Dangerous liaisons: Sexual intimacies in supervision.

The existing literature concerning supervisor–supervisee sexual intimacies was reviewed before proposing a conceptualization of sexual contact in the supervisory relationship. Three definitions of sexual contact (sexual harassment, sexual involvement, and sexual discrimination) are presented. The nature of the supervisory relationship is defined by comparison with other professional relationships (instructor–student and therapist–client). The process of supervisor and speculation about vulnerabilities of trainees to sexual advances by supervisors are discussed in terms of the developmental model of therapist training. The damaging effects of sexual contact between supervisors and supervisees are discussed and suggestions for improved graduate education are noted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying and reducing risk factors related to trainee–client sexual misconduct.

Sexual misconduct involving therapists-in-training and their clients is addressed. Personal and situational factors that may constitute risk factors for the development of inappropriate sexual activity between trainees and their clients are identified. Although there may be certain characteristics that put particular students at risk for such involvement, the authors believe this risk is more strongly related to systemic, programmatic, and pedagogic characteristics of the environments in which students train. Examples include, respectively, the decline of concern over transference and countertransference, failure to include education about client–therapist sexual attraction and the consequences of sexual misconduct in graduate psychology curricula, and the reluctance of supervisors to deal straightforwardly with trainees' sexual feelings. Suggestions for reducing risks for client–therapist sexual misconduct are directed toward these situational factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist homophobia, client sexual orientation, and source of client HIV infection as predictors of therapist reactions to clients with HIV.

Four hundred twenty-five psychologists received vignettes depicting a male client who was either gay or heterosexual and whose source of HIV infection was sexual contact, a blood transfusion, intravenous drug use, or unspecified. Respondents' homophobia and reactions to the client in the vignette were measured. Canonical correlation analyses revealed that therapist attributions of client responsibility for problem cause were predicted by the source of HIV infection and therapist homophobia. In addition, therapists responded with less empathy, attributed less responsibility to the client for solving his problems, assessed the client's functioning to be worse, and were less willing to work with the client when the client's source of HIV infection was other than drugs, when the client was gay, and when therapists were more homophobic. (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)     

Psychologists' Clinical Evaluations and Attitudes: An Examination of the Influence of Gender and Sexual Orientation.

Becoming aware of factors that may affect differential treatment of clients is necessary for psychologists to practice competently. Scholarly writing and empirical studies have suggested that therapist gender, client gender, and client sexual orientation are 3 such factors. This study examined therapist gender, client gender, and client sexual orientation in relation to psychologists' attitudes and clinical evaluations for clients. Results indicated that female psychologists held more positive attitudes and treatment expectations for clients than did male psychologists and that some psychologists hold inconsistent attitudes toward female clients generally and lesbian, gay, and bisexual clients in particular. Continuing education and consultation are recommended to increase psychologists' awareness of gender and sexual orientation issues and potential influences in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resistance: A reconceptualization.

Discusses concepts of resistance in psychotherapy and argues that a therapist–client adversarial stance is common across many theoretical orientations, including Freudian and neoanalytic, nonanalytic (Gestalt, behavioral), and family therapies. The present authors advocate abandoning the concept of resistance because (1) research has shown that a cooperative client–therapist relationship is more beneficial to clients than an adversarial relationship; (2) research has shown that therapist understanding of the client–therapist relationship is poor; and (3) there is a move among analytic and nonanalytic approaches away from an adversarial client–therapist stance. It is suggested that the resistance concept be replaced with the therapist's recognition of possible client fears and misunderstanding of the therapy process. (73 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintenance strategies for the treatment of obesity: An evaluation of relapse prevention training and posttreatment contact by mail and telephone.

129 21–57 yr old moderately obese volunteers who averaged 57% over ideal weight were randomly assigned to 1 of 6 experimental conditions in a 3?×?2 factorial design. Three treatment conditions (nonbehavioral therapy, behavior therapy, or behavior therapy plus relapse prevention training) were crossed with 2 posttreatment conditions (posttreatment client–therapist contact by telephone and mail or no posttreatment contact). All treatments produced substantial initial weight losses, but Ss tended to regain weight during the follow-up period. Posttreatment client–therapist contact by mail and telephone significantly enhanced the maintenance of weight loss for groups that received nonbehavioral treatment or behavior therapy plus relapse prevention training, but it did not improve maintenance for groups that received behavior therapy only. At 12-mo follow-up, the only condition that maintained its mean posttreatment weight loss was the one that received behavior therapy plus relapse prevention training and posttreatment contact. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family dysfunction, alexithymia, and client attachment to therapist.

