Therapists Who Have Sex With Their Patients

Treatment And Recovery

Herbert S. Strean

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781317758563
• Topic: Psychology
• Subtopic: Human Sexuality in Psychology
• Index: Psychology

First published in 1994. Therapists who use and abuse their power make for high talk show ratings and tabloid sales, but are these people simply to be written off as sick and evil? Dr. Herbert Strean believes not. In this unflinchingly honest book, Dr. Strean-who has treated such abusive caregivers many times in his practice-seeks to create a more humane portrait of therapists who have affairs with their patients. Central to the book are four fascinating case studies of therapists: Ronald S. is a heterosexual psychiatrist with homosexual fantasies who wants to be a woman with his own male therapist; Roslyn M. is a therapist who administers love treatment in the therapy room and charges for it; Bob W. is a promiscuous sex addict who thinks, despite his physical unattractiveness, that all his women patients hunger for him; Al G. is a sadomasochistic social worker who makes his female ex-patients suffer. These cases give voice to the feelings, fantasies, and dreams of therapists who have crossed the boundary. Through them, we come to understand that it is treatment, not punishment, that will prevent others from falling prey to healers who are them­selves in desperate need of healing.

CHAPTER I

SEX IN PSYCHOTHERAPY

Ever since the formal inception of psychotherapy as a profession, psychotherapists have had major difficulties in monitoring their sexual wishes toward patients. In Freud's inner circle, Otto Rank turned his analysand, Anais Nin, into his mistress. Ernest Jones, Freud's biographer, spent a good part of his career fending off accusations that he sexually molested young patients and had sexual intercourse with older ones. Sandor Ferenczi believed that his patients needed physical comfort; therefore, he openly fondled their breasts and hugged them frequently. Carl Jung had prolonged affairs with several of his patients, including one who became a psychoanalyst (Grosskurth, 1991).

Sexual activity with patients by the pioneers of psychotherapy has been more than replicated by their followers and contemporaries. In the April 13, 1992 issue of Newsweek magazine, it was well documented that a spate of cases involving sexual liaisons between patients and therapists has come to the public's attention in the last decade (Beck, 1992). Although at least 10% to 20% of those mental health practitioners who have been queried on the subject acknowledge sexual activity with their patients, their numbers are probably higher. Many clinicians, despite being granted anonymity, are frightened to tell the truth because they fear retribution (Gabbard, 1989).

Although the percentage of psychotherapists having sex with their patients has probably not decreased since Freud's day, and may have even increased, the interest and concern about the issue has intensified. There is now a rich literature on the subject clearly demonstrating the profound and deleterious effects that are inflicted on the patient who has been sexually seduced by the practitioner. Numerous articles and books in the professional and nonprofessional literature have provided indisputable evidence that the patient who has sexual relations with his or her therapist emerges full of emotional scars. Often the victim, usually a woman, appears similar to a battered child who has been emotionally abused and sexually exploited by a parental figure (Bates & Brodsky, 1989; Freeman & Roy, 1976; Leonard, 1983; Rutter, 1989).

In contrast to the laissez-faire attitude that was shown toward clinicians like Jung, Rank, Ferenczi, and Jones for their sexual improprieties, today's therapists who have sexual liaisons with their patients are subjected to law suits, loss of their licenses, disbarment from professional organizations, and other retaliatory measures. How can we account for both the strong shift in concern about therapists having sex with their patients and for the dramatic reversal in response when they are discovered?

During the past three decades numerous phenomena have coalesced to account for the dramatic modification in concern and response to clinicians having sexual liaisons with their patients. Probably one of the most influential factors is the feminist movement (Chesler, 1972). Sparked by the leadership of NOW, the National Organization for Women, and by other social activists, women have been consistently speaking out against sexual harassment and exploitation in industry and elsewhere. Recognizing that they are not compelled to submit to a subordinate, demeaned role at the work place and elsewhere has helped them to be more assertive as patients in psychotherapy and to feel freer to question "therapeutic harassment."

Concomitant with some of the successes of the feminist movement has been a reconsideration of sexual practices and sexual roles in society (Buunk & Driel, 1989; Murstein, 1978). Women are refusing to be treated as "objects," whether it be by their spouse, employer, physician, or psychotherapist. They are demanding a mutual relationship of two equals at home and work, and this mature, legitimate demand has been heard by mental health professionals.

