Sexual assaults in therapeutic relationships: prevalence, risk factors and consequences

C. Eichenberg, M. Becker-Fischer, G. Fischer
DOI: 10.4236/health.2010.29150                

Abstract

A law has been passed in Germany (paragraph 174c StGB), which prohibits therapists from having sexual contact with their patients. This provides the background for a follow-up survey to the previous study completed by Becker- Fischer and Fischer in 1995. The results of this survey are discussed here on the basis of the current status of research concerning preva- lence and risk factors of sexual assaults in therapeutic relationships. The focus of the re- search lies in determining the specific condi- tions of sexual assaults in psychotherapy and psychiatry, risk variables of the therapists and patients, the effects it has on the patients as well as the legal consequences it results in. To en- sure the comparability of the data, an online version of the Questionnaire about Sexual Con- tacts in Psychotherapy and Psychiatry (SKPP; Becker-Fischer, Fischer & Jerouschek) was cre- ated and a survey of N = 77 affected patients was conducted. The majority of the participants in the study reported a serious decline in their overall well being following the incident. How- ever only very few undertook legal steps - only in three cases did it come to a legal procedure. The assumption that sexual contacts in psy- chotherapy result in extremely damaging con- sequences to patients, was affirmed. Despite the changed legal situation, therapists in Ger- many are still not held legally responsible more often than they were 10 years ago. Based on these results a more intensive education of the patients concerning their legal rights is recom- mended.

Keywords

Sexual Assaults; Psychotherapy; Patient Abuse; Professionale Misconduct

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Ehlert-Balzer, M. (1999) Fundament in frage gestellt. Sexuelle grenzverletzungen in der psychotherapie. Mabuse, 121, 47-51.
[2]	Arnold, E., Vogt, I. and Sonntag, U. (2000) Umgang mit sexueller Attraktivit?t und Berichten über sexuelle Kontakte in psychotherapeutischen Beziehungen. Zeits- chrift fur Klinische Psychologie, Psychiatrie und Psychotherapie, 48(1), 18-35.
[3]	Bouhoutsos, J., Holroyd, J., Lerman, H., et al. (1983) Sexual intimacy between psychotherapists and patients. Professional Psychology Research Practice, 14(2), 185- 196.
[4]	Gartrell, N., Herman, J., Olarte, S., et al. (1987) Reporting practices of psychiatrists who knew of sexual misconduct by colleagues. American Journal of Orthopsychiatry, 57(2), 287-295.
[5]	Koller, R. (1999)Sexuelle Kontakte in der Psychotherapie: Einstellung zu sexuellen Kontakten und praktische Erfahrungen mit sexuellen Kontakten. Unpublished Ma- sterthesis, University Zürich, Zürich.
[6]	Pope, K. and Vetter, V. (1991) Prior therapist-patient sexual involvement among patients seen by psycholo- gists. Psychotherapy, 28(3), 429-438.
[7]	Stake, J. and Oliver, J. (1991) Sexual contact and touching between therapist and client: A survey of psychologists’ attitudes and behavior. Professional Psychology Research Practice, 22(4), 297-307.
[8]	Kuchan, A. (1990) Survey of incidence of psychotherapists’ sexual contact with clients in Wisconsin. In: Schoener, G., