RESEARCH ON THE SCOPE THE PROBLEM

Surveys, data from ethics committees gives us knowledge about sexual misconducts. But there
is a limitation to the research as only a few people report sexual misconducts. Disciplinary
committees and courts can only deal with the accused. As it is an professional taboo it is no
wonder that those who did not report a misconduct might be answering honestly. Even clients
who report a sexual misconduct by former client only report the discontinuation of the therapy
and nothing about the counsellor. Some of the evidence leads to the following conclusions:

• The majority of offenders are male than females.

• Sexual misconduct victims are not only adults.
• Counselors older than the client are involved more often.
• According to studies between 1970s and 1980s an average of about 8.3% of mental health
professionals admitted sexual misconduct.
• In 1990s the percentages were reduced to 1.7%-0.7%.
• Some studies suggest that high level of education and high level professionals are likely to
engage in sexual misconduct.
• Those who professionals violated this code of ethics show little success to rehabilitation
efforts.
Data on Sexual Attraction of Therapist to Clients:
Studies suggest that about 80-90% of therapist have experienced atleast once, attraction
towards the client but only a small percentage acted on it.

SEXUAL CONTACT WITH FORMER CLIENTS: A

CONTROVERSIAL ISSUE

Rate of sex with a former client has not decreased over time. Surveys and researches shows
that sexual relationship after a gap is considered either low level of unethical or neither ethical
nor unethical for many mental health professionals. The ACA and APA committee issued codes
of ethics on sexual misconduct after 1990s. The ACA code of ethics allow to a relationship after
2 years, while APA refers to almost never code. The professionals are allowed when the
professional interaction is brief and properly terminated.
If the issues of the client are truly resolved and relationship is completely terminated, then if
you meet the client after 2 years or more, that even accidently then being an adult you can
engage in an intimate relationship. Gonsirek and brown (1989) proposed two types of
therapies. Type A in which there is transference as central feature, it might be due to duration
or severity of mental condition of the client. Type B is a short term therapy which gives
minimum chances of transference. A type A therapy is not qualified for a future relationship,
whereas, Type B needs to qualify these four conditions:
1. Initiation does not come from the therapist.
2. Atleast a proper termination of therapy since 2 years.
3. Atleast 2 years of no contact with the client after therapy ended.
4. There is no recommendation of follow-up.

Gottlieb (1993) proposed another 3 aspects of dual relationship:

1. Power: The power of the therapist is high.
2. Duration: The longer the relationship the more the counselor can impose power.
3. Clarity of Termination: Termination does not only mean a gap in future contact, but the
client is also not likely to contact in future.

There are certain scholarly disagreements with policy of APA which are summarized by Gabbard
(1994):
• There is no proof that transference is resolved within 2 years.
• Only the client can determine if the professional relationship is ended or not and there is
no way to measure transference.
• The records are maintained for more than 2 years and there is no limit to privilege.
• The therapeutic information can be misused in future relationship.
• Posttermination relationship may only change the nature of therapy.
• There are some evidences that posttermination relationship may cause harm to the
client.
• Codes should not contain an exception to atypical cases.
SEXUAL CONTACT IN EDUCATIONAL, CONSULTATION
AND EMPLOYMENT SETTINGS

Exploitative relationships. ; Code of ethics. (ACA):

1. Counselors do not engage in sexual relationships with students or supervisees & do not
subject them to sexual harassment.
2. Counselors do not engage in exploitative relationships with individuals over whom they have
supervisory, evaluative, or instructional control or authority.