As the revolt against sexism has become a powerful phenomenon in our society, concern has been expressed about the possibility of a latent sexism in the practice of psychotherapy (Karasu, 1980). The alleged sexism in psychotherapy may be reflected in the finding that the vast majority of practitioners who have sex with their patients are male therapists exploiting female patients (Gabbard, 1989).

As discrimination against women has been discussed in and out of psychotherapy, some basic Freudian postulates have also been reconsidered. One of the most important notions to be questioned has been Freud's "seduction theory." Psychoanalysts have tended until recently to support the idea that women in psychoanalysis and psychotherapy who have reported being sexually abused by fathers and other male adults are, in most cases, reporting fantasies and not actual events. Initiated by Masson (1984) and reinforced by other researchers (Gediman, 1991), mental health professionals now tend to believe that the many women who report in their therapy that they have been sexually abused have, indeed, been so mistreated. Because of this shift in perspective, courts and ethics committees of professional organizations are now more apt to believe a woman who claims she was sexually abused by her therapist. Currently, about one-third of the states have made therapist-patient sexual relations illegal (Pope, 1986).

As the "seduction theory" has been questioned, the problem of incest has become another salient issue in the last two decades. Mental health workers have reported from their studies of caseloads in clinics and in other outpatient facilities a rate somewhere between 30% to 35% (Rosenfeld, 1979; Spencer, 1978). As the extremely disruptive and traumatic effects of incest have become more apparent (Gelinas, 1983; Strean, 1988), victims of sexual exploitation by their psychotherapists have been compared to victims of incest (Bates & Brodsky, 1989). According to Barnhouse (1978), inasmuch as most, if not all, therapeutic relationships are characterized by the development of a powerful parent-child transference, sexual liaisons in therapy relationships are always "symbolically incestuous."

In his book, Sexual Exploitation in Professional Relationships (1989), Glen Gabbard points out:

The analogy to incest is appropriate for a number of reasons. Incest victims and those who have been sexually exploited by professionals have remarkably similar symptoms: shame, intense guilt associated with a feeling that they were somehow responsible for their victimization, feelings of isolation and forced silence, poor self-esteem, suicidal and/or self-destructive behavior and denial. Reactions of friends and family—disbelief, discounting, embarrassment—are also similiar in both groups, (p. xi)

Concomitant with changes in the broader culture that have helped to focus more attention on sex between therapists and patients, there have been several new developments in the psychotherapy profession itself that make sex between clinician and patient a more pertinent topic.

Psychotherapists of the 1990s eschew the medical model that alleges that a healthy, mature, and wise professional treats an unhealthy, immature, and naive patient. Instead, most current mental health professionals avow that the therapeutic situation involves two imperfect, vulnerable human beings who form a partnership. Not only do the patient's transference reactions influence the process and outcome of the treatment, but the practitioner's subjective countertransference reactions make a major contribution as well (Fine, 1982; Kottler, 1986; Strean, 1990; Sussman, 1992). When patients and therapists accept with more assurance that therapists have definite responsibilities that influence the process and outcome of the treatment, the therapist will more likely be viewed as capable of behaving like the patient. Therefore, the therapist can also resist the therapeutic process in ways similar to the patient and demonstrate unresolved problems, such as the propensity to act out sexually.

As the therapeutic situation has been more carefully researched, the person who becomes a psychotherapist has been more thoroughly investigated. For example, what attracts individuals to the practice of psychotherapy? It has been very well documented that many, if not most, psychotherapists have serious neurotic and interpersonal problems and in many cases suffer as much or more than their patients (Bermak, 1977; Burton, 1972; Deutsch, 1984; Finell, 1985; Freudenberger & Robbins, 1979; Maeder, 1989; Searles, 1975). Also, there is now a rich literature on countertransference difficulties that consistently suggests that countertransference is an ever-present phenomenon in psychotherapy (Brenner, 1985; Slakter, 1987; Teitelbaum, 1990); clinicians are much more willing to discuss their mistakes in the treatment situation, particularly how their characterological problems can inhibit and/or retard the therapeutic process (Baudry, 1991; Chused & Raphling, 1991).

In addition to the greater attention given to the therapeutic situation and to the psychodynamics of the mental health professional, more consideration has been given to the limitations and problems inherent in psychoanalytic and psychotherapeutic training programs, some of which may contribute to the sexual acting out of therapists with patients.

We will now turn to a detailed examination of the aforementioned phenomena that have made the issue of sexual liaisons between patient and therapist an important one both to professionals and to nonprofessionals. Let us begin our discussion with some of the more recent insights about the therapeutic situation.

