Harmful effects of posttermination sexual and romantic relationships between therapists and their former clients.

[Correction Notice: An erratum for this article was reported in Vol 25(4) of Psychotherapy: Theory, Research, Practice, Training (see record 2007-12032-001). Reference was made to the Minnesota law regarding reporting of "any sexual or romantic relationship in which the parties were once therapist and client" (p. 250). Upon further review by the author, it was determined that the law is more complicated than conveyed in the article. A detailed explanation of the law is provided in the erratum, although legal counsel is suggested for further interpretation.] Examines anecdotal evidence regarding the harmful effects of posttermination sexual or romantic relationships between therapists and clients, focusing on relationships between female therapists and former clients who are also women. The question of equality of power between therapists and former clients is addressed. The impact of these relationships on the community in which they occur is considered. It is concluded that posttermination relationships between therapists and clients have the potential to do as much harm as relationships initiated during therapy and that such relationships should be defined as unethical. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual and business relationships between therapists and former clients.

Examined the incidence of post-termination sexual (PTSRs) and business relationships (PTBRs) between therapists and former clients, as well as the legal, clinical, demographic, and professional judgment considerations related to both PTSRs and PTBRs. Among a sample of 348 therapists (aged 29–81 yrs; 52% male) who had been delivering psychotherapy services for an average of 14 yrs, it was found that 6.5% engaged in PTSRs and 29% engaged in PTBRs. Demographic comparisons showed that males were significantly more likely to engage in both PTSRs and PTBRs. PTSRs were always viewed as more inappropriate than PTBRs. Results provide considerable support for the inclusion of prohibitions against sexual intimacies with former clients as part of the Ethical Principles and Code of Conduct (American Psychological Association; see record 1993-19413-001). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reconsidering the American Psychological Association's policy on sex with former patients: Is it justifiable?

This article invites reconsideration of the American Psychological Association's policy permitting sexual involvements between therapists and their former patients under certain conditions. The article (1) restates 5 major concerns about sex after termination that have not been adequately addressed; (2) examines 9 major arguments set forth in support of allowing posttermination sexual relationships, all of which appear ill-founded, fallacious, or misleading; and (3) describes 6 obstacles that seem to hinder attempts to create sound legal and professional policies in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Graduate training in psychotherapy: Are therapy outcomes enhanced?": Comment on Stein and Lambert (1995).

Comments on the article by D. M. Stein and M. J. Lambert (Journal of Consulting & Clinical Psychology, 1995[Apr], Vol 63[2], 182–296). The authors misunderstood the meta-analysis of P. Crits-Cristoph et al (see record 1992-20595-001) as examining the relation of therapist experience to "therapist effects" (i.e., differences between therapists in their average outcomes). The Crits-Cristoph et al results did not show that experienced therapists had better outcomes than less experienced therapists. It is also noted that the data in Table 3 are, in fact, correct. However, these 2 errors do not affect the main findings of Stein and Lambert's article. (The following abstract of this article originally appeared in PA, Vol 82:26915.) Several sources of indirect evidence supporting the value of graduate training in psychotherapy are reviewed here. Training protocols that are known to enhance trainees' skills are briefly discussed, as are conclusions of meta-analytic reviews examining relationships between therapist experience and training, and therapy outcome. An updated meta-analysis of therapy outcome studies involving within-study comparisons of psychotherapists of different levels of training and experience is summarized.… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Counselor deliberate postural lean and communication of facilitative conditions": Correction.

Reports an error in "Counselor deliberate postural lean and communication of facilitative conditions" by Gary L. Hermansson, Alan C. Webster and Ken McFarland (Journal of Counseling Psychology, 1988[Apr], Vol 35[2], 149-153). The date of receipt indicated for the revision of this article was incorrect. The correct date of receipt is provided in the erratum. (The following abstract of the original article appeared in record 1988-36435-001.) This experimental study examined the relation between counselor deliberate postural lean and the communication of intensity, empathic understanding, respect, and genuineness. Results, from 12 male counselors acting as their own controls under three postural lean conditions (forward, backward, and choice) in counseling interaction with female clients, suggested compensatory processes in operation. Making a required lean forward was associated with decreased facilitative levels and backward with increased levels. The latter effects were more marked, with significant differences in intensity and respect. The effects were also more marked with those counselors who, as revealed in their choice session, preferred to move forward rather than backward, with these counselors also being the most effective as assessed by communicated empathy levels. It was concluded that for effective counselors in particular, deliberate postural lean results in a subtle maintenance of an equilibrium of verbal–nonverbal communication behaviors judged as most appropriate to the moment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexualité, intimité et relation d'aide.

