Comments on “Sexual Contact Between Psychologists and Their Former Therapy Patients: Psychoanalytic Perspectives and Professional Implications” by Natalie Shavit and Steven Bucky

The American Journal of Psychoanalysis -     

Sexual Contact Between Psychologists and Patients

Summary

This article discusses sexualized dual relationships between psychologists and patients, including both sexual contacts while treatment is in progress and after its termination. The reported prevalences of sexual contact between psychologists and patients and between psychologists and former patients are discussed as well as practitioners attitudes towards these two types of relationships. The profiles of both psychologists and patients likely to be involved are outlined as are the clinical and professional consequences of these behaviours. Finally, the APA Ethics Code (2002) is examined to determine whether its inclusions in these areas are adequate and to shed more light on clinicians' continued roles and responsibilities even after treatments have concluded.     

Nonsexual Relationships Between Psychotherapists and Their Former Clients: Obligations of Psychologists

This article examines the issue of nonsexual relationships between psychologists and their former therapy clients. What little research is available concerning nonsexual relationships with former clients suggests that psychologists have clear reservations about some of these relationships, especially personal ones and intentional social interactions. Relationships immediately following termination are seen as particularly suspect. Drawing on the literature dealing with multiple relationships in general, and sexual relationships with former clients in particular, a number of arguments are made outlining why psychologists should avoid significant nonsexual relationships with former clients for at least some period of time following termination.     

Examining Relationships Between Physicians and Their Patients: A Psychoanalytic Model

This is a study of a group of physicians' reflections about their communication with patients. Using an applied psychoanalytic framework for self-inquiry in groups, the authors summarize their findings and provide a model for others to use. They describe their method of conducting and studying three physician groups. The authors identify six essential dynamics within groups and illustrate the dynamics with examples of physician reflections. They summarize further their observations about the composition, dominant themes, and phases of development for each group. The intent of the self-inquiry groups—to clarify physicians' habits and thought patterns about patients—is upheld in the report's conclusion, in which the authors report participants' evaluation of their learning experience. Recommendations are made for analysts to apply the model in work with general physicians.     

Medicating Patients in Psychoanalytic Therapy: Implications for Introjection,Transference, and Countertransference

If a patient comes for psychotherapy or psychoanalysis, why medicate him with psychotropic drugs? The answers to this question are explored and addressed from several points of view. The central hypothesis of this paper suggests that most of the reasons for medicating patients have to do with therapist's unresolved countertransference issues. Furthermore, medicating a patient may have deleterious effects on his introjected sense of self, and impacts the transference relationship in a significant way. The issues surrounding medication as adjunctive therapy are elucidated and clarified in terms of rationale, efficacy, and the impact on the psychotherapeutic relationship. Psychoanalytic solutions are offered and discussed.     

National Survey of Social Workers' Sexual Attraction to Their Clients: Results,Implications, and Comparison to Psychologists

A survey form sent to psychologists (Pope, Keith-Spiegel, & Tabachnick, 1986) was adapted and sent to 1,000 clinical social workers (return rate = 45%). Most participants reported sexual attraction to a client, causing (for most) guilt, anxiety, or confusion. Some reported having sexual fantasies about a client while engaging in sex with someone other than a client. Relatively few (3.6% men; 0.5% women) reported sex with a client; training was related to likelihood of offending, though the effect is small and complex. An analysis of eight national studies (data from 5,148 therapists) found significant effects for gender (more male offenders) and year of study (about 10% annual decrease in reported offenses since 1977) but not profession (i.e., no difference among psychiatrists, psychologists, and social workers). Most social workers reported no graduate training whatsoever about sexual attraction; only 10% reported adequate training.     

Counselor-Client Sexual Contact: Implications for Ethics Training

Most programs spend little or no time addressing the prohibition against sexual contact with clients, yet it is the most commonly violated of the ethical principles. This article provides a brief overview of models of ethics training and addresses specific strategies for preventing counselor-client sexual contact. These strategies include knowledge, activities that promote self-awareness, and provision of a climate that enhances the development of moral values and behavior. The responsibilities of training programs are addressed, including the provision of clear statements of the rights and responsibilities of trainees and of a due process and grievance procedure for review of impaired or problematic trainees.     

The Phenomenon of Comparative Development Between Female Survivors and Their Partners: Implications for Couples Therapy

The aim of this phenomenological study was to better understand the influences of families of origin on couple relationships when the female was a childhood sexual abuse survivor. Six couples participated in semi-structured individual interviews and each individual completed two-week diaries. The findings revealed that female survivors and their partners had comparable developmental histories. Implications for practice include the importance of recognizing that (1) male partners who had developmental experiences that were similar to those of their partners may contribute to the difficulties in the current couple relationship; and (2) both partners’ developmental experiences should be taken into consideration equally to facilitate the female survivors’ recovery process.     

