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Balancing the Power Dynamic in the Therapeutic Relationship

Section 2
Abuse in the Consulting Room

Question 2 | Test | Table of Contents

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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?

3 Factors Contributing to the Outcome of Sexual Contact
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
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. 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.

7 Key Exploitative Behaviors
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.

Reviewed 2023

Peer-Reviewed Journal Article References:
Borelli, J. L., Sohn, L., Wang, B. A., Hong, K., DeCoste, C., & Suchman, N. E. (2019). Therapist–client language matching: Initial promise as a measure of therapist–client relationship quality. Psychoanalytic Psychology, 36(1), 9–18.

Goren, E. R. (2017). A call for more talk and less abuse in the consulting room: One psychoanalyst–sex therapist’s perspective. Psychoanalytic Psychology, 34(2), 215–220. 

Keem, S., Shalley, C. E., Kim, E., & Jeong, I. (2018). Are creative individuals bad apples? A dual pathway model of unethical behavior. Journal of Applied Psychology, 103(4), 416–431. 

Kouchaki, M., & Wareham, J. (2015). Excluded and behaving unethically: Social exclusion, physiological responses, and unethical behavior. Journal of Applied Psychology, 100(2), 547–556. 

Pizer, B. (2017). “Why can’t we be lovers?” When the price of love is loss of love: Boundary violations in a clinical context.Psychoanalytic Psychology, 34(2), 163–168. 

Summers, F. (2017). Sexual relationships between patient and therapist: Boundary violation or collapse of the therapeutic space? Psychoanalytic Psychology, 34(2), 175–181. 

Wu, K. S., & Sonne, J. L. (2021). Therapist boundary crossings in the digital age: Psychologists’ practice frequencies and perceptions of ethicality. Professional Psychology: Research and Practice.

What are some factors exploitative therapy relationships can contain? To select and enter your answer go to Test.

Section 3
Table of Contents