Sexual Intimacy in Psychology Training:
Results and Implications of a National Survey
ABSTRACT: In a nationwide survey of members of APA Division 29 (Psychotherapy), which had a 48% return rate (N = 481), 10% of the respondents reported sexual contact as students with their educators; 13% reported entering sexual relationships as educators with their students. However, only 2% believed that such relationships could be beneficial to trainees and educators. Gender differences were significant: 16.5% of the women, compared with 3% of the men, reported sexual contact as students; however, 19% of the men, compared with 8% of the women, reported such contact as psychology educators; and 12% of the males, compared with 3% of the females, reported sexual contact as psychotherapists with their clients. Sexual contact in psychology training programs seems to be increasing: 25% of the recent female graduates had had sexual contact, compared with only 5% of those with degrees for more than 21 years. The literature on ethics, standards, research, theory, and practice leaves both psychology graduate students and those psychologists responsible for their education without clear expectations, information, or guidelines concerning sexual intimacy in psychology training. This article represents an attempt to raise the issue and to present some initial information.
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The purpose of this article is to raise some issues about sexual relationships between students and educators in psychology training programs and to present some relevant information. In spite of suspicion, rumor, and an occasional accusation, the possibility of psychologists engaging in sex with those toward whom they hold a professional responsibility went unacknowledged until relatively recently, both by the profession as a whole and by the public. However, a drastic change occurred, precipitated by numerous factors including, the consumer movement, the feminist movement, sex therapy, insurance companies and other organizations urging psychology to put its house in order, and an occasional vocal advocate of such sexual relationships (Romeo, 1978; Shepard, 1971). The attention was limited to psychotherapists, and the amount of concern, publicity, and controversy was overwhelming.
Psychologists began serious, systematic investigations of the prevalence and effects of sex between therapists and clients (Holroyd & Brodsky, 1977; Taylor & Wagner, 1976). The American Psychological Association (1977a) declared such contact unethical--on the urging of its Task Force on Sex Bias and Sex-Role Stereotyping in Psychotherapeutic Practice ("Report of the Task Force," 1975). The task force also discussed the need for training therapists in how to deal with seductive clients and particularly with their own sexual feelings (see, e.g., Pope, Sonne, & Holroyd, 1993; Pope, Keith-Spiegel, & Tabachnick, 1986; Pope & Tabachnick, 1993).
The evidence suggests that most incidents of therapist-patient sex involve an older male therapist and a younger, attractive, female client (Belote, 1974; Butler & Zelen, 1977; Davidson, 1977; Pope, 1994, 2000; Pope & Bouhoutsos, 1986; Pope & Vasquez, 1998; Pope & Vetter, 1991; Taylor & Wagner, 1976).
Sexual relations between psychologists acting as therapists and their clients have been declared unethical, are generally vulnerable to legal actions in the form of malpractice claims (Pope, Weiner, & Simpson, 1977; Pope & Bouhoutsos, 1986; Pope, 1994; Pope & Vasquez, 1998), are not covered or are covered only in limited manner by the major companies offering professional liability insurance to psychologists, and have been criminalized as felonies in an increasing number of states (Pope, 1994). Masters and Johnson (1976) advocated that therapists who exploit their power in order to have sexual intercourse with their patients should be charged with rape. The public as well as the profession has informed itself about these issues. In the 1970s, the theme began to receive attention in large, front-page headlines (Brenneman, 1978), in the widely read "Dear Abby" column (Van Buren, 1978), and in the popular television show Sixty Minutes (Glauber, 1978).