Examines sexual relationships in terms of their impact on the client, therapist variables, and the basic features of the helping relationship. Even though ethical formulations unanimously condemn sexual relationships between clients and therapists, it is suggested that the clients' interests require the articulation of an integrative and practical model of sexual interaction in therapeutic relationships. (English abstract) (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing therapist and client perspectives on reasons for psychotherapy termination.

Examines the extent of agreement on the reasons for psychotherapy termination given by therapists and their clients. 194 client files in a psychology training clinic were reviewed to obtain reasons for termination cited by therapists in treatment termination reports. Telephone interviews were conducted with 87 of these former clients to determine their perspectives on reasons for termination. Consistent with previous research, there was little concordance among the reasons cited by therapists and by clients regarding clients' decisions to terminate therapy. Of the clients identified by therapists as terminating because of the successful attainment of therapeutic goals, three-quarters reported this reason as important in their termination decision; of those clients reporting termination because of attaining therapeutic goals, only half were identified by therapists as having achieved their goals. Dissatisfaction with therapy and/or the therapist were reported by many clients as important in their termination decisions; such factors were rarely cited by therapists as reasons for termination. Attention to discrepancies between client and therapist expectations of therapy and therapy termination is necessary to reduce the high rate of premature termination in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathways from childhood abuse and neglect to HIV-risk sexual behavior in middle adulthood.

Objective: This study examines the relationship between childhood abuse and neglect and sexual risk behavior in middle adulthood and whether psychosocial factors (risky romantic relationships, affective symptoms, drug and alcohol use, and delinquent and criminal behavior) mediate this relationship. Method: Children with documented cases of physical abuse, sexual abuse, and neglect (ages 0–11) processed during 1967–1971 were matched with nonmaltreated children and followed into middle adulthood (approximate age 41). Mediators were assessed in young adulthood (approximate age 29) through in-person interviews between 1989 and 1995 and official arrest records through 1994 (N = 1,196). Past year HIV-risk sexual behavior was assessed via self-reports during 2003–2004 (N = 800). Logistic regression was used to examine differences in sexual risk behavior between the abuse and neglect and control groups, and latent variable structural equation modeling was used to test mediator models. Results: Child abuse and neglect was associated with increased likelihood of risky sexual behavior in middle adulthood, odds ratio = 2.84, 95% CI [1.74, 4.64], p ≤ .001, and this relationship was mediated by risky romantic relationships in young adulthood. Conclusions: Results of this study draw attention to the potential long-term consequences of child abuse and neglect for physical health, in particular sexual risk, and point to romantic relationships as an important focus of intervention and prevention efforts. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"Exploitation and inference: Mapping the damage from therapist-patient sexual involvement": Correction to Williams.

Reports an error in "Exploitation and inference: Mapping the damage from therapist-patient sexual involvement" by Martin H. Williams (American Psychologist, 1992[Mar], Vol 47[3], 412-421). On page 419, the sentence "In this case, the odds that a patient will become sexually involved with his or her psychoanalyst are 1 in 1,129 or a likelihood of 0.9%" should read "In this case, the odds that a patient will become sexually involved with his or her psychoanalyst are 1 in 1,129 or a likelihood of 0.09%." (The following abstract of the original article appeared in record 1992-25076-001.) A growing body of evidence documents a clinical pattern of harmful effects of therapist–patient sexual involvement. In addition, surveys suggest that 1 to 12% of all therapists may have engaged in this behavior at least once in their careers. In order to develop a more comprehensive research agenda, several of these studies are reviewed in terms of inferences that may or may not be drawn. Case studies and surveys may provide for inference of clinical harm and syndrome, but they are limited in terms of generalizations about incidence in the overall population. A population approach coupled with case sampling may provide a useful tool by which to approximate a minimum level of incidence and of effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homosexuality: The ethical challenge.

