Sexualization of therapeutic relationships: The dual vulnerability of patient and therapist.

Contends that consumerism (a humanistic-egalitarian therapeutic orientation) and feminism have heightened awareness of the problem of sexual intimacies between patients and therapists. Evidence suggests that sexual intimacy between patients and their therapists has become a more common mode of experience than previously thought. Sexual abuse occurs when the relationship between the patient and therapist is violated, and the patient is victimized by the therapist; erotic involvement between patient and therapist has been likened to incest. Data from the 1970's show that the overwhelming majority of sexually abusive therapists are male. Education during therapists' training period and alternatives for therapists at risk for sexually abusive behavior, including avoidance, referral, treatment programs, and punishment, are suggested as ways to deal openly with this small but severe problem. Public education, in a nonalarmist manner, is also recommended. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The legal implications of sexual activity between psychiatrist and patient

The author examines the legal and professional sanctions against sex between therapist and patient. The relevant literature of criminal law suggests that charges of rape or related sexual offenses against psychotherapists who exploit their patients are a remote possibility. Although sexual activity between therapist and patient may form the basis of a malpractice claim, the existing case law is complicated, and the legal distinctions are not always consistent with good psychiatric practice. Professional associations lack the legal expertise and indemnification to act in these situations, but medical boards in some states have the power to revoke licenses. In the end, patients must depend on the decent moral character of their therapists.     

Factors in premature termination in long-term psychotherapy.

Examined the relationship between patient and therapist variables and the incidence of premature termination at a private outpatient psychotherapy clinic. Using a qualitative rating scheme, 718 long-term psychotherapy cases were reviewed to determine whether termination had been premature. The 273 cases judged to be premature terminations were compared with the patient population as a whole on 10 patient variables. For 27 psychotherapist-Ss (aged 29–68 yrs), the rates of premature termination among their patients were examined with reference to 9 therapist variables. Results indicate that premature patient terminators differed significantly on race, age, source of referral, type of payment, employer, presenting complaint, and diagnosis. Psychologists were found to have significantly lower rates of premature termination among their patients than psychiatrists or social workers. Therapists who had undergone personal therapy showed significantly lower rates than those who had no therapy. Therapists' defense style and life stresses did not relate significantly to rates of premature termination. Results are discussed in terms of motivational factors in patients and identification with the values of long-term psychotherapy by therapists. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biased reporting of therapist–patient sexual intimacy.

To investigate bias in reports of therapist–patient sexual intimacy, information about 559 patients who were sexually intimate with their previous therapists was collected via questionnaire from 318 psychologists who subsequently saw these patients in therapy. Psychologists, the experimental Ss in the present study, were predominantly aged 40–49 yrs, and 64% were male. It was found that Ss who reported that no harm occurred to patients as a result of therapist–patient sexual intimacy (SI) admitted twice the prevalence of SI between patients and themselves than did Ss in general. Those Ss who had experienced SI with patients were less likely to report adverse effects of SI either for patients or for therapy. Fewer Ss with a history of SI than those without reported anger toward offending therapists, and fewer recommended punishment. A higher percentage of female than male Ss reported anger toward offenders and recommended punishment, yet women did not rate the effects of SI as more harmful than did men. In general, anger toward offending therapists and recommendations for punishment were associated with the degree to which patients were thought to have been harmed. Ss who had been consultants to a greater number of other therapists about sexual contact with patients reported relatively more cases in which therapy ended soon after SI began than did Ss who were consulted by fewer therapists. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beneath the surface of long-term therapy: Therapist and client report of their own and each other's covert processes.

Therapists and clients reported on their own and their perceptions of each other's covert processes in long-term therapy. Therapists had a match rate of .45 for client reactions, with therapists rating match on therapeutic work reactions as helpful. Although 65% of clients left somethimg unsaid (primarily because of avoidance), only 27% of therapists were able to match what clients left unsaid. Of the clients, 46% had secrets (often sexual), primarily because of shame or insecurity. Clients had a match rate of .50 for therapist intentions, with therapists rating match on exploratory and restructuring intentions as helpful and both clients and therapists rating match on assessment intentions as not helpful. Thus, awareness of the other's covert processes had an effect on therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist qualities preferred by sexual-minority individuals.

Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapist as patient: Special problems and considerations.

Argues that despite the awareness among mental health professionals of the need for the care of fellow practitioners, with emphasis on professional burnout and occupational counseling, the difficulties encountered by therapists in the treatment of their colleagues have been noticeably neglected. Based on experience treating colleagues, interventions and insights designed to avoid pitfalls while facilitating treatment are offered. It is suggested that the choice of a therapist should permit the patient a reasonable degree of social life-space anonymity, a sense of compatible treatment values and philosophy, and knowledge of and respect for the therapist's professional expertise. Factors that motivate a therapist to seek personal therapy are often more complex in reality than for the general patient population. Therapists who become patients have apprehensions that feelings emerging in their own psychotherapy will erode the carefully honed sense of self-as-healer/patients-as-wounded paradigm. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Process and outcome in psychotherapy and behavior therapy.