Psychologists functioning as educators may at times bear at least a superficial resemblance to psychologists functioning as therapists. Both may be attracted to their students or clients and may desire or engage in sexual relations with those with whom they are also attempting to function as professionals. Both as educators and as therapists, psychologists clearly seem to be more powerful or less vulnerable than their students or clients, and acting on the sexual attraction might interfere with the overt task (teaching or therapy). Yet there are striking differences. Psychologists functioning as therapists, as they consider the possibility of sex with their clients, have access to the norms of such behavior, to scholarly research into the likely precipitants and effects, to various therapeutic rationales, to precedents and analyses suggesting the likely legal consequences, and to clear ethical guidelines established by the American Psychological Association. Psychologists functioning as educators, as they consider the possibility of sex with their students, simply have none of these norms, information based on research, educational rationales, reasonably predictable legal consequences, clear professional standards and guidelines, or even an open discussion of the issues in the professional literature.
The profession of psychology would benefit from a careful examination of current practices and an open discussion of these issues. The research reported in the following sections represents an attempt to gather some initial information.
Our sample consisted of 1,000 people whose names and addresses were listed in the APA Directory as members of Division 29 (Psychotherapy). This division was selected because it includes not only therapists (for comparison with previous therapist surveys) but also psychologists presumably interested in and aware of psychotherapy training and with some likelihood of having served as a clinical supervisor, teacher, or administrator. To achieve the closest possible approximation to a random sample of 500 males and 500 females, each nth name in the division roster was chosen using a new n for each choice, based on a random number (0-9) table. Those selected by this procedure were classified as male or female according to the traditional or popular gender associations to their given names, a procedure that admittedly invited some errors.
A structured questionnaire concerning sexual activity and graduate education in psychology was developed through -pilot testing and the critical comments of colleagues. In order to promote the highest possible return rate, the final form was brief in space (one page) and time required to fill out (about five minutes).
Respondents provided descriptive information about themselves-gender, area of training (clinical or nonclinical), years since receiving doctorate, and age at the beginning of graduate training. They indicated whether or not they, as graduate students, had had sexual contact (defined as intercourse or genital stimulation) with psychology department teachers, administrators, or clinical supervisors. They were asked whether they believed such sexual contact could be beneficial to both parties.
Respondents were asked whether they had had sexual contact with a student or client in the course of their work as psychology teachers, administrators, clinical supervisors, psychotherapists, or in other professional capacities.
The questionnaire also elicited information which, because of space limitations, is not reported in this article. Among these topics were seductive behaviors, respondents' knowledge of propositions or sexual 'contact involving other students or faculty, and comments or narrative accounts in response to an open-ended invitation to respond "in greater detail to any issues raised by this questionnaire."
The questionnaires were mailed out with a one-page cover letter, a stamped, addressed envelope for returning the questionnaire, and a stamped, addressed postcard for the respondent's use in requesting a summary of the results of the study. The cover letter explained the nature of the research, including the source of funding (there was no funding from any organization or institution; the Investigators, all of whom were named, paid all expenses), informed the recipients how they had been selected, and outlined procedures for establishing the confidentiality and anonymity of the respondents. The questionnaires did not solicit the individual participant's name nor any readily identifying information; they were not linked to the addresses by any sort of coding process. The sensitive nature of the subject matter and the trust required for the respondent in self-disclosure warranted extreme care in preserving anonymity. To help prevent accidental identification of respondents through the simultaneous rival of their returned questionnaire and postcard requesting a results summary or through an association of their handwriting (or postmark) on the questionnaire and postcard, two steps were taken: (1) The questionnaires were mailed out from one city; the envelopes for returning the questionnaires were addressed to a second city; the postcards for requesting a summary of results were addressed to a third city; and (2) those who received and read the questionnaires saw neither the postcards nor the original selection list, and vice versa. The research involved no deception.
Of the 972 questionnaires that were not "returned to sender" by the U.S. Postal Service, 512 were mailed back by the respondents. Thirty-one of these questionnaires were received too late (six weeks after the mailing) to be included in the analyses. The results below are based on replies from 245 men, 220 women, and 16 who did not indicate gender. The 481 responses received in time were all used in the analyses, though some data were missing for some respondents due to item nonapplicability or omission.