THE THERAPEUTIC SITUATION

Sigmund Freud, the psychiatrist and neurologist from Vienna, is considered by most to be the founder of dynamic psychotherapy. Because Freud worked as a physician for many years, he tended to use a medical model to treat his patients. His early patients, as Freud assessed them, suffered from clear-cut illnesses, namely, anxiety neurosis, anxiety hysteria, and obsessive-compulsive neurosis. Those patients who could not be treated by his psychoanalytic method were afflicted by another illness, namely, schizophrenia (Freud, 1896).

Although there are still vestiges of the medical model observed in current psychotherapeutic practice, most mental health professionals have abandoned the paradigm of the sick patient who has to be treated for his illness by the authoritarian doctor. Patients and therapists tend to regard themselves as two vulnerable individuals who are quite similar in many ways, form an "alliance" (Greenson, 1967), and try to help the patient resolve conflicts so that he or she can enjoy working and loving with more freedom.

By the late 1950s, psychotherapists began to realize that each individual patient is unique and so complex that giving him or her a diagnostic label stereotypes the patient and fails to individualize him or her. In 1959, the highly respected psychiatrist and psychoanalyst Karl Menninger stated: "Diagnosis in the sense in which we doctors have used it for many years is not only relatively useless in many cases; it is an inaccurate, misleading, philosophically false predication" (1959, p. 672). In 1965, Anna Freud pointed out, "The descriptive nature of many current diagnostic categories runs counter to the essence of psychoanalytic thinking" (p. 110). As modern-day clinicians note, the standard psychological diagnostic system (the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association) has proven to be so unsatisfactory in categorizing clinical phenomena that it has been repeatedly revised (Brill, 1965; Fine, 1982). Diagnostic systems do not describe the pain and anguish of someone who cannot love enthusiastically. They do not relate to the guilt that many patients feel in their day-to-day lives. They do not consider the anxiety that can be generated by aggressive and sexual fantasies that emerge in relationships. In sum, the medical model with its emphasis on diagnosis and treatment of an illness has been repudiated by most sophisticated professionals.

With the medical model essentially discarded, patients and therapists have begun to view each other very differently from the way they did in the early days of psychotherapy. The more democratic atmosphere in therapy with its emphasis on "relationship," "interaction," and "communication" has made the modal therapeutic situation much less sterile and more stimulating. Patients, instead of looking for treatment of illness, now seek an empathetic human being who will complement their own personalities and offer "corrective emotional experiences" and a "corrective emotional relationship" (Alexander, 1961).

Now that the therapeutic situation is more frequently conceptualized as one in which two human beings have intense feelings toward each other and mutually influence each other, countertransference is considered to be as crucial a dynamic variable in the therapeutic situation as transference. The same can be said about counterresistance and resistance (Strean, 1993). With the sharp focus on the human relationship in therapy, it has of course been inevitable that there would be much more appreciation by the therapist and patient of each other as sexual beings.

By the 1970s, clinicians became so preoccupied with the sexual dimension of the therapeutic situation that a few professionals began to openly advocate that sex be part of the therapeutic transaction in some cases. Martin Shepard (1971) in his book The Love Treatment took the position that the many women who needed to like themselves more as sexual beings and who seek psychotherapy would benefit by having sexual liaisons with their therapists. Feeling the emotional and sexual acceptance by their "love doctors" would help them accept themselves with more equanimity.

Around the time that Shepard was prescribing overt sex as part of "good" psychotherapy, Masters and Johnson (1970) were developing programs all over the country in which patients often had sex with their "sexual surrogates." Surrogates act as guides and mentors to those patients suffering from sexual difficulties. Much of the treatment involves surrogate and patient "pleasuring each other."

Somewhat similar to the Masters and Johnson program is Helen Kaplan's The New Sex Therapy (1974). Although not advocating "surrogates" as part of the treatment, her emphasis is on helping patients learn new sex techniques through active discussion and demonstration of helpful bodily exercises.

Concomitant with the "love treatments," "surrogate treatments," and the "new sex therapies" were the development of the encounter and sensitivity training movements. These "therapies" that very much influenced many therapists with differing theoretical perspectives prescribe touching, hugging, and "more physical interaction" between therapist and patient (Kovel, 1976).

By the late 1970s and early 1980s, the traditional therapeutic setting with its concentration on the "talking cure" was strongly challenged. The popularity of psychoanalysis, with its emphasis on introspection and not action, was declining. Group therapy and family therapy, with its emphasis on the "here and now," were on the ascendancy. The therapist was becoming much more of a "good friend" and much less of a dispassionate diagnostician and neutral therapist. Consequently, sex between patient and therapist was not such a foolhardy notion nor a remote possibility.

