Sexual exploitation of patients. The position of the Canadian Psychiatric Association

Sleeping with the past: the ethics of post-termination patient-therapist sexual contact

OBJECTIVE

The aim of the paper is to devise an ethical argument to support the contention that post-termination patient-therapist sexual contact (PTSC) is always unethical.

METHOD

Arguments both defending and condemning post-termination PTSC are reviewed and their strengths and weaknesses explored.

RESULTS

Analysis of these arguments reveals a strong case for the universal condemnation of post-termination PTSC.

CONCLUSIONS

Ethical codes, including that of the Royal Australian and New Zealand College of Psychiatrists, should be amended to explicitly prohibit post-termination PTSC.

Therapist-patient sexual contact: a non consensual, inherently harmful activity

Therapist-patient sexual contact is unethical, whether it is the patient or the therapist who attempts to sexualize the therapeutic relationship. Therapist-patient sexual contact is non consensual; patients cannot provide a morally valid consent to sexual relations with their therapist because the key elements of a morally valid consent--intentionality, substantial understanding, substantial voluntariness and autonomous authorization--cannot be met. As well, therapist-patient sexual contact harms patients, patients' families, and the profession. The most significant harm caused is experienced by the patients, the majority of whom are women.

Sex and gender and the impaired therapist

A brief review of the problem of impaired therapists is followed by a more comprehensive review of sexual relationships arising in and following psychotherapy. The prevalence of this latter problem is approximately 10%. Offenders are predominantly male, one half are said to be "ruthless" and "exploitative", whilst the remainder are often "lovesick". The author relates these phenomena to processes of repudiation of the relational/feminine self of the highly masculinised clinician. Characteristics of offenders and consequences for patients are presented and issues of detection, sanctions, legislation, and prevention are addressed. Studies suggest that the vast majority of patients are harmed by the experience and that neither improved training, licensing, personal therapy, nor supervision of therapists will guarantee against its occurrence.

Fatal attraction: the ethical and clinical dilemma of patient-therapist sex

This article reviews the existing literature on the subject of patient-therapist sexual contact. Seven point one percent to 10.9% of male therapists and 1.9% to 3.5% of female therapists admit to engaging in intimate contact with patients. Offenders tend to justify their behaviour as being at least innocuous if not beneficial for the patients. The consequences to the patients include increased psychological and psychosomatic complaints, greater mistrust and anger towards men, hospitalization and suicide. Transference and countertransference issues which account for this behaviour are explored as is the issue of post-termination involvement. Education of physicians and residents concerning the temptations and dangers of this type of contact is strongly recommended.