Seventy-eight percent of the respondents indicated that they were trained in clinical psychology, 20% in a field other than clinical, and 21% in both clinical and nonclinical fields. Because there was no significant difference in responses to the questionnaire items between persons trained in clinical psychology and those with nonclinical training, the findings presented here are based on a pooling of these groups.
On the average, respondents began their graduate training at 26.7 years of age (SD = 6.7). As a group, women (M = 27.4 years) were older than men (M 25.8 years) at the start of training, t(346.4) = 2.69, (p < .01). (This t test was based on separate variance estimates for each group because variance between groups were significantly different.) For some analyses, respondents were divided into thirds based on their age at the start of graduate training. The resulting three groups were (1) less than 23 years old, (2) 23-27 years old, and (3) more than 27 years old.
Respondents had received their doctorates an average of 13.6 years ago (SD = 9.7). There was a tendency for men to have had their doctorates longer than women (14.3 vs. 12.8 years), t(412.8) = 1.64, p = .10.2 For some analyses, respondents were divided into quartiles based on the number of years since they had obtained their docätorates. The resulting four groups were those holding doctorates (1) 6 years or less (n = 126), (2) 7-10 years (n = 114), (3) 11-20 years (n = 120), and (4) 21 or more years (n = 108).
Interaction effects between recency of obtaining the doctorate and age at start of training were evaluated by 4 X 3 analyses of variance and multilevel χ2 analyses. Only two findings were significant: (1) Of those who had had sexual contact with their teachers, the majority of recent graduates had done so when they were young, whereas all of those who had had their doctorates more than two decades had had such sexual contact when they were older, χ2(6) = 13.74, p < .05. (2) All of the recently graduated clinical supervisors who had sex began training at a young age, whereas all of the seasoned supervisors who had sex began training when they were older, χ2(2) = 6.88, p < .05.
A significant 4 X 3 analysis of variance, F(6, 424) = 3.51, p < .002, and the consequent analyses of simple effects showed that recent graduates began their training when they were older than those who had had their doctorates for more than 21 years (34.9 vs. 31.8 years). The effects of this interaction on the quantitative responses to the questionnaire were evaluated by analyses of covariance (controlling for age) and were not found to be significantly different from analyses examining only main effects, which are presented in the text.
More than one third of the respondents wrote detailed comments in addition to answering the questions. Three respondents enclosed unsolicited and anonymous donations to help pay for this research.
Sexual Contact As a Student
Slightly less than 10% of the respondents reported sexual contact, such as genital stimulation or intercourse, while a student, with at least one of their psychology educators (see Table 1). Only 3% of the women, χ2(1) = 23.61, P < .0001.
*χ2 significant at p < .01 for gender difference.
**χ2 significant at p < .001 for gender difference.
The more recent the degree, the more likely a report of experiencing sexual contact with an educator while earning that degree. Almost three times the number of recent graduates (six years or less) indicated that they had had sexual contact with teachers, compared with those in the other three groups (13% vs. 5%, 3%, and 4%), χ2(3) = 11.77, p < .01. For women, the recency of degree was associated with even more striking differences. One fourth of all recent female graduates (six years or less) had had sexual contact with an educator, compared with only 5% of those with doctorates for 21 or more years, χ2(3) = 8.6, P < .05.
Women who had had sex, then, tended to be more recent graduates (M = 9.7 years) than those who had not had sex (M = 13.4), t (211) = -1.88, p = .06, and were also younger when they began their training (M = 25.4 vs. 27.8 years), t(66) = -2.33, p < .05.
For women, 75% of those who had had sex as a student with a psychology educator had done so with teachers, and 47% had done so with clinical supervisors. For men, the figures were reversed. Most men reporting sex as a student had done so with their clinical supervisors (86%) rather than with psychology teachers (29%).