The rationale for this prohibition is that the person in the subordinate role such as
students, supervisees, employees, research participants and clients have significantly less
power and may feel vulnerable to the potential misuse of the superior and may feel worried
about the risk of refraining from an invitation and thus could be uncomfortable in professional
settings. Once the student is involved he or she is anxious about the implication of terminating
the affair.
It not only effect the person who is subjected to sexual harassment or in a sexual relationship
with his or her superior but also it effects other students or supervisees who learn that one of
their mates is involved in the supervisor in one way or in other and wonder whether they will
received fair consideration or not?
Inspite of the fact that it’s prohibited, it’s still prevalent! Most studies have found a
higher rate of sexual contact with students than with clients. 17% of female psychologists
report their own sexual experiences during their student year

A CASE STUDY OF ISABELLE AND YORITOMO:

Isabelle a graduate student in school counselling enrolls in a course of substance abuse
counselling as an elective. The course is taught by Yoritomo, adjunct faculty member
with an active private practice in the community. About ten weeks into the semester,
Isabelle approaches Yoritomo after class, seeking additional reading on substance abuse
educational programs for teenagers. They discuss the topic at lengths and they meet few
times after that in Yoritomo’s office to talk over the readings. When Isabelle is turning in
her final examination yoritomo asks her to come to his office in a few minutes. At that
time he suggests that they continue to meet to discuss this issue and get to know each
other better. In an offhand way he suggest that perhaps they could have dinner together
sometime. Isabelle hears in his comments an invitation to a dating relationship. If her
assessment of the professor’s interest is correct, did Yoritomo act unethically?
Ethical dilemma
 From Yoritomo perspective (atleast unconsciously) he knew that he had more power
and Isabelle might be more agreeable when he is still her instructor that’s why he
invited her for a dinner, just before her examination. Even if he intended to grade the
examination completely irrespective of whatever Isabelle answer will be, then also his
objectivity in evaluating her will be compromised.
 From Isabelle perspective she may feel trapped as Yoritomo is still her supervisor and
may worry about the implication of refusal on her grades.
Even if Yoritomo’s intentions was entirely honorable, his invitation
was entirely unethical because he sensitively placed the student in a confusing state.
Alternative;
1. If Yoritomo had waited one month after the termination of the course to invite Isabelle
for dinner, the codes of ethics would be little more insensitive.
2. If he wanted to communicate to Isabelle a willingness to continue his assistance to her
in her work at school, he had other options; he might have sent her a note or have
called her after the course grades were submitted.
DISTINGUISHING BETWEEN SEXUAL FEELINGS AND SEXUAL
MISCONDUCT
Research suggests that most mental health professional experience times when they have felt
sexual attraction for their clients which can lead to feelings of guilt, confusion and anxiety. The
dilemma faced by counselors and therapists here is whether attraction is an ethical violation in
itself and how sexual attraction to clients should be viewed.
Occasional counselor experiences of sexual arousal towards a client in normal and does not
warrant misconduct as counselors cannot be expected to leave their sexuality outside the
consulting room door. An experience of sexual arousal must be distinguished from sexualizing
of the therapy relationship which includes acting on the momentary sexual feeling. However, if
the arousal significantly compromises the competence of service, then the counselor should
consider referring the client to another practitioner or at least compensate for the inadequate
service by providing additional time. To help resolve the sexual attraction, a counselor should
consult with a supervisor or a colleague, a line of action that was taken by 60% of the sample in
a study by Rodolfa et al (1994). Whenever sexual arousal is frequent or persistent, a counselor
is well advised to seek therapy to understand the source of this feeling. Research indicates that
trainees can be reluctant to discuss sexual feeling as they frequently misinterpret sexual
attraction as unethical in its own right. Epstein and Simon (1990) have published an exploitation
index that can help mental health professionals identify early signals that they may be at risk
for engaging in exploitive activities with clients.
If sexual attraction prompts a counselor to seek consultation, therapy or referral to another
counselor than the professional may wonder whether the attraction ought to be disclosed to
the client. This decision must depend on considerations based on the client’s interest in
disclosure against the potential for that information to cause harm or impede therapeutic
progress. The nature of the transference, the client’s distress and the power of the professional
make such a disclosure risky and potentially quite harmful.
Counselors face an ethical dilemma when clients for whom they have experienced sexual
feelings disclose being sexual attracted towards them. Generally, the literature cautions against
revealing the feeling even if there is no intention to act on it, unless the revelation has a clear
treatment rationale and would not risk harm to the client. However almost 80% psychologists
view such a disclosure as unethical in itself.

