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

Such "politically correct" simplifications stifle vital understanding, Gutheil warns. "Patients, and therapists, come in all flavors," and sexual misconduct is often a complex interaction even if only the therapist can be held responsible. Ignoring the fact that some patients characteristically behave seductively because of their emotional problems--a consequence, for example, of early sexual abuse--can blind therapists to important warning signs that can aid prevention.

In the politically correct scheme of things, "the victim is always severely harmed," adds Gutheil, "and to say anything less is to excuse the crime." But in actuality, while many exploited patients are devastated, others emerge unscathed. And if we truly want to understand the complex dynamics of abuse, we should know why.

Paradoxically, the politically correct concept of patient-therapist sex assumes a set of sexual stereotypes--that only men, not women, have sexual feelings, and that men always initiate sexual relationships while women submit to them. That, however, is not the way things really are, Gutheil points out.

The vivid image of predatory male and victimized female is too important to dismiss, insists Peter Rutter, M.D., author of Sex in the Forbidden Zone (Tarcher, 1989). "I believe it's an accurate perception of the psycho-cultural field in which abuse is happening. We have to keep facing and understanding the image of rapacious, incestuous invasion of masculine energy that our culture has lived by for so long."

But individual cases must be judged on their own merits, he agrees. "Everything about power, trust, and inherent vulnerability is true regardless of gender. The duty to care, potential for tremendous harm, and responsibility are identical."

GENDER COMBOS

In fact, sexual exploitation takes place in all gender combinations, in heterosexual and homosexual variations. In one survey, 7.1 percent of male psychiatrists admitted sexual misconduct--but so did 3.1 percent of female psychiatrists. Another found that while most exploitation (80 percent) involved a male therapist and female client, the second most common scenario--13 percent--involved a female therapist and female patient. The therapist was female and the client male in 2 percent of cases, and both therapist and client male in 5 percent.

Minneapolis psychologist Mindy Benowitz, Ph.D., studied 15 cases of female therapist-female client abuse and found striking similarities to the classic male-female situation: the therapists were older than their patients (an average of 11 years); about half of them were serial offenders; and, like men, they were especially likely to violate the boundaries of therapy when in the midst of personal crisis.

"The dynamics were the same," says Benowitz. "The therapist was meeting her own needs by exploiting the therapy; sometimes, she was fooling herself, too." Half of those who directly broached the subject actually told their patients they were mixing sex and therapy in order to help them--by teaching them how to have a healthy relationship, for example.

Benowitz' study carries a strong lesson about sex, therapy, and power. "Power may typically have to do with gender, but there's also power just in the role of being a therapist, regardless of whether you are mate or female," she says. "And being in the client role is inherently vulnerable."

Failing to take seriously the minority of cases in which abusers are female, she says, can turn sexual stereotypes into a dangerous illusion of safety. "It's harder for victims of female therapists to recognize when therapy becomes sexualized, because of the belief that physical contact between women is 'okay.'" One of the patients she interviewed said she'd ignored boundary warning signals because her therapist was a woman. "If it were a man, I would have gotten out after the second session," she said.

Male victims make up a small part--about 7 percent--of the reported total. But this may underrepresent the reality. "Men in this situation rarely view themselves as victims," says Gabbard. "They rarely sue. And usually, if a male patient and female therapist have sex, people blame the patient. Sex-role stereotypes say that men are always the seducers, women the seduced." Like mother-son incest, it was once believed that distasteful as such relationships were, they did not cause much psychological harm. "We know differently now," he says.

Gabbard, who has treated a number of women therapists who have slept with male patients, has repeatedly seen what he calls the "Rowdy Man" scenario: she gets involved with a wild, even criminal, man in the misguided belief that her love can rescue this essentially decent person from his destructive and self-destructive ways.

Such a therapist is buying into a pervasive cultural myth-seen in countless pop novels and such movies as Clint Eastwood's Unforgiven--that all a "rowdy" young man really needs is a "good woman" to "settle him down." It's a particular risk among women working in prisons and substance-abuse programs.

If offending therapists can't be typecast, neither should exploited patients. Certain persons are clearly at special risk: many who were sexually abused early in life, for example, passively accept exploitative relationships that others would fight against what one psychiatrist calls the 'sitting duck syndrome.' And certain personality disorders generate unruly passions that create desperate, eroticized attachments and refusal to accept boundaries.