Suggests that behavior therapists have not attended sufficiently to the factors influencing the desire of some homosexuals to change their sexual orientation. Therapists of all persuasions too often make decisions for their voluntary clients. A perusal of the psychotherapy and behavior therapy literature indicates that therapists generally regard homosexuality as undesirable, if not pathological. Since professionals are unlikely to work on treatment procedures unless they see a problem, it is probable that the very existence of change-of-orientation programs strengthens societal prejudices against homosexuality and contributes to the self-hate and embarrassment that are determinants of the "voluntary" desire by some homosexuals to become heterosexual. A proposal is made that therapists stop offering help to homosexuals to change their sexual orientation and concentrate instead on improving the quality of their interpersonal relationships. Alternatively, more energy could be devoted to sexual enhancement procedures in general, regardless of the adult gender mix. (17 ref) (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)     

Diversity within African American, female therapists: Variability in clients' expectations and assumptions about the therapist.

Despite the presence of some literature that has addressed the characteristics of the African American female therapist, most psychotherapy training proceeds with the assumption that therapists are members of dominant groups, and most of the psychological and psychotherapy literature has been written by therapists and psychologists who come from dominant cultural perspectives. Not as much has been written about psychological paradigms or the process of psychotherapy from the perspective of the therapist who is not a dominant group member. This article explores both the common and divergent experiences that we, the authors, share as African American female therapists and the different reactions we frequently elicit in clients. We also explore how individual differences in our physical appearances, personal backgrounds, and different characteristics of our respective practices elicit distinct responses from clients that we believe are based on differences between us, despite the fact that we are both African American women. We believe that many of the stereotypes that affect perceptions of African American female clients also exist for African American female therapists. We will address how the intersection of gender, race, and sexual orientation of the client highlights the complexity of culturally competent practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Remembering childhood sexual abuse: A national survey of psychologists' clinical practices, beliefs, and personal experiences.

A national survey of 1,000 psychologists, to which 223 responded, assessed professionals' clinical practices and beliefs about the treatment of adult survivors of childhood sexual abuse (CSA), personal CSA history, and the phenomenon of clients remembering CSA in therapy. Results indicated that over 25% of therapists reported using guided imagery, dream interpretation, bibliotherapy regarding sexual abuse, referral to sexual abuse survivors' group, and free association of childhood memories as memory retrieval techniques with clients who had no specific memory of CSA. However, the majority of therapists reported that they had not seen any cases of adult clients entering therapy with no memory of CSA and subsequently recalling abuse in the course of therapy. A personal history of CSA was not associated with most clinical practices related to treating sexual abuse survivors. The implications for training and establishing scientific standards of psychological practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Larsson, Kaldo, and Broberg (2009).

Reports an error in "Similarities and differences between practitioners of psychotherapy in Sweden: A comparison of attitudes between psychodynamic, cognitive, cognitive–behavioral, and integrative therapists" by Billy P. M. Larsson, Viktor Kaldo and Anders G. Broberg (Journal of Psychotherapy Integration, 2009[Mar], Vol 19[1], 34-66). The results of the post hoc tests were printed illegibly. In order to make it possible for the reader to understand which of the effect sizes belong to which of the comparisons, the tables are clarified in this erratum. (The following abstract of the original article appeared in record 2009-03150-003.) This study focuses on similarities and differences between Swedish psychotherapists of four orientations: psychodynamic, cognitive, cognitive–behavioral, and integrative therapy. The aim is to describe similarities and differences regarding (a) background factors, (b) focus in psychotherapy, (c) attitudes toward psychotherapy as art/craftsmanship, (d) scientific outlook, (e) what characterizes a good psychotherapist, and (f) how psychotherapy ought to be pursued. The therapists had very similar attitudes about the therapeutic relationship and rather similar attitudes about which effects psychotherapy ought to obtain. The greatest differences were related to psychotherapeutic techniques and science. The results are discussed with emphasis on the distance or proximity between the orientations. The conclusion is that there are differences between psychodynamic psychotherapy compared with cognitive and cognitive–behavioral therapies, which imply difficulties in integrating these orientations. However, the differences between the cognitive and cognitive–behavioral therapists are not of such a magnitude that they necessarily present an obstacle to integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Routine inquiry into sexual victimization: A survey of therapists' practices.