THE PLACE OF NON-EROTIC TOUCH IN THIS CONTEXT

The issue of whether counselors should ever touch adult clients has always been controversial.
Non erotic touch includes such things as a handshake, touch on the hand, arm, shoulder, a hug
or other brief physical contact. On one side of the issue are those who view touch as a
forbidden behavior that interferes with therapeutic progress, confuses clients and risks the
generation of overtly sexual feelings in both parties. This strong rejection of touch has been
based on the concepts of transference and blurring of the clear boundaries set between the
 roles of client and therapist. However, other therapists believe that touch is valuable in
engaging clients in the therapeutic process and promoting therapeutic change. It is a common
belief that a judicious use of touch may reassure or console a client in a way that verbal
communication cannot. Findings consistent with the result that the highest frequency of
physical contact occurs between male professionals and female clients coupled with the
evidence of higher levels of sexual contact by male therapists has led some to be concerned
about a ‘’slippery slope” phenomenon, where non erotic touch can be a first step toward sexual
contact.
Criteria for non-erotic contact with an adult client includes clarity about counselor’s motivation
to touch a client, clients’ needs to relive their anxiety in the face of the emotions clients express
by touching them. Touch should be avoided when counselors are feeling strong
countertransference, when the content of the session has focused on sexual matters, when a
client has poor impulse control, when the touch appears to function as a replacement for talk
therapy and when the behavior is not congruent with counselor’s feelings. Counselors who find
they have a pattern of differentially touching male and female clients must also examine their
motivation for touching as that might be construed as sexist. The decision about whether to
touch a client must also be grounded in an understanding of cultural and social issues. Client
characteristics and experiences ought to weigh heavily in the decision about whether touch is
therapeutically appropriate. Research shows that many clients have had prior experiences of
sexual abuse and harassment and these people may have difficulty with a therapist’s use of
touch. Other clients dislike touch either because of family history, individual experience or the
psychological issues that prompted them to enter counseling. At the same time, it is wise for
counselors to learn a whole repertoire of behaviors for demonstrating emotional connections
with clients so that they can adapt their response to the needs of the individual client.

PROVIDING EFFECTIVE SUBSEQUENT THERAPY FOR

VICTIMS
Research shows that between 22% and 65% of professionals will see clients who report being
sexually exploited by their former therapists. Effective treatment for such clients is difficult and
Dr. M is facing financial challenges with his fledgling private practice and begins consulting at a weight
loss clinic to supplement his income. He finds him-self sexually attracted to Ms. Y, a former patient he
used to treat. They seem to click interpersonally, and he extends his office visits with her. Ms. Y clearly
enjoys this extra attention, and Dr. M begins including personal disclosures in his conversations with her.

In his residency training, Dr. M was taught never to date a current or former patient, but he views this
situation as different. Ms. Y is seeing him only at the weight loss clinic, and he rationalizes that he is
providing her with “psychiatric” care anymore. On 2 occasions he gives her a limited quantity of
benzodiazepines for mild anxiety, which he considers a transitory stress-related condition and not an
“official” DSM-IV-TR disorder. Eventually, Dr. M asks Ms. Y to dinner and she accepts. After they begin
dating, he decides to transfer her to another clinic physician “just to be safe.”
requires expert, diligent treatment. Therapists who seek to provide competent service to the
victims should familiarize themselves with the growing literature on the topic, get qualified
supervision and be prepared to have an emotional reaction to the information the client is
disclosing. If the client wishes to pursue an ethics complaint against a former counselor, the
current counselor is obliged to provide information about the process and to give the client the
option to discuss, in subsequent sessions, feelings and reactions to pursuing a complaint.
However, professionals are cautioned against pressuring clients into taking action against the
offending therapist, because clients who experience such demands feel interrogated and
unsupported.

Ethical Dilemma
 According to APA guidelines, sexual activity with a former or current client is clearly unethical.
Dr M not only had sexual feelings for his former client, Ms. Y but also acted on them.
 Despite not being her clinician anymore, he gave Ms.Y medications which is wrong on two
counts. Firstly, since he is no longer her counselor, he should not be prescribing her any
medications. Second, as he is dating her now, it is unethical to prescribe her medicines in a
professional capacity.