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Balancing the Power Dynamic in the Therapeutic Relationship

Section 3
Sexual Relationships Between Patient and Therapist

Question 3 | Test | Table of Contents

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Hopefully, by this point in the course I've made a believer out of you regarding this topic's legitimacy and importance. If so, the next question that may arise in your mind is "How can sexual abuse of a client by a therapist come about?" With those clients I've treated who've suffered abuse, I've noticed a certain pattern.

Pattern of Sexual Abuse Victimization

♦ Vulnerability
 The victim, who is seeking help for a disorder or problem, may have some vulnerability in addition to being in the patient or client role. For example, in Mary's case, she was going through a divorce. The mystique and authority of the role of the "therapist" created a situation in which she saw the therapists as having some sort of special healing powers. Thus she felt she needed to comply with his directions, advice, and suggestions.

Once the treatment began, the therapist came to have a parent-like importance to her. She described feeling like a young child, anxious to comply readily with her therapist's advice and suggestions. Admittedly, we have all had clients that place us in this role and give their power away to us, thus creating an imbalance.

♦ The Unique Emotional Component - Faith
The relationship between mental health professional and client, as you know, is not just a business relationship. Its unique emotional component helps explain the faith clients have in us. This faith adds to the emotionally charged factors of power, superiority, and self-esteem. The therapeutic relationship gives the professional authority to enter and explore vulnerable aspects of the clients' minds.

Conditioned as children to embrace the superiority and power of professionals, some of our clients readily admire their therapists' positions or titles, respect our knowledge, comply with our directions, and defer to our opinions. Because our clients have faith in us as professionals, they believe that they will be taken care of, and make a commitment to us. This added ingredient of "faith" often triggers clients to comply automatically, and without hesitation, causing a dramatic shift in power in the therapeutic relationship.

"He was everything to me..."
This "Special Status Role" accorded to Mental Health Professionals was evident when Mary talked to me about her therapist. "He was everything to me -- sun, moon, stars, mother, father, confessor, everything." She had faith that the professional was a person of honesty and integrity who had only her best interests at heart. In the initial sessions with the therapist, I'll call him Russ, he was able to relieve some of Mary's stress related to her divorce. This reinforced even further for her that the professional had some special healing powers.
Reviewed 2023

Peer-Reviewed Journal Article References:
Foote, W. E., & Goodman-Delahunty, J. (2021). Understanding sexual harassment: Evidence-based forensic practice (2nd ed.). American Psychological Association.

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.

Hakimi, D., Bryant-Davis, T., Ullman, S. E., & Gobin, R. L. (2018). Relationship between negative social reactions to sexual assault disclosure and mental health outcomes of Black and White female survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 270–275.

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. 

QUESTION 3
What is one key factor that adds to the power imbalance between client and therapists? To select and enter your answer go to Test.

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