Alexithymia involves problems differentiating affective states such as fear, sadness, or anger; difficulty expressing feelings; and a tendency to rely on external cues rather than internal experience for making decisions. This study examined alexithymia as a possible mediator by which dysfunctional family environment in childhood affects adult clients' attachment relationship to their therapist. Clients (N?=?61) completed measures of dysfunctional family structure (Family Structure Survey), alexithymia (Toronto Alexithymia Scale), and their counseling relationship (Client Attachment to Therapist Scale). Findings suggest that fear of separation was associated with both alexithymia and poor client attachment to therapist. Parent–child role reversal was associated with problems in identifying feelings. Role reversal and marital conflict were both associated with problems in client attachment to therapist. Results suggest that alexithymia may be a significant mediator of the relationship between family dysfunction and client attachment to therapist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rights of clients, responsibilities of therapists.

Discusses ways in which ethical principles can be put into practice in the client–therapist relationship. Historically, ethical codes for therapists were drawn up to protect the professions from regulation by external agencies. Implicit in the ethical codes, however, is a model for the client–therapist relationship that fosters the goals of mental health. It is suggested that just as ethical codes have been given specific content in standards for providers of psychological services in human service facilities, ethical codes can be given specific content in the client–therapist relationship. It is recommended that therapists take responsibility for incorporating ethical standards into their practices so that clients' rights will be an integral part of therapy. Four illustrative situations are presented: providing clients with information to make informed decisions about therapy, using contracts in therapy, responding to clients' challenges to therapists' competence, and handling clients' complaints. (63 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The current state of sexual ethics training in clinical psychology: Issues of quantity, quality, and effectiveness.

Given the harm caused to clients and the psychology profession by therapist sexual misconduct, sexual ethics training should be given high priority in graduate training programs. The present study surveyed sexual ethics training and student understanding of sexual ethics in clinical psychology doctoral programs from the perspectives of 84 training directors and 451 students. Ninety-four percent of the students had received sexual ethics training; programs provided an average of 6 hr of training. Still, students showed significant deficits in knowledge of sexual ethics principles. Students who had discussed a client attraction with a supervisor showed the best understanding of sexual ethics. Suggestions for ensuring adequate sexual ethics training are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An analog study with beginning therapists suggesting bias against "activity" in women.

Investigated the effects of client sex and therapist attitudes toward women on treatment planning for an "active" client by having 28 social workers, 28 psychiatrists, 2 nurses, and 3 psychologists (aged 20–30 yrs) formulate a treatment plan for either a male or female client whose cases were identical except for client sex. The client was portrayed as active in work, sex, and interpersonal relationships. Results show bias against activity in women: The female client was seen as having an intrapsychic problem requiring individual insight-oriented therapy, while the male client, with the same presenting problem of marital conflict, was seen as having an interpersonal relationship problem requiring couples' therapy. Activity in a woman was viewed as neurotic. The conflict was conceptualized as unresolved issues about sexual identification, implying normal femininity had not been achieved. Therapists expected that the woman would make the concessions in the relationship and would compromise her career ambitions to achieve a more satisfactory balance of the roles of career woman and wife. It is suggested that therapists must reexamine their conceptualization of activity in men and women and the consequences of their beliefs in everyday clinical practice. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role expectations and symmetrical/complementary therapeutic relationships.

Rated 25 tape recorded initial therapy interviews taken from graduate and undergraduate students on the process variable of topic determination, which was indicative of the type of relationship (either complementary or symmetrical) between client and therapist. Topic determination was defined as the ratio of successful topic changes to topic change initiations. It was hypothesized that matched client–therapist role expectations would be related to a complementary relationship, as determined by a high degree of topic determination. Conversely, nonmatched client–therapist role expectations would be related to a symmetrical relationship, as determined by a low degree of topic determination. It is concluded that matched/nonmatched client–therapist role expectations are important variables in determining whether the subsequent therapeutic relationship will be complementary or symmetrical. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparative evaluation of minimal therapist contact and 15-session treatment for female orgasmic dysfunction.