Psychologists' Sexual Contact with Students and Clients
Twenty percent of the respondents who indicated, some profession (educators or therapists) reported having had sexual contact with their students or clients (see Table 2). This percentage, however, may be somewhat inflated because approximately one third of the respondents did not indicate that they had functioned as teachers, supervisors, administrators, or therapists. If these cases are included in the analysis, with the assumption that they are professionals who did not have sexual contacts with students or clients (which would greatly underestimate the frequency), the percentage of the total sample indicating that they had had sexual contact as professionals drops from 20% to13%. Seven percent of those indicating that they had practiced psychotherapy reported engaging in sexual contact with their clients. A greater percentage of those indicating they were psychology teachers (12%) reported sexual contact with their students; a lower percentage of those who said they were clinical supervisors (4%) and administrators (3%) reported sexual contact with their students.
|Educators (n = 291)||19||8*||13|
|Psychology teacher (n = 247)||18||4**||12|
|Clinial supervisor (n = 263)||6||2||4|
|Administrator (n = 203)||4||1||3|
|Psychotherapist (n = 305)||12||3**||7|
|Other (n = 27)||62||18*||44|
|Total sample indicating profession (n = 318)||30||9***||20|
|Total sample (n = 481)||20||6***||13|
* Fisher's exact test significant at p < .05 for gender difference.
** χ2 significant at p < .01 for gender difference.
***χ2 significant at p < .0001 for gender difference.
Women reported more sexual contact as graduate students, but it was the men (30%) rather than the women (9%) who reported significantly more sexual contact as psychologists with their students and clients. As mentioned above, percentages dealing with professional contact may be inflated due to missing cases. However, even if all missing cases were included as cases where no sexual contact took place, gender differences would be quite large: 20% of the male professionals, compared with 6% of the female professionals, reported sexual contact with students or clients.
Not only gender but also age at start of training is associated with 'sexual activity as a professional psychologist. Those who began their training when they were in their mid-twenties were more likely to have sex with their students (21%) in their professional capacity as teachers than those who began graduate school at an earlier (8%) or later (6%) age, χ2(2) = 10.74, p < .01.
For women, engaging in sexual contact as students with educators was statistically related to later sexual contact as professionals. Of those women who had had sex as a student, 23% reported sex as a professional, compared with only 6% of those who, while students, had had no sex with their educators, χ2(1) = 6.25, p = .01. For men, the sample of those reporting sexual contact with their educators (n = 7) was too small to present an adequate test of significance of the relationship to later sexual contact as a professional.
Beneficial Effects of Sexual Contact
Only 2% of 'those surveyed responded affirmatively to the statement, "I believe that sexual relationships between students and their psychology teachers, administrators, or clinical supervisors can be beneficial to both parties." Seventy-seven percent indicated "no," and the remaining 21% circled "perhaps." Taken as a whole, groups of men and women do not differ in their attitudes toward the benefit of sexual contact. However, for women, 50% of those who had had sex while students disagreed that such sexual activity could benefit both parties, compared with 85% of those who had not had sex, χ2(2) = 28.15, p < .0001. A higher percentage of professionals who did have sexual contact with students or clients (12%) than those who did not (0.4%) believed that sexual relationships between students and their educators could be beneficial to both parties, χ2(2) = 53.00, p < .0001. Of particular interest is that 43% of -the respondents who had sexual contact with clients or students believed that such relationships were clearly not beneficial to both parties. Gender was not systematically associated with these beliefs.
Early vs. Late Returns
In an attempt to learn more about possible attitudes of the 48%, who did not return the questionnaire, analyses using a median split (ns = 240, 241) of the data based on the speed of the reply were calculated. Significant differences revealed that those who returned their questionnaires later had earned their doctorates more recently (12.5 vs. 14.9 years ago), t(457.1) = 2.72, P < .01.2 Those who responded later had had more sexual contact as students with their teachers (10% vs. 3%), χ2(1 ) = 6.70, p < .01, and with their supervisors (8% vs. 2%), χ2(1) = 7.36, p < .01. Furthermore, as professionals, they were almost four times more likely to have had sex with students or clients (22% vs. 6%), χ2(1) = 5.44, p < .02. A larger percentage of the later respondents (28%) than the earlier respondents (19%) believed that sexual relationships between students and their psychology educators were or at least perhaps might be beneficial to both parties, χ2(2) = 6.97, p < .05.