Sexual Contact During and After Professional Relationships: Practices and Attitudes of Female Counselors

A national sample of female counselors (N = 377) was surveyed regarding sexual contact in professional relationships. Few respondents reported engaging in sexual contact either during or following professional relationships with clients, supervisees, or students. Individuals with doctoral degrees were more likely to have engaged in sexual contact with their own counselors, supervisors, or teachers. Counselors viewed sexual contact in current professional relationships as less ethical than contact in subsequent relationships, although relationships with former clients were seen as less ethical than relationships with former supervisees or students. Compared with male counselors from a previous study, female counselors were less likely to report sexual contact in their professional roles. Implications for research and training are discussed.     

Emerging Perspectives on Distinctions Between Romantic Love and Sexual Desire

Abstract— Although sexual desire and romantic love are often experienced in concert, they are fundamentally distinct subjective experiences with distinct neurobiological substrates. The basis for these distinctions is the evolutionary origin of each type of experience. The processes underlying sexual desire evolved in the context of sexual mating, whereas the processes underlying romantic love—or pair bonding—originally evolved in the context of infant-caregiver attachment. Consequently, not only can humans experience these feelings separately, but an individual's sexual predisposition for the same sex, the other sex, or both sexes may not circumscribe his or her capacity to fall in love with partners of either gender. Also, the role of oxytocin in both love and desire may contribute to the widely observed phenomenon that women report experiencing greater interconnections between love and desire than do men. Because most research on the neurobiological substrates of sexual desire and affectional bonding has been conducted with animals, a key priority for future research is systematic investigation of the coordinated biological, behavioral, cognitive, and emotional processes that shape experiences of love and desire in humans.     

Clinical Dynamics During Adolescence: Psychoanalytic and Attachment Perspectives

In this essay, we discuss the contribution of psychoanalytic theory and attachment to the understanding of dynamics in adolescence. While psychoanalysis describes adolescence as a period of upheaval that challenges the balance achieved in childhood between Ego and Id and begins the shedding of family dependencies and the loosening of infantile object ties, attachment, on the contrary, considers this period as one characterized by the persistence of strong bonds to parents, which become more complex and articulated. In order to illustrate psychoanalytic and attachment perspective, a clinical vignette of a 17-year-old boy is presented and discussed to consider his difficulties in the area of identity and loss.     

Sexual Contact During and After the Professional Relationship: Attitudes and Practices of Male Counselors

The authors of this article surveyed a national sample of male counselors and educators (N = 366) on both attitudes toward and participation in sexual misconduct with clients, students, and students under supervision. Although relatively few respondents (1.7%) reported having engaged in sexual misconduct with clients during a professional relationship, the prevalence rate increased to 17% when the definition of sexual misconduct was expanded to include (a) students and students under supervision and (b) occurrences of sexual misconduct after the professional relationship. Respondents who indicated that erotic sexual conduct may not constitute professional misconduct were more likely to report having engaged in such behavior.     

Obesity in America: Implications for Clinical and Health Psychologists

The number of individuals classified as overweight and obese is increasing at alarming rates and these conditions are associated with numerous psychological and physiological health problems. Within this epidemic, there is an increasing need and demand for psychologists and other mental health professionals to participate in the care of patients with obesity, both in assessment and treatment domains. The current paper provides a review of the status of the obesity epidemic, including psychological comorbidities and treatment approaches. Throughout this review, we highlight and discuss the important roles and impact psychologists can have. These roles include serving as members of multidisciplinary obesity treatment programs, conducting assessments for bariatric surgery, and treating related psychiatric disorders, such as depression and disordered eating. Other considerations, such as weight gain associated with psychiatric medications, and directions for future involvement of psychologists in addressing the obesity epidemic are also discussed.     

Ethical Considerations for Psychologists Taking a Public Stance on Controversial Issues: The Balance Between Personal and Professional Life

Previous literature has documented the general issues psychologists often face while balancing their personal and professional lives. The struggle stems from attempting to satisfy the need to maintain a life outside of work while having the professional obligation to follow the American Psychological Association’s (APA’s) Ethical Principles of Psychologists and Code of Conduct (Ethics Code) to prevent their personal lives from interfering with their professional roles and relationships. The present article analyzes the subject of psychologists taking a public position on controversial public issues. Although the APA Ethics Code does not restrict how psychologists conduct themselves during their personal time, taking a public stance on a controversial issue could potentially strain professional relationships and inadvertently reflect negatively on the profession. The present article examines ethical issues that (a) should be taken into account before psychologists take a public position on a controversial issue and (b) are in conflict with APA’s Ethics Code or current research.     

Family Therapy Training: Academic and Internship Opportunities for Psychologists

Institutions that train psychologists in psychotherapy skills have generally neglected the family approach. This article provides information on both university departments of psychology and psychology internship facilities that include family therapy training in their programs.