Compared a 4-session minimal therapist contact (MTC) program for treatment of lifelong global orgasmic dysfunction in women to a 15-session full therapist contact (FTC) program. 14 couples were treated in the MTC format, 29 couples in the FTC format. All spouses (aged 20–52 yrs) completed the Locke-Wallace Marital Adjustment Test, a sexual interaction inventory, and a sexual history form at intake, pretreatment, posttreatment, and 3-mo follow-up. Both programs were effective in producing female orgasm in masturbation, but the MTC program resulted in more frequent orgasms with vibrator stimulation. The programs were comparably effective in producing orgasm with the spouse both by manual stimulation and intercourse. Both programs resulted in improvements in satisfaction with the sexual relationship, and women in the MTC treatment reported greater happiness in marriage. It is concluded that for this sexual dysfunction, therapist contact time can be greatly reduced without loss of effectiveness. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Client attachment to therapist: Relation to client personality and symptomatology, and their contributions to the therapeutic alliance.

This study examined the relation of client attachment to the therapist to diverse facets of the therapeutic alliance, client personality, and psychopathological symptoms, as well as the relative importance of therapeutic attachments, personality, and symptomatology in predicting the alliance. Eighty clients in ongoing therapy completed measures of client attachment to therapist (CATS), personality (6FPQ), psychopathological symptoms (BSI), and therapeutic alliance (WAI–Short, CALPAS, HAQ). Secure and Avoidant–Fearful attachment to the therapist correlated positively and negatively, respectively, with total and subscale alliance scores. Preoccupied-Merger therapeutic attachment was unrelated to the alliance. Exploratory analyses suggested however that the relationship between Preoccupied–Merger attachment and the alliance was moderated by the extent to which clients were distressed. Clients' therapeutic attachments were unrelated to basic personality dimensions. Preoccupied–Merger attachment to the therapist correlated significantly with several symptom dimensions. Clients' therapeutic attachments emerged as superior and more consistent predictors, relative to client personality and symptomatology, of the therapeutic alliance. (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)     

The necessary and sufficient conditions of therapeutic personality change.

(This reprinted article originally appeared in the Journal of Consulting Psychology, 1957, Vol 21, 95–203. The following abstract of the original article appeared in PA, Vol 33:842.) For constructive personality change to occur, it is necessary that these conditions exist and continue over a period of time: (1) Two persons are in psychological contact. (2) The first, whom shall be termed the client, is in a state of incongruence, being vulnerable or anxious. (3) The 2nd person, whom shall be termed the therapist, is congruent or integrated in the relationship. (4) The therapist experiences unconditional positive regard for the client. (5) The therapist experiences an empathic understanding of the client's internal frame of reference and endeavors to communicate this experience to the client. (6) The communication to the client of the therapist's empathic understanding and unconditional positive regard is to a minimal degree achieved. (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)     

Male therapists' clinical bias: Influence of client gender roles and therapist gender role conflict.

This study examined male therapists' gender role conflict, client sexual orientation, and client emotional expression as they interrelated with clinical judgments about male clients. Using a series of written clinical vignettes to manipulate the client variables of sexual orientation and emotional expression, 196 experienced male therapists completed a measure of male gender role conflict, read a clinical vignette varying the client's sexual orientation and emotional expression, and rated the client on several clinical dimensions. Canonical analysis revealed 2 roots indicating that therapist gender role conflict factors, in combination with client sexual orientation and emotional expression, were associated with therapists' ratings of the male client's prognosis and how much therapists liked, had empathy for, had comfort with, and had willingness to see the male client. Implications for counseling practice, limitations, and future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist sexual orientation, gender, and counseling practices as they relate to ratings on helpfulness by gay and lesbian clients.

Three hundred ninety-two lesbian and gay volunteers described their experiences with 923 therapists, reporting therapist sexual orientation, therapist gender, and perceived helpfulness of the therapist in each case. Gay, lesbian, and bisexual therapists of both genders and heterosexual female therapists were all rated more helpful than heterosexual male therapists. Participants also reported whether each therapist exhibited 9 negative and 4 positive practices. Relative risk ratios indicated that 8 of the 9 negative therapist practices were significantly associated with (a) client designation of a therapist as unhelpful and (b) termination after 1 session. All 4 of the positive practices were inversely associated both with unhelpful ratings and with termination after 1 session. Therapist practices accounted for more of the variance in ratings of helpfulness than did therapist demographic characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of the relationship between the Black client and the White therapist.

Discusses the psychological issues involved in having White therapists treat Black clients. The topics examined are the importance of the White therapist understanding his or her own feelings, countertransference, the detrimental effect of therapist guilt, and the impact of the therapist's need to be powerful. Also explored are the need for awareness of client–therapist interpersonal similarity and the need for an understanding of our social system for effective psychotherapy. Concrete suggestions are offered for helping therapists deal more effectively with Black clients. The White therapist–Black client relationship is proposed as a paradigm of how people with differing values learn to help each other. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)