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Section 9
Track #9 - How the Shift Occurs

Question 9 found at the bottom of this page
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You may ask yourself...How does a normal, healthy therapeutic relationship shift into a power imbalance that results in sexual abuse?

Various factors contribute to the outcome of sexual contact. These factors can be identified in both the victim and the abusive mental health professional, as well as in the situation itself, which may facilitate the emergence of an abusive relationship. Using Mary's accounts and the professional literature, we will examine the following overlapping concepts: (1) reframing the relationship, (2) boundary violations, and (3) Pope's description of ten common scenarios. This will be followed by a consideration of situational factors, and finally, of special issues for victims of childhood abuse.

In the literature, like other survivors, therapy survivors like Mary frequently experienced a similar kind of manipulation for sex. The abusive professional would gradually reframe or reinterpret his client's childlike dependency on a parental figure. In the course of this reinterpretation, the parent or parental figure would become a romantic or sexual partner.

In her book "Betrayal," Julie Roy describes her therapist teasing her about having a "bathtub party" and making frequent inquiries about her sexual fantasies about him. Later, he suggests that they have sex, claiming that this will remove her fear of men and cure her of being a lesbian. Initially she refuses, telling her therapist, "I feel I would be destroyed. In the end it would be bad for me." The therapist insists that she needs to love him, so that she can learn to love men. Over the course of the next few months, he progresses from touching her, kissing her and caressing her.

Regarding Boundary Violations, in the case of Mary
Over the three years that she saw her abusive therapist, when he returned from conference trips, he would bring her coins, records, trinkets, and other gifts. He also invited her to go to a conference with him.

Looking at boundary violations from the professional's perspective, Epstein and Simon developed an "exploitation index" for therapists. They describe the following exploitative behaviors:
1. Seeking a diversion from treatment: The therapist initiates social contact with patients.
2. Erotic: The therapist relishes romantic daydreams about patients.
3. Exhibitionistic: The therapist seeks out clientele who are famous or VIP.
4. Dependent: Talking about one's own difficulties.
5. Power seeking: Requesting personal favors from patients.
6. Greedy: Accepting large gifts.
7. Enabling: Failing to set limits because of apprehension about the patient's disappointment or anger.

QUESTION 9
What are some factors exploitative therapy relationships can contain? To select and enter your answer go to Answer Booklet.