The exploited, however, include many women who are functioning at a
high level. In Benowitz' study, one third of female patients were
themselves training or practicing therapists and came to therapy with
relatively minor problems. "We have to get past the belief that those who
are well don't let this happen to them," observes Rutter. "The very act
of going to a therapist engages that part of oneself that needs to be
vulnerable in order to develop."
SYMBOLIC INCEST
Whoever the victim, why is the impact so often so dire? Given the
power of feelings aroused by therapy--echoes of the primal feelings first
directed toward mother and father--the psychological experience of sex
with one's therapist is very much like incest. It is a symbolic incest,
and can bring about the same toxic mix of torments, including guilt,
shame, a terrible feeling of emptiness, and isolation. Chaotic surges of
emotion can be intense and unpredictable. Like the incest victim, the
exploited patient is frequently paralyzed by ambivalence, torn between
rage at the exploiter and a protective, loyal attachment to him.
A crippled ability to trust is, not surprisingly, a common
consequence of exploitation. Adding insult to injury, it often impedes
formation of a healing relationship with a future therapist, which is
desperately needed to repair the damage. And many victims develop
post-traumatic stress disorder (PTSD), with the same pattern of
flashbacks and nightmares that inflict agony on combat veterans and
victims of crime.
"I developed PTSD, just as strongly as if I had been violently
raped," says Barbara Noel, who described her victimization by a prominent
psychoanalyst in a recent book, You Must Be Dreaming (Poseidon, 1992).
Eight years after her therapy ended, she recalls, she fled a restaurant
when an older gentleman who resembled the doctor sat at the next table.
When she revisited the building where her violation had taken place, "I
burst into tears and ran out. I was terrified."
The sexual misconduct needn't be flagrant to do substantial harm.
Benowitz found that patients subjected to "covert" exploitation--which
might include a therapist's flirting, talking about her own sex life, or
pressuring the client to talk about hers, or long full-body
hugs--experienced the same intense feelings and suffered the same
symptoms as those whose therapists engaged them in real sex acts. "I
think covert sexualizing of therapy is a lot more common," she
says.
A PROBLEM OF PROFESSIONALS
Although the sexual misdeeds of psychotherapists have reaped the
most headlines, concern about other professions is also growing. The
Hippocratic Oath has unequivocally barred doctor-patient sex for 2400
years, but the American Medical Association didn't add its own explicit
ban until 1989. The American Bar Assocation still doesn't forbid lawyer
members to sleep with their clients (such a ruling by the national
association would not be legally binding, anyway), although its ethics
committee did, for the first time, strongly warn against the
practice.
Some state bar associations have passed (California, Oregon) or are
considering (Arizona) rules that make such misconduct unethical and
subject to disciplinary action. The American Academy of Matrimonial
Lawyers added its own ban against client-counsel sex to its Standard of
Conduct in 1991.
Perhaps the clearest signs of the times are appearing in the
courtroom. "We've just had the first case in the country that held
attorney-client sex to be malpractice," says Cambridge, Massachusetts,
attorney Linda Jorgensen, who has written extensively on the subject of
lawyers' misconduct. "I think we're going to see a surge of cases against
attorneys and non-psychiatric physicians who have sex with their clients.
"
No one knows how many lawyers exploit their clients sexually each
year, and statistics about the clergy--another profession whose
misconduct has made major headlines--are hard to come by (one researcher
estimated that, like therapists, the rate runs between 10 and 15
percent). As for physicians, a recent nationwide survey of nearly 2000
family doctors, internists, obstetrician-gynecologists, and surgeons
found that 9 percent (10 percent of the men, 4 percent of the women)
admitted to sexual contact with patients.
The authors of the study urge that medical education include
"comprehensive training on physician-patient sexual contact," teaching
doctors-to-be to deal with the strong emotions that arise during
treatment, and making sure they understand the legal consequences of
misconduct. More than half of the doctors surveyed, however, reported
that these issues had never been addressed during training.
THE SAME BREACH OF TRUST
What is also new is the recognition that sexual contact in other
professions represents the same abuse of power as in therapy, and can
inflict nearly equal damage. Seattle psychologist Shirley
Feldman-Summers, Ph.D., contends that like the therapist-patient
relationship, these are all "fiduciary" relationships--in which the
professional is sworn to act in the client's best interests. Because of
the trust the client places in the professional, all such relationships
readily give rise to strong feelings similar to those generated by
psychotherapy.
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