THE PROBLEM AND ITS HISTORY
When people are hurting, unhappy, frightened, or confused, they may seek help from a therapist. They may be depressed, perhaps thinking of killing themselves. They may be unhappy in their work or relationships, and not know how to bring about change. They may be suffering trauma from rape, incest, or domestic violence. They may be bingeing and purging, abusing drugs and alcohol, or engaging in other behaviors that can destroy health and sometimes be fatal. The therapeutic relationship is a special one, characterized by exceptional vulnerability and trust. People may talk to their therapists about thoughts, feelings, events, and behaviors that they would never disclose to anyone else. Every state in the United States has recognized the special nature of the therapeutic relationship and the special responsibilities that therapists have in relation to their clients by requiring special training and licensure for therapists, and by recognizing a therapist-patient privilege which safeguards the privacy of what patients talk about to their therapist. A relatively small minority of therapists take advantage of the client's trust and vulnerability and of the power inherent in the therapist's role by sexually exploiting the client. Each state has prohibited this abuse of trust, vulnerability, and power through licensing regulations. Therapist-patient sex is also subject to civil law as a tort (i.e., offenders may be sued for malpractice), and some states have criminalized the offense. The ethics codes of all major mental health professionals prohibit the offense.
The health care professions at their earliest beginnings recognized the harm that could result from sexual involvement with patients. The Hippocratic Oath, named after the physician who practiced around the fifth century B.C., prohibits sex with patients as does the code of the Nigerian Healing Arts, which was created prior to the life of Hippocrates. Freud, a pioneer of the "talking cure," emphasized the prohibition in his writings. The historical consensus among health care professionals that sex with patients is prohibited as destructive continued into the modern age. In the landmark (i.e., one of the first women to successfully bring suit against her therapist on these grounds) 1976 case of Roy v. Hartogs, the court held: "Thus from [Freud] to the modern practitioner we have common agreement of the harmful effects of sensual intimacies between patient and therapist." HARMFUL EFFECTS
What are the "harmful effects" the court referred to? While the scientific and professional literature had contained carefully documented individual case studies and theoretical papers describing the harm that therapist-patient sex could cause, larger scale studies began to emerge in the 1960s and 70s. William Masters and Virginia Johnson, for example, gathered data from many research participants for their 1966 report Human Sexual Response and the 1970 report Human Sexual Inadequacy. They were surprised at the number of participants in their samples who had engaged in sex with therapists. The extensive data that Masters and Johnson collected on each participant allowed them to compare the consequences of sex with a therapist to the consequences of other events such as consensual sexual relationships with a spouse or life-partner, consensual sex occurring outside long-term relationships, and various forms of rape, incest, and abuse. So striking were the harmful consequences associated with therapist-patient sex that Masters and Johnson wrote: "We feel that when sexual seduction of patients can be firmly established by due legal process, regardless of whether the seduction was initiated by the patient or the therapist, the therapist should be sued for rape rather than malpractice, i.e., the legal process should be criminal rather than civil." Psychologist Phyllis Chesler, in her landmark 1972 study Women and Madness, included a section on...
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