Behind Closed Doors: Sex Therapists

Read about what happens when therapists cross the line.

By Carl Sherman, published on May 01, 1993 - last reviewed on August 30, 2004

Abuse of power occurs shockingly often--among doctors, lawyers, and professors, as well as psychotherapists. And all for the same reason: the professional relationship.

Suddenly, it seems that psychotherapy has turned into a grotesque distortion of its high-minded healing purpose: headlines and talk shows are full of therapists gratifying their sexual needs at their patients' expense. One national news magazine calls it "a growing crisis of ethical abuse." Has there been a swift, massive breakdown in professional morals?

No, says the evidence. The number of psychiatrists, psychologists, social workers, and other therapists who admit to sexual misconduct--behavior intended to arouse or satisfy their own desire--with past or present patients is indeed alarming: surveys put it between 7 and 12 percent. But there is no indication of any sudden increase; as far back as the 1960s, rates were comparable, and some studies suggest that the number of incidents may have actually declined in recent years. The majority of therapists are still ethical practitioners who respect and protect their clients.

And despite their disproportionate share of publicity, therapists are hardly unique in their libidinous misdeeds. A 1992 survey of family doctors, internists, gynecologists, and surgeons found as many guilty parties--9 percent--as among therapists. Similar rates of sexual misconduct are estimated in the clergy. And recognition of the problem among lawyers and teachers is growing.

What has changed is awareness--a testament, in large part, to the cultural impact of feminist consciousness-raising, so that women are no longer disbelieved when they allege abuse by those entrusted with their care. "The parallels with incest are striking," says Glen O. Gabbard, M.D., director of the famed Menninger Clinic in Topeka, Kansas. "The abuse went on for years, but it didn't come out into the open until the last decade or so. It used to be, when a patient said her therapist had sex with her, we assumed it was a fantasy. The rise of feminism made us all more aware of what is really going on."

Many incidents that swell today's chorus of turpitude actually took place years ago. "I'm seeing women who in the early 1970s tried to make complaints to medical boards, but were dismissed," says Rina Folman, Ph.D., chair of the Massachusetts Psychological Association Committee on Professional Standards. "Some of the same people who were not believed then are believed now." What's more, there's a snowball effect, as patients who hear about the abuses of others feel permission to reveal what shame and fear had long kept buried.

A fuller recognition of its potential destructiveness, including lethality, heightens the outrage about patient-therapist sex. A reported 90 percent of victims are psychologically damaged, many severely. Emotions generated by the intimacy of therapy are intense, and abusive experiences violate taboos as explosively as incest--arousing comparable guilt, shame, anger, and despair. In one survey, 11 percent of sexually exploited patients had been hospitalized as a result of their involvement, and 1 percent committed suicide. "I haven't seen anyone who hasn't had some suicidal thoughts," says Folman, who has treated over 100 victims.

Besides the magnitude of the problem itself, sexual exploitation in therapy ignites impassioned headlines because it taps into a more general societal rage against the abuse of power. "In the last two or three years, we've seen great feelings of anger at and alienation from those in authority who promise the world, take a lot from it, and then screw us over," says Gary Schoener, executive director of the Walk-In Counseling Center of Minneapolis. "What did we hear in the last election but anger at incumbents? 'We trusted you!'"

The river of rage actually began building decades ago, as the civil rights and women's movements brought to the glare of public scrutiny how those with the lion's share of power so often use it selfishly, at the expense of those who have less. Discrimination, poverty, rape, sexual harrassment in school and on the job all have come to be known as the malignant spawn of a power imbalance that cries out for reform.

While doctors and lawyers, professors and politicians commit similar misdeeds, the therapist gone wrong seems to symbolize a particularly heinous betrayal. In the closed room of therapy, we are asked to bare not our bodies but our souls, letting down defenses and trusting our most intimate selves to the professional skill and integrity of a stranger.

THE DARK SIDE

Therapists' power to hurt is the dark side of their power to heal. Putting ourselves in their hands with an almost child-like faith that they will help us, we readily bestow on them the same intense affection and urgent need for approval we once felt for our parents. Because (as Freud was the first to recognize) the sex drive begins in childhood, directed toward those who care for us, that affection can have a distinctly sexual tinge. This "transference" into the present of feelings from our early years is seen in many personal and professional relationships, but the emotionally charged conditions of therapy make them especially strong.