Therapist-Patient Sexual Intimacy Involving Children and Adolescents
The national incidence studies of therapist-patient sexual intimacy (e.g., Gartrell, Herman, Olarte, Feldstein, & Localio, 1986; Gechtman & Bouhoutsos, 1985; Holroyd & Brodsky, 1977; Pope, Keith-Spiegel, & Tabachnick, 1986; Pope, Levenson, & Schover, 1979; Pope, Tabachnick, & Keith-Spiegel, 1987; for a review and statistical analysis of the national studies, see Pope, 1994, 2000; Pope & Vasquez, 1998) have provided useful information about the degree to which this phenomenon occurs, but have not assessed the degree to which it may involve minor patients. Therapists may be reluctant to acknowledge -- even within the presumed safety of anonymous surveys -- such seriously criminal behavior. Therefore, the survey reported here asked psychologists to report "any instances of sexual intimacy between a therapist and a minor client" that they had personally encountered in the course of their professional work. In order to reach experienced psychologists who tend to work with minors, we sent about three-fourths (77) of the 100 forms to individuals randomly selected from the membership of American Psychological Association (APA) Division 37 (Child, Youth and Family Services) who also met the criterion of having Fellow or Diplomat status.
The remaining 23 forms were sent to psychologists who had published in the area of therapist-patient sexual intimacies. Half of the total sample were APA Fellows and two thirds were Diplomates of the American Board of Professional Psychology.
Of the 90 who responded to the survey, 22 (24%) reported encountering instances of sexual intimacies between therapists and minor patients. An additional five psychologists reported hearsay accounts, but noted that they had not personally encountered these cases.
A total of 81 instances were reported. Fifty-six percent involved female patients; 44% involved male patients. The age was reported for 20 female patients and 18 male patients.
The ages of the female patients ranged from 3 through 17, with a mean of 13.7 and a standard deviation of 4.1. The ages of the male patients ranged from 7 through 16, with a mean of 12.5 and a standard deviation of 3.0.
These data provide no precise estimates, but strongly suggest that sexual intimacies between therapists and their minor patients are a problem. The virtual absence of this topic from the research and related literature needs to be corrected.
These findings support three recommendations. First in their effort to prevent therapist-patient sexual intimacy, those in the profession must take account of the fact that children and adolescents are involved in a number of cases. Second, psychologists working with minor patients need to be alert to the possibility of sexual abuse by a prior therapist, just as they are alert to the possibility of incest and other forms of child abuse. Third, the approaches to individual and group therapy for victims of therapist-patient sexual intimacies reported in the literature thus far have focused exclusively on adult victims, but the needs of child and adolescent victims must also be addressed.
[NOTE: The reference section has been updated since the original publication of this article.]
Gartrell, N., Herman, J., Olarte, S., Feldstein, M. & Localio, R. (1986). Psychiatrist-patient sexual contact: Results of a national survey, I; Prevalence. American Journal of Psychiatry, 143, 1126-1131.
Gechtman, L. & Bouhoutsos, J. C. (1985, October). Sexual intimacy between social workers and clients. (Paper presented at the annual meeting of the Society for Clinical Social workers. Universal City, CA)
Holroyd, J. C. & Brodsky, A. M. (1977). Psychologists' attitudes and practices regarding erotic and nonerotic physical contact with patients. American Psychologist, 32, 843-849.
Pope, K. (1994). Sexual involvement with therapists: Patient assessment, subsequent therapy, forensics. Washington, DC: American Psychological Association.
Pope, K.S. (2000). Therapists' Sexual Feelings and Behaviors: Research, Trends, and Quandaries. In L. Szuchman & F. Muscarella (Eds.), Psychological Perspectives on Human Sexuality (pages 603-658). New York: John Wiley & Sons.
Pope, K. S., Keith-Spiegel, P. C. & Tabachnick, B. G. (1986). Sexual attraction to clients: The human therapist and the (sometimes) inhuman training system. American Psychologist, 41, 147-158.
Pope, K. S., Levenson, H. & Schover, L. R. (1979). Sexual intimacy in psychology training: Results and implications of a national survey. American Psychologist, 34, 682-689.
Pope, K. S., Tabachnick, B. G. & Keith-Spiegel, P. C. (1987). Ethics of practice: The beliefs and behaviors of psychologists as therapists. American Psychologist, 42, 993-1006.
Pope, K., & Vasquez, M. (1998). Ethics in psychotherapy and counseling, 2nd edition. San Francisco: Jossey-Bass.
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