This research suggests five major aspects of sexual activity between psychology graduate students and their educators:
- Sexual contact-such as intercourse or genital stimulation-occurs between a substantial number of students and educators;
- The contact is mostly between female students and male educators, just as sex in psychotherapy usually occurs between a female client and a male therapist;
- Such contact seems to be increasing;
- Only 2 % of the respondents clearly affirmed the proposition that such contact could be beneficial to both parties; and
- The literature on ethics, standards, research, theory, and practice leaves both psychology graduate students and those psychologists responsible for their education without clear expectations, information, or guidelines.
Twelve percent of the psychology teachers, 4% of the supervisors, and 3% of the administrators reported sexual contact with their students. These figures may be compared with the 7% of psychotherapists in the current survey who reported such sexual contact with their clients and with the 7.7% in a previous survey of those psychologists "who answered positively any of the questions regarding erotic-contact behaviors or intercourse during treatment" (Holroyd & Brodsky, 1977). View a table presenting the findings of national studies of therapist-patient sex published in peer-reviewed journals.
As Holroyd and Brodsky pointed out, it is unlikely that respondents "overclaimed" such contact, suggesting that the findings are conservative estimates. With both the current and the previous survey, respondents claiming sexual contact were significantly later in responding, suggesting that the nonresponse bias is toward underestimating the sexual contact. There are no published statistics about sexual activity between educators and students in the allied professional training programs for comparing psychology with psychiatry, general medicine, or social work. Nor do published explorations of sexual activity occurring in other organizational or working relationships--for example, between white collar workers in the same office (Quinn, 1977) or between police officers and those whom they apprehend (Kenny, 1979)--offer data for comparison; such reports are limited to a few case studies, to impressionistic, qualitative information, or to hearsay accounts. Also useful for comparison would be carefully collected information on the incidence of student-teacher sexual contact in undergraduate education or the graduate programs of other academic disciplines. The pioneering study in this area was conducted by Nielsen, a reporter for the college newspaper at California State University at San Francisco ("Teacher's Pets," 1973). She distributed a questionnaire to half of the faculty (the 600 who had campus mailboxes) at that university. One fourth were returned. About one half of the respondents claimed they would never have an affair with a student; one fourth reported that they had had relations with students; and the remaining one fourth indicated that although they had not yet been sexually involved with their students, they would not turn down the right opportunity. Though beset by some serious methodological problems, Nielsen's study appears, on the basis of an extensive literature search, to be the only survey of sexual relations in the teaching of undergraduates or graduate students in other disciplines.
When sexual contact occurs in the context of psychology training or psychotherapy, the predominant pattern is quite clear and simple: An older, higher status man becomes sexually active with a younger, subordinate woman. In each of the higher status professional roles (teacher, supervisor, administrator, therapist), a much higher percentage of men than women engage in sex with those students or clients for whom they have assumed professional responsibility. In the lower status role of student, a far greater proportion of women than men are sexually active with their teachers, administrators, and clinical supervisors. This pattern has been found in research on sexual relations between therapist and client (Belote, 1974; Butler & Zelen, 1977; Davidson, 1977; Pope, 1994, 2000; Pope & Bouhoutsos, 1986; Pope & Vasquez, 1998; Pope & Vetter, 1991; Taylor & Wagner, 1976). The data are consistent with frequent claims that sexual contact with clients represents the unethical behavior of a therapist acting out his own needs for power, esteem, acceptance, or sexual fulfillment (Chesler, 1971; Holroyd & Brodsky, 1977; Tennov, 1976). Claiming that such patterns of sexual contact constitute sexual discrimination, New Haven lawyer Anne Simon (personal communication, June, 1978) is trying a suit, involving university teaching in general rather than psychology training in specific, against Yale University on behalf of students charging sexual harassment. It may be, however, that the tendency for sexual activity to occur between male educators and female students is more the result of discrimination or imbalance at a different level of the training program (e.g., recruitment of faculty and students) leading up the time when the current survey was conducted. Prior to this survey, the ratio of male to female faculty in the typical program was 9:1, and there were three male students for every one female student who would earn a doctorate ("Report of the Task Force on the Status of Women," 1973). With more potential partners of the opposite sex available, female students would seem to be in a higher risk situation than their male counterparts. What these ratios fail to explain, however, is why the percentage of female faculty, who are in a higher risk situation (since the male students outnumber the female) is smaller than the percentage of male faculty who have sexual contact with students.