Surveyed therapists regarding their practices in assessing clients' sexual abuse history. Of the 105 respondents, 51% reported that they routinely ask all clients or most clients about sexual abuse at some time during the course of therapy; 19% reported that they had asked only a few clients or that they never ask clients directly about sexual abuse. Therapists who were younger, who had been in practice for a shorter period of time, and whose current caseload included a high percentage of sexually abused women were most likely to have asked all or most of their clients about having been sexually abused. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex with therapy clients: Its prevalence, potential consequences, and implications for psychology training.

Reviews literature indicating the prevalence and clinical consequences of therapist–client sexual contact. Ethics complaints; administrative action; therapist rehabilitation: posttermination therapist–client sexual contact; and legal consequences in the US and Canada, including the Canadian Supreme Court's Norberg v. Wynrib (1992) decision, are discussed. Recommendations for psychology to prepare students to appropriately handle sexual attraction to clients and deal with related ethical issues are offered. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exploitation and inference: Mapping the damage from therapist-patient sexual involvement": Correction.

Reports a revision of an earlier correction in the original article by M. H. Williams (American Psychologist, 1992[Mar], Vol 47[9], 412–421). On page 419, the sentence "In this case, the odds that a patient will become sexually involved with his or her psychiatrist are 1 in 1,129 or a likelihood of 0.9%' should read, "In this case, the odds that a patient will become sexually involved with his or her psychiatrist are 1 in 1,129 or a likelihood of 0.09%.' (The following abstract of this article originally appeared in record 1992-25076-001.) A growing body of evidence documents a clinical pattern of harmful effects of therapist–patient sexual involvement. In addition, surveys suggest that 1 to 12% of all therapists may have engaged in this behavior at least once in their careers. In order to develop a more comprehensive research agenda, several of these studies are reviewed in terms of inferences that may or may not be drawn. Case studies and surveys may provide for inference of clinical harm and syndrome, but they are limited in terms of generalizations about incidence in the overall population. A population approach coupled with case sampling may provide a useful tool by which to approximate a minimum level of incidence and of effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An experimental inquiry into transference roles and age.

In this psychotherapy analogue investigation, the effects of client age and therapist age on transference-like projections onto therapists were examined. Young (25–35) and older (60–70) pseudoclients compared paraprofessional therapists to significant figures in their own lives after a dyadic "helping" interview. The results provide empirical support for the phenomenon of reverse transference in therapy with older patients. Older clients were more inclined than young clients to view therapists, particularly younger therapists, as similar to their children. Young clients more willingly attributed parental qualities to older therapists. Both old and young clients may see therapists more as peers or friends than as family members. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Bobo revisited: What the research says": Correction to Drewes (2008).

Reports an error in "Bobo revisited: What the research says" by Athena A. Drewes (International Journal of Play Therapy, 2008[Sum], Vol 17[1], 52-65). A reference was incomplete. The correct reference is Trotter, K., Eshelman, D., & Landreth, G. (2003). A place for Bobo in play therapy. International Journal of Play Therapy, 12, 117-139. (The following abstract of the original article appeared in record 2008-04333-005.) There has been some discussion in the play therapy literature regarding whether to use a Bobo doll (bop bag) in the play therapy room. The following article reviews research studies from the fields of personality, learning, and social psychology, and underlying theories to help inform and assist play therapists in their decision-making regarding Bobo. Suggestions are offered regarding future empirical research in play therapy outcomes and the choices of play materials in the playroom. (PsycINFO Database Record (c) 2010 APA, all rights reserved)