was single. Finally, patients who reported the greatest number of psychological and somatic symptoms before treatment reported more symptoms after treatment with a professional with whom they had sexual contact, than those with fewer symptoms.

The effects of sexual contact which begins after termination of therapy have been little investigated, but there is some research evidence to suggest that this, too, is harmful to the patient. In Pope and Vetter's (1991) survey of psychologists, it was reported that harm occurred in 80% of the cases in which therapists engaged in sex with a patient after termination of therapy. Respondents were asked how many of the patients they had treated who had been sexually intimate with a former therapist, had "suffered harm as a result". This finding is supported by that of Grunebaum (1986) who interviewed patients whose sexual contact with their psychotherapist began after termination, and had been experienced as harmful. Brown (1988) suggests that the women she interviewed whose therapists had waited until after termination to become sexually involved with them, experienced similar levels and types of harm to those patients whose therapists had sexual contact with them during therapy.

As a result of their work with patients who had sexual contact with their therapists, and of growing anecdotal reports in the literature (e.g. Schoener, Milgrom and Gonsoriek, 1984) of the damaging effects of therapist-patient sexual contact, Pope and Bouhoutsos (1986) have developed the concept of the "Therapist-patient Sex Syndrome" which includes ambivalence (Schoener et al, 1984), guilt (Schoener et al, 1984), feelings of isolation and emptiness (Vinson, 1984, cited in Pope and Bouhoutsos, 1986), cognitive dysfunction (Vinson, 1984, cited in Pope and Bouhoutsos, 1986), identity/boundary

Chapter 1 Critical Review o f the Literature 77 disturbance, and inability to trust (Schoener et al, 1984; Voth, 1972), sexual confusion, lability of mood, and suppressed rage (Schoener et al, 1984) and increased suicidal risk (D'Addario, 1977, cited in Pope and Bouhoutsos, 1986; Pope and Vetter, 1991). Patients' symptoms are increased (D'Addario, 1977, cited in Pope and Bouhoutsos, 1986; Voth, 1972) and hospitalization is frequently necessary (Pope and Vetter, 1991; Voth, 1972). Disturbances in patients' interpersonal relationships may also develop (Bouhoutsos et al, 1983; Forer and Greenberg, 1983; Voth, 1972).

There is a suggestion that sexual contact with health professionals, and thus possibly psychotherapists, may result in Post Traumatic Stress Disorder (Frederick, 1986), which shares many of the characteristics described by Therapist-patient Sex Syndrome (Pope and Bouhoutsos, 1986).