Behind Closed Doors: Sex Therapists

Read about what happens when therapists cross the line.

By Carl Sherman, published May 1, 1993 - last reviewed on June 9, 2016

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.

Aired and analyzed, these feelings, including erotic ones, can be a potent force for growth and healing change--the intimate relationship with the therapist often makes it possible to come to terms with long-hidden love, shame, anger, and fear. But it is the therapist's highest responsibility to make sure it all remains talk, not action--to keep therapy a safe place where the deepest feelings can be bared without getting out of control.

For this reason, any responsible therapist will scrupulously maintain the businesslike boundaries that separate personal from professional: making sure doctor and patient stay in their respective chairs during the therapy hour and avoiding contact outside the office. Responsible therapists keep their own problems and private life out of the therapeutic relationship.

Not all honor and protect those boundaries, however. A calculating, predatory therapist may violate them deliberately, encouraging a vulnerable patient to act on the strong emotions brought up from the past. He may tell a patient who is confused by the rush of unfamiliar feelings that sex is a legitimate treatment, dismissing her fears and attempts to repel his advances as "resistance" to therapeutic change. A substantial number of sexually exploiting therapists fall into this category, says Gabbard. Many are sociopaths incapable of true remorse or empathy and who may leave a trail of 20, 50, or more victims.

But the story isn't always such black and white melodrama. Basically healthy, moral therapists are human, too; in the intimacy of therapy, a patient's powerful needs and affections may call forth intense "countertransference" emotions, awakening strong feelings from the therapist's own past. To feel adored and idealized can be heady stuff even to a professional, particularly one who may be depressed, lonely, in the midst of a personal crisis such as divorce, or just feeling unappreciated at home. Under such circumstances, the best intentions and scruples maybe swept away.

Perhaps half of those who engage in sex with patients are what Gabbard calls "lovesick" therapists: they sincerely believe that what's happening to them is true love, not transference. They believe it is a once-in-a-lifetime miracle that obeys no laws but its own, and that they and their patient are "soulmates" to whom ordinary rules do not apply.

To know where transference and countertransference feelings are coming from and how to avoid acting on them should be basic training for all therapists, but in fact it's largely a hit-or-miss affair. Residency training in psychiatry and graduate programs in psychology must include some ethics instruction, but there's no strict requirement that sex issues be treated explicitly or at length. "We've surveyed the field, and there's a range, from excellent to cursory, in teaching about boundary violations and sexual misconduct," says James H. Scully, M.D., deputy medical director of the American Psychiatric Association.

No matter how thorough or lax their education, every psychotherapist in practice today should surely know this: sex between therapist and patient is ethically wrong, whatever the scenario. Always. Every professional psychotherapy organization--the American Psychological Association, the American Psychiatric Association, the National Assocation of Social Workers, the American Association for Marriage and Family Therapy--is in unambiguous agreement on that point.

But why, if the patient is willing? Because the feelings unleashed in therapy are so strong, "consent" may have no more meaning than it would with an underaged sex partner. Even when the patient initiates sex--as happens in an estimated 14-25 percent of cases--it is still the therapist who is ethically, and increasingly legally, obligated to make sure it doesn't happen.

"A patient can be seductive, threaten to kill herself if she doesn't get what she wants, or take off her clothes in the session. She has no code to uphold, no standard of behavior to violate," says Thomas Gutheil, M.D., professor of psychiatry at Harvard Medical School. Still, if sex invades therapy, "only the professional can be to blame."

A MALE PRACTICE?

In the majority of cases, the therapist is male and the exploited patient female--a reflection, some say, of power imbalance in a society where men are used to getting what they want and women are conditioned to giving in to them. And so to many, therapy abuse has been reduced to a burning symbol of male oppression.

Some believe, however, this focus has gone too far, transforming a complex issue into a gender-war morality play in which a psychopathic male therapist invariably preys on a passive female patient who has done nothing to elicit such behavior and is always severely traumatized. "Any variation from this rigid formula feels, to some people, as if you excuse the therapist or the sex, or you blame the victim," says Gutheil. In one extreme example, a speaker who chose to illustrate her lecture on sexual misconduct with a case involving a female therapist and male patient was formally accused of sexual harassment by two members of her audience.

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.

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.

As in therapy, when we put ourselves in the knowledgeable hands of anyone who will take care of us, "we transfer to them the feelings we would have for an idealized parent," she says. Such feelings are likely to flare up swiftly and strongly because the client--a woman in the midst of a divorce, for example, or frightened about her health--is so often in a state of heightened emotional vulnerability and need.

