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I was recently reading about Colin Bouwer, the infamous psychiatrist in New Zealand who was convicted of slowly poisoning his wife to death with insulin. In addition to murder, Dr. Bouwer had a few other psychopathic credits in his pathological portfolio; he was a pathological liar, prescription drug abuser, and a skilled manipulator. He was accused of having sex with at least two of his patients, who alleged that, during the course of therapy, he had told them that he had not had marital relations with his wife for months because she was dying of cancer.
While no one would tout Dr. Bouwer as the poster boy for psychiatry, he is, unfortunately, not alone in his alleged willingness to sexually exploit his therapy patients. Between 7 and 12 percent of mental health practitioners (psychiatrists, social workers, psychologists, etc.) in the U.S., 80 percent of whom are male, acknowledge having had erotic contact with a client. Given that these statistics are based on self-reports, it's a pretty safe bet that the real number is higher.
Certainly, most mental health clinicians have clear boundaries and their clients' best interest at heart. Therapists often work hard and long hours, consult with colleagues if needed and do their very best to help their clients. In spite of the fact that therapy takes place in a 1:1 setting and involves intimate sharing, the vast majority of mental health professionals would never take sexual advantage of a client.
However, the psychological toll of a sexually exploited, already-vulnerable client can be severe. In fact, 24 states have recognized that the unequal power inherent in a therapeutic relationship is so great that therapist-patient sex is treated as a criminal act similar to statutory rape. Whether we're psychologists, patients, or someone who cares about either, it's important to be aware of who is most likely to sexually exploit a client and how to recognize the "foreplay" that leads up to it.
What kind of person has sex with clients?
What limited research we have on the personality profiles of sexually exploitive mental health professionals suggests they fall into four groups. Most rare is the psychotic professional, whose sexual transgressions are part of his delusional or disorganized thinking. Also rare is the professional who is not psychologically equipped to deal with a challenging client and gradually lets his or her boundaries erode in a misguided attempt to "save" him or her from suicide or self-harm.
Most common is the practicing professional who is isolated, in the middle of a personal crisis, and becomes convinced he is in love with his client. This "lovesick" professional tends to be middle-aged and separated or in the middle of a divorce; his "victim" tends to be female, 10-25 years younger and often has a history of sexual abuse. Blinded by his or her own needs, the abusive therapist rationalizes his behavior by pretending that the relationship is mutual, by minimizing the problems that led the patient to the therapist office to begin with, or by ignoring the damage his or her actions will cause.
The last group is the most dangerous and is the one most likely to have Dr. Bouwer as a member. This group, the narcissistic/antisocial personality type, hide their predatory ambitions behind a professional demeanor. They are most likely to have multiple victims and to be sadistic or demeaning in their sexual exploitation. Interestingly, they are also most likely to be recognized as problematic by their peers; a 1997 Canadian study that followed a graduating group of psychiatrists found that of the two who were eventually convicted of sexual misconduct had personality pathology that had been identified in training.
The slippery slope to sex
In the vast majority of sexually exploitive therapy situations, there is a certain amount of "grooming" that takes place during which the therapist begins to change the tone of the relationship from professional to personal. The focus shifts from the patient's needs to the therapist's desires and this shift is often reflected in how therapist interacts with the client inside and outside the office.
For example, the therapist may:
- Text and/or call in between sessions
- Reschedule sessions at the end of the time
- Extend treatment sessions well past their allotted time
- Begin disclosing current problems or sexual fantasies
- Initiate hugging and/or embracing the client on a regular basis
- Tell sexual jokes or stories
- Give constant attention to your looks or physical appearance
- Encourage dependency by implying that s/he has special knowledge or commitment (I'll never let you down, I'm the only one who understands/can help you).
- Discuss his or her sex life (or lack thereof)
- Provide alcohol during sessions
- Give significant gifts
- Make romantic statements (You are so special; I really love you)
Many client/victims of sexual exploitation say that they felt uncomfortable when some of these earlier behaviors started but were confused and/or unsure if their "gut" feelings were right. If there's one thing to remember from this article, it's this; Trust your gut, at least enough to talk about it with three people—someone who cares about you, someone whose opinion you trust, and someone who knows about therapist abuse.
The bottom line
As someone who's been on both sides of the couch, I know that effective therapy does not only heal wounds, it can help a person grow. However, when the therapist's needs take precedence over the client's, especially when it comes to sex, the results can be devastating. Not only are the original problems not addressed, they can be exacerbated by self-blame, mistrust, confusion, emotional turmoil, and relationship difficulties.
Therapists are human; we are going to have feelings about our clients, have our own life struggles, and, yes, at times have our own mental health challenges. However, clients place a huge amount of trust when they walk into our office and open their hearts. At the very least, we must do no harm, and be held accountable if we do.