As historians have noted repeatedly, when there is a social or political movement going in one direction, there is often a countermovement (DeMause, 1981). This same phenomenon seems to occur in the mental health field as well. The emphasis on touching, hugging, and sexual contact that appeared to be gaining popularity in the early 1970s was met by opposition in the 1980s. Masters and Johnson began to have many critics (Fine, 1981; Karasu, Rosenbaum & Jerrett, 1979; Zilbergeld & Evans, 1980). The sensitivity and encounter movements were also seriously questioned (Kovel, 1976; Strean, 1976); writers like Shepard were reprimanded and repudiated (Bates & Brodsky, 1989). Many psychoanalysts and psychotherapists began to point out that the erotic transference was often "a bid for reassurance, a cover up for hostility, an expression of penis envy, an oral-incorporative wish, a defense against homosexuality, and all of these at different times" (Fine, 1982, p. 95). They also pointed out that many patients who talked about sex a great deal and made many sexual demands were often sexually starved and sexually conflicted (Karasu & Socarides, 1979).

During the 1980s and early 1990s, as dynamically oriented therapists and other mental health professionals began to speak out against overt sexual gratification in the therapy, lawsuits against therapists who transgressed became popular. Many books and articles pointed out that sex with the patient is similar to incest, rape, and other destructive acts (Bates & Brodsky, 1989; Freeman & Roy, 1976; Gabbard, 1989; Rutter, 1989). In this kind of atmosphere, it is understandable that few writers emerged who would speak with understanding about the severe disturbances in psychotherapists that led to their acting out sexually with patients. The therapist who acted out seemed to be more deserving of punishment than of humane treatment.

Although the tension was great between the traditional therapist who believed in a talking therapy with sexual abstinence and the one who championed physical contact, the controversy had some positive effects. Professionals like Masters and Johnson (1970), Helen Singer Kaplan (1974), and other behav- iorists began to include in their programs some notions on transference, countertransference, and resistance. Dynamically oriented clinicians began to emphasize the importance of being more aware of the sexual dimension in therapy.

Stated Reuben Fine:

Even though it is undesirable for therapists to act out attraction toward their patients, it is quite the opposite [to have] feelings. The more the therapist is able to experience a genuine liking for the patient, the more help he or she will be able to give. Because of the need to keep feelings in check, the analyst often takes the path of least resistance, denying them altogether. This creates another problem for the patient, who in addition to feeling rejected for neurotic reasons is being rejected in reality. The fact that the therapist's rejection is a neurotic defense mechanism to protect him or her against his or her own sexual feelings does not alter the matter; in this way the analyst does not differ from other opposite-sex people whom the patient meets. (1982, p. 103)

Dr. Harold Searles averred that even with very emotionally disturbed women patients, it is crucial to give them the feeling that they are realistically attractive to the therapist. Said Searles:

Since I began doing psychoanalysis and intensive psychotherapy, I have found, time after time, that in the course of the work with every one of my patients who has progressed to, or very far towards, a thoroughgoing analytic cure, I have experienced romantic and erotic desires to marry, and fantasies of being married to, the patient. (1975, p. 284)

As the view of the therapeutic situation changed, so did notions on the patient who sought psychotherapy, particularly his or her similarities to and differences from the rest of the population.

CHANGING VIEWS OF THE PATIENT IN PSYCHOTHERAPY

By the 1960s, many studies confirmed the presence of emotional conflicts in virtually every man, woman, and child (Dohrenwend & Dohrenwend, 1969; Leighton, 1963; Rennie, 1962); the difference between the patient diagnosed as "psychotic" and the so-called "normal" individual is only a matter of degree (Fine, 1990). As a result, more people from many diverse walks of life sought out mental health professionals for therapy. Social workers who traditionally worked with individuals of lower socioeconomic classes began to treat middle-class individuals and families, and psychoanalysts and psychiatrists who customarily worked with the more affluent began to treat individuals and families from lower socioeconomic classes (Henr...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• Acknowledgments
• Chapter I Sex in Psychotherapy
• Chapter II The Case of Ronald Sterling
• Chapter III The Case of Roslyn Mason
• Chapter IV The Case of Bob Williams
• Chapter V The Case of Al Green
• Chapter VI Conclusions
• References
• Index