The boundless respect, even adoration, that arise are purely situational--we want our doctor or lawyer to be all--knowing because we want to believe he can really help us. But it's easy for the professional to take these feelings personally and respond accordingly. The privacy and confidentiality of the consulting room compound the danger, and a professional who misuses the power given to him by a needy client is unlikely to meet much resistance.

Sexual contact between teachers and students involves the same abuse of power, and many observers say the same boundary standards should apply. Indeed, romancing one's students, once a winked-at professorial perk, has become the subject of harassment suits and ethical censures. Regulations banning such relationships are becoming widespread: Ohio State University, for example, recently forbade them as conflict of interest.

Rarely do academics get any education in the exploitative nature of student-faculty sex, or any training to help them avoid it. The University of Alabama is a notable exception. There Beverly E. Thorn, Ph.D., director of clinical training in psychology and sexual-harassment counselor, gives a two-hour talk on sexual misconduct as part of a week-long training program for graduate teaching assistants. "I stress how a truly 'consensual' relationship cannot occur between faculty and student," she says. "Students see a huge halo over the professor's head. He can exploit that so easily, and some do."

A CRIME?

If the trend in other professions is to see sex with clients as a major ethical violation, in psychotherapy it's fast heading towards a criminal offense. Nine states (Minnesota, Wisconsin, North Dakota, Colorado, California, Maine, Florida, Iowa, and Georgia) now classify it as a felony, with penalties that can include serious prison time. Similar proposals are widely under discussion elsewhere. "It draws a line in the sand," approves Gary Schoener. "We've had some repeat offenders who told us they stopped when it was criminalized."

Lesser penalties--revoking a doctor's or psychologist's license, for example--can't keep the offender from practicing psychotherapy, which requires no license at all in most states. With criminalization, a suspended sentence can be "a club" to get an offender to stop. But not everyone is enthusiastic. "It's killing a fly with a sledgehammer," says Gabbard. "A few of these people--the real predators--should be in jail, but most should not; they need treatment, not prison."

Gutheil observes that complaints in some states dropped after criminalization. "Patients don't want the doctor to go to jail. Lose his license, his money, yes. But jail? People don't want to go that route. It makes them feel sadistic. It's not the coin in which they want to be paid."

Criminalization may also make it more difficult for abused patients to collect compensation for damage from the therapist's malpractice insurance, which generally excludes coverage of criminal activity. And once criminal proceedings begin, control passes from the patient to a prosecutor who may not zealously pursue a crime less blatant than murder or assault. "Think of how prosecutors prosecute date rape. It's not exactly at the top of their agenda," says Feldman-Summers. "Will this be a top priority for prosecutors? I don't think so."

BLAME THE VICTIM?

On a popular talk show last year, two women described sexual betrayal by their therapists. Then the audience had its turn. "She submitted to sex of her own volition. That's not abuse," said one member. "I'm enraged at this woman," said another. "She put herself in that position."

Barbara Noel, one of the women who appeared on the show, wasn't surprised at the reaction. Since she made her victimization public (with the courageous help of advice columnist Ann Landers, to whom she presented the evidence), she has encountered similar hostility--even in rape support groups where she sought help. "People jumped all over me," she recalls. "They'd been raped by strangers and friends. But a therapist? 'How dare you malign these wonderful people. It must be your fault!'"

Such hostility toward victims of therapy abuse, especially from other women, is far from unusual, according to Schoener. Behind it is defensive denial, "a knee-jerk fear response. If the victim caused it, it can't happen to you."

A similar denial leads to the "bad apple" delusion among psychotherapists, that once the sociopathic felons are rounded up and drummed out of the profession, everything will be fine, Schoener notes. "Therapists like to wash their hands of it and say 'It couldn't be me'"--forgetting that perhaps half the offenders are ordinary men and women who would not have crossed the line but for the stress of personal crisis and the spell of intense emotion that comes with the territory of psychotherapy.

"We have to understand that this is a more dangerous line of work than they told us in medical school or graduate school," says Schoener. "We have to come to grips with our own corruptibility."

SEX AFTER THERAPY?

The emotions generated by therapy are so potent and lasting that some therapists think the ban on sex should continue indefinitely. "A patient should be forever off limits," says Glen Gabbard, M.D. "Even after the professional relationship has been terminated, the same feelings are immediately reestablished if they get back together."