Three behavior therapists and 3 analytically oriented psychotherapists treated a total of 60 neurotic outpatients for 4 mo. Data were collected as part of a larger study by R. B. Sloane et al (1975). Measures of Rogers-Truax (C. B. Truax and K. M. Mitchell, 1971) factors, nonlexical speech characteristics, therapist informational specificity, and a content analysis of therapist activity were taken from recordings of the 5th interview. Therapists rated their feelings toward their patients, and patients completed the Relationship Questionnaire and rated therapists on an inventory by M. Lorr (see record 1965-10372-001). In psychotherapy, patients who were most liked by their therapists and those with greater total speech time showed greatest symptomatic improvement. Patients who used longer average speech durations improved most in both treatments. It is concluded that patient improvement was more a function of patient characteristics than of specific therapist interventions. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist flexibility/rigidity and work stress.

The relation between personal flexibility/rigidity and psychotherapists' reports of stress from five work-related factors and five patient-related factors was studied in a questionnaire survey of 227 licensed psychologists with a wide range of experience. After multiple-regression equations had isolated the effects of gender, social desirability, therapist style, and experience level, measures of personal flexibility/rigidity correlated primarily with levels of reported stress associated with patient behaviors. More rigid therapists reported more stress from negative affect and suicidal threats. Therapists with greater fusion tendencies reported more stress from psychopathological symptoms, suicidal threats, and passive–aggressive behaviors. Therapists with a preference for maintaining clear boundaries indicated that they felt less stressed by psychopathological symptoms and suicidal threats. These personality dimensions did not generally correlate with reports of stress from work-related factors, though therapists with greater fusion tendencies did report more stress from professional doubt and from maintaining the therapeutic relationship. Therapist experience level and therapist flexibility/rigidity appear to correlate with different aspects of the stresses associated with psychotherapeutic work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Erotic transference through countertransference: The female therapist and the male patient.

Explores the female clinician's countertransference as the primary limiting factor in sexual transference. The female therapist, who may be unconsciously fearful of losing a boundary or being violated, may afford her male patient a less than optimal chance of understanding the shame attendant to his sexuality or the aggression that may be associated with it. Although sexual transference is the entree into the patient's psychic life, sexual countertransference is anathema, a double standard that is now coming under fire. Two cases are described in which men develop strong sexual transferences and engender stong countertransferences in return. Although these men were sexually overstimulated as children and possibly abused, the processes they undergo may be extrapolated to other male patient–female clinician dyads. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Process issues in treatment: Application to sexual offender programs.

How critical is the therapeutic alliance in the treatment of sexual offenders? To date such process issues have been neglected in the field of sex offender treatment. This article reviews the literature on the influence on behavior change of therapist features, clients' perceptions, and the therapeutic alliance. Among the many therapist features identified as helpful are empathy, warmth, and being directive and rewarding. Therapists who are aggressively confrontational appear not to foster beneficial changes in their clients. These issues are directly related to treatment issues faced by therapists who work with sexual offenders, such as dealing with cognitive distortions, lack of empathy, and lack of motivation to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acceptance, values, and therapeutic change.

Studied the role of therapist acceptance of patient values, patient acceptance of therapist values, and value persuasion on outcome among 13 psychotherapy dyads. Therapists consisted of 13 graduate students in clinical psychology, all of whom had been trained in relationship/insight-oriented therapy. The 13 17–25 yr old patients were randomly selected, 1 from each therapist's caseload. Before beginning therapy all therapists completed a series of value questionnaires; patients completed the same scales after the 1st and 12th therapy sessions. A priori assessment of value acceptance was related to patients' perceptions of their therapists and ratings of improvement, with outcome being enhanced by selective value rejection as well as acceptance. A significant relationship was found between the patients' acquisition of their therapists' values and their ratings of improvement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological impacts of sexual contact between therapists or other health care practitioners and their clients.

14 females who had had sexual contact with their therapists/psychiatrists (Group 1), 7 females who had had sexual contact with their health care practitioners (principally physicians [Group 2]), and 10 females who had received counseling services but had not engaged in sexual contact with therapists (Group 3) were compared by administering a questionnaire on self-esteem, depression, attitudes, beliefs about sexual contact, emotional effects of treatment, sexual attitudes, and psychosomatic and psychological symptoms. In addition, data were obtained from Ss, who were primarily aged 26–45 yrs, on (1) history of sexual victimization, (2) marital status of therapist/physician, (3) who initiated sexual contact, and (4) frequency of sexual contact. Results show that Ss in Group 1 had greater mistrust of and anger toward males and therapists and a greater number of psychological and psychosomatic symptoms following the cessation of therapy than did Ss in Group 3. Ss in Groups 1 and 2 did not differ in psychological impacts. Severity of impacts were significantly related to the magnitude of psychological and psychosomatic symptoms prior to treatment, prior sexual victimization, and the marital status of the therapist or health practitioner. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ratings of Therapist Dynamic Activities and Alliance Early and Late in Psychotherapy.

