A 'forbidden zone' sexual attraction in psychotherapy.

Abstract

Therapist-client sexual involvement has been shown to have damaging effects on clients, therapists and the mental health professions. As sexual attraction necessarily precedes sexual involvement, the incidence, experience and management of sexual attraction to clients was investigated in a sample of 485 South African clinical psychologists (return rate 23%). Evaluation of training and attitudes to sexual involvement with current and former clients and to other forms of touch in therapy were also investigated. Survey data from 111 psychologists reveal that 63.1% (79.1% of men and 52.9% of women) have been sexually attracted to clients, at least on occasion, while 97.1% have never become sexually involved with a client. Most (61.4%) do not feel anxious, guilty or uncomfortable about the attraction, although more women (50%) than men (26.5%) do. More than half (58.2%) felt that their sexual attraction had benefited the therapy process, while 76.1% believed that it had never been harmful. Men reported significantly more frequent benefit than women. In managing their sexual attraction, 60.8% sought support from supervisors, peers and their own therapists, while 31.9% worked through the feelings on their own. Ethical practice and welfare of clients were more important reasons for refraining from acting on sexual attraction than fear of legal or professional censure. Ethics codes consulted reflect the lack of nationally endorsed guidelines. Almost half (45.7%) had received no education about therapists' sexual attraction to clients, while only 10.6% had received adequate education. Education about the ethics of therapist-client sexual involvement was rated as significantly more adequate than training about therapists' sexual attraction to clients. Most (74.2%) said that their training was useful in helping them to make informed decisions about sexual involvement with clients. The majority (92.5%) felt that education on these issues should be a required part of training for clinical psychologists. Sexual involvement with former clients was considered less unethical than with current clients (65.2% vs 98.9%). 55.9% believe that there are circumstances in which sexual involvement with former clients might not be unethical, particularly depending on time since termination. Appropriate time between termination of therapy and sexual involvement ranged from immediately (1.8%) to never (44.1 %). Certain forms of touch are considered ethical, although attitudes varied depending on context and form. A handshake was rated to be always ethical by 66.3%, while 83.2% believe kissing is never ethical. There was lack of consensus about hugging and holding hands. Implications of findings and directions for future research are discussed.