Neglecting such a ban could gravely corrupt the therapy itself. A therapist or patient who envisions fulfillment of longings somewhere down the road is unlikely to be entirely open and honest. "You can't do therapy when you're withholding information or keeping secrets to make a good impression because you might want to date later," says Gabbard. Symptoms may miraculously vanish when consummation awaits the end of therapy.

Many in the American Psychiatric Association share his view. Right now, their ethical code calls sex with a former patient "almost always" wrong, and a proposal to remove the "almost" is close to approval.

Other experts, however, call the lifetime ban unrealistic and probably illegal. "The constitution guarantees freedom of association," says Gary Schoener. The evidence of harm is ample enough to justify abridging that right to forbid sex during therapy, but not afterward. What's more, the vast majority of misconduct complaints occur when sex begins immediately after termination; by six months, all but one percent have been filed.

Minnesota and other states forbid sex for two years after therapy. One year would probably be enough, he says.

Many professionals marry their former patients, Schoener points out. A survey of 101 therapists found that most (with the exception of psychoanalysts, who take transference feelings more seriously) didn't consider such behavior unethical. "There's no evidence these marriages don't work," he says.

But on this score, too, some remain dubious. Often, observes Rina Folman, Ph.D., the original power imbalance remains throughout the marriage. "The patient stays the patient. And I've seen cases where the therapist goes on to have affairs with other patients."

BUYER BEWARE

While many offenders are inferior clinicians whose sexual misconduct fits into a pattern of general incompetence, a disturbing number are eminent experts at the top of their profession.

This includes those who have every reason to know better. A researcher whose pioneering work helped document the extent and harm of sex in therapy was later sued for divorce and ousted from his psychiatric association for having an affair with a patient. The American Psychiatric Assocation expelled Charles Culver, M.D., for exploiting a patient through a personal relationship. He was professor of psychiatry and ethics at Dartmouth Medical School, and the editor of a book on medical ethics.

Ideally, the taboo against sex should be discussed explicitly when therapy begins. Given the discomfort that both patients and therapists feel around this issue, a brochure can make sure it's not forgotten. In one state, California, psychotherapists are obligated to give patients such a brochure at the first session.

This approach seems effective. Beverly Thorn, Ph.D., found that after reading a brochure, current and prospective patients better understood what is and isn't appropriate in therapy. They felt they'd be more assertive if a therapist did something to make them uncomfortable, and were more confident in their ability to deal with sexual misconduct. Despite therapists' fears, the brochure didn't undermine trust. Patients said they were less likely to file a false complaint than they were before.

If you're in therapy, it's important to know that sexual exploitation rarely comes out of the blue. "Sexual misconduct usually begins with relatively minor boundary violations, which often show a crescendo pattern," psychiatrists Gutheil and Gabbard point out in an article in the American Journal of Psychiatry (Vol. 150, No. 2). "A direct shift from talking to intercourse is quite rare; the 'slippery slope' is the characteristic scenario." Regard the first slips as warning signs.

o In a typical sequence, the relationship first changes from a last-name to first-name basis. "There may well be instances when using first names is appropriate, but therapists must carefully consider whether they are creating a false sense of intimacy that may subsequently backfire," they write.

o Next, conversation turns increasingly from the clinical to the personal. For therapists to talk unduly about themselves should warn of potentially dangerous departures from their proper role.

o Body contact often follows, beginning with friendly pats and progressing to hugs. Therapists should initiate nothing more intimate than a handshake, the authors advise, and gently discourage patients' attempts at closer contact.

o Trips outside the office are the most common next step.

o "Sessions during lunch are an extremely common form of boundary violation," the authors say. "This event appears to be a common way station along the path of increasing boundary crossings culminating in sexual misconduct."

o Patient and therapist may then get together for movies or other social events--a familiar dating pattern before they move on to bed.

o Along the way, gifts may be exchanged, debts waived (erasing the boundary that keeps therapy businesslike), and personal services rendered. Not all boundary violations lead to sexual misconduct , and some may be justified ( for example, sending flowers to a patent who, after years of struggle with infertility, has given birth). But anything that blurs the distinction between therapy and rest of life, or between the role of "therapist" and "friend," deserves serious second thoughts.

o A therapist who talks excessively about himself or offers to drive you home is showing a dangerous tendency to fudge the hard line between life and therapy.

An occasional empathic pat or hug can be nurturing and therapeutic, but if any contact feels wrong to you, it is wrong. Don't hesitate to say no, seek another opinion or, if you feel in danger, walk out. In therapy, "let the buyer beware" translates into "trust your feelings."