The present study examines the concurrent and predictive relationships between therapist psychodynamic-interpersonal activity and therapist-rated alliance. Ratings from 45 patient and therapist dyads engaged in short term psychodynamic psychotherapy from a point early (3rd or 4th session) and late (the session at which 90% of the treatment was completed) in treatment were used. The results suggest that therapists who have positive views of the alliance early in treatment also have positive views of the alliance later in treatment. Therapists who used psychodynamic-interpersonal activities early in treatment also made use of psychodynamic-interpersonal activities later in treatment. Moreover, the use of psychodynamic-interpersonal activities early in treatment was positively related to both global and specific aspects of therapist-rated alliance late in treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Lesbians, gay men, and their families. Some therapeutic issues

Although a body of scientific data about working with parents and families of gays and lesbians has not yet developed, there is a growing body of literature of an anecdotal and personal nature that has been cited. These works provide therapists with background information and clients needing assistance with guided reading. Therapists working with families and friends of gay men can find the experience rewarding and the therapeutic interventions effective. Much of the work is common sense, listening with the "third" ear for those underlying issues separate from the son's gayness that may affect the person's attitudes, feelings, and responses. Maintaining a professional demeanor while conveying a sense of caring and concern for the individuals is a key issue. As gay people become more visible in society and as the number of individuals coming out increases, there will be a need for more therapists who can assist families with their own coming out process. This article provides some basic guidelines and, as individual therapists gain more experience in this area, it will be important that others report those experiences, sharing them with the rest of the therapist community.     

Therapist retrospective recall impasses in long-term psychotherapy: A qualitative analysis.

Twelve experienced therapists completed a questionnaire, and 8 of the 12 were then interviewed about their experiences with a therapeutic impasse that ended in the termination of therapy. Data were analyzed using a qualitative methodology. Results indicated that most of the clients were anxious and depressed with personality disorders and interpersonal problems. Therapists perceived impasses as having a profound negative impact on both clients and therapists. Variables associated with impasses in a majority of the cases were a client history of interpersonal problems, a lack of agreement between therapists and clients about the tasks and goals of therapy, interference in the therapy by others, transference, possible therapist mistakes, and therapist personal issues. Implications for training, practice, and research are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' anger, hate, fear, and sexual feelings: National survey of therapist responses, client characteristics, critical events, formal complaints, and training.

Therapists reported frequencies of experiencing 24 instances of feeling anger, hate, fear, and sexual attraction or arousal; encountering 16 client events (e.g., client orgasm, client disrobing, client suicide, client assault on therapist or 3rd party); and engaging in 27 behaviors (e.g., avoiding clients with HIV, kissing clients, massaging clients, using weapons or summoning police for protection from clients). Responses differed according to therapist gender (e.g., more male than female therapists experienced patient suicides and faced malpractice, ethics, or licensing complaints), client gender (e.g., more female than male clients were noticed as "physically attractive," hugged, and cradled in therapists' laps), and theoretical orientation. Many participants rated graduate training regarding anger, fear, and sexual arousal as inadequate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent and therapist evaluation of behavior therapy in a child psychological clinic.

Obtained evaluations from the parents of 70 children who were treated by psychological interns being trained in behavior therapy. Therapist ratings of specific problem improvement were obtained at close of therapy. Improvement ratings of the same specific problems were obtained from parents approximately 6 mo later. Classification of an S as improved or unimproved depended on the averages of both the therapist and parent ratings of the presenting problems. This procedure indicated overall improvement in 87 and 90% of the cases, based on therapist and parent averages, respectively. Therapists rated 80% of all specific problems improved at termination, as compared to 77% of problems improved as rated by parents at follow-up. Correlation between the improvement ratings of each problem by parent and therapist was highly significant (r = .51). 96% of the parents liked their therapists, and personal characteristics most frequently noted by the parents were warmth, understanding, and sincere interest in the S. The high improvement rates reported by therapists and parents are discussed in regard to previous therapy outcome studies with children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of client-therapist sexual involvement in Rhode Island as reported by subsequent treating therapists.

In this study, the authors surveyed all licensed mental health professionals in the state of Rhode Island and asked them if they had treated clients who had been sexually abused by a former therapist. Twenty-six percent of the respondents reported having treated victims of therapist sexual abuse. In addition, the treating therapists reported 120 incidents of other boundary violations. These data point to a dramatic difference between the actual occurrence of therapy boundary violations and the reporting of violations to state licensing boards. The nature of the violations that do occur and the impact on patient victims are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex bias in psychotherapy: An examination of the effects of client sex, pathology, and therapist sex on treatment planning.

Investigated the effects of therapist sex, client sex, and client pathology on treatment goals formulated by a pool of 32 male and 32 female practicing psychotherapists (psychiatrists, clinical psychologists, psychiatric social workers, and therapists from related disciplines). Each therapist recommended treatment goals for either 2 male or 2 female pseudoclients who differed in their presenting pathology, which was severe and clearly defined. Male therapists chose significantly more feminine treatment goals for all their clients, whereas female therapists chose significantly more masculine goals, regardless of client sex. Therapists responded to the client's pathology, rather than the client's sex, in formulating treatment goals. This suggested either that client sex is not important in determining treatment goals or that client sex may affect therapists' treatment goal choice only when pathology is vague or not severe. (PsycINFO Database Record (c) 2010 APA, all rights reserved)