The findings suggest that the frequency of sexual activity, or at least self-reports of sexual activity, between psychology graduate students and their educators has apparently increased. Whereas 9.4% of all respondents reported sexual contact as students with their educators, the percentage rises to 13% when only those receiving their degrees within the last six years are considered. Gender differences place this increase in sharp focus. Of the female respondents who received their degrees within the last six years, 25% had had sexual contact with their psychology educators. For those recently graduated women who had been sexually active with their educators, 75% had had sexual contact with their psychology teachers, and 47%, had had such contact with their clinical supervisors. Clearly, issues of sex with educators are prominent and difficult to avoid for women who are currently psychologists in training.
Instances of sexual contact between graduate students and their psychology educators have increased, but the number of psychologists believing in its positive aspects or effects remains extremely small. Only 2% of all respondents affirmed the statement that "sexual relationships between students and their psychology teachers, administrators, or clinical supervisors can be beneficial to both parties." Even a minority of those psychologists who reported sexual contact with their students endorsed this statement.
Psychologists can scarcely afford continuing their selective inattention to these issues. The subject of sexual contact between educators and students should be brought out of the closet and aired in free, open-minded, and serious discussion. Because the profession, though tending to hold an idealized view of itself, is forced to recruit its members from the human race, these discussions will likely be characterized not only by informed wisdom and altruism but, also by anxiety, conflicts, and occasional low self-disclosure. When interviewing psychologists and psychiatrists who had had sexual relations with their patients, Butler (1975) found that although 95% had experienced considerable conflict, fear, and guilt, less than half had sought consultation. Psychology educators may be even more reluctant to discuss with others, even within the framework of a confidential consultation, issues involving sex with students, particularly because these sexual partners will soon became colleagues within the same profession. Given the profession's public silence toward the issues thus far, it may be reasonable to assume that many psychologists find it difficult to acknowledge their attraction to or eagerness for sexual relations with their students, let alone that they have considered acting or have already acted on this attraction or eagerness.
The profession needs to inform itself, to seek information with which to create and test useful theories concerning sexual behavior between psychology students and educators in particular and the training of new professionals in general. Psychologists confront a number of important questions:
- Does sexual contact between psychology students and their educators promote, inhibit, or fail to affect the task of training new professionals?
- Is it the case, as the findings of this survey suggest, that students who sleep with their teachers tend themselves, once they become teachers, to engage in sex with their students?
- If so, does this represent a modeling effect?
- Do students who are sexually active with their educators tend themselves, once they become therapists, to seduce their clients?
- How does engaging in sexual contact or refusing to engage in sexual contact with their educators affect the personal lives or future careers of psychology trainees?
The profession can no more offer confident, clear, noncontroversial answers to questions in this area than in such important areas as therapy research, the definition of intelligence, or the development of schizophrenia. But this area, unlike the others, offers a special challenge: Here the profession must overcome a longstanding failure to acknowledge the area and seek information.
NOTE: Some references have been updated since the original publication of this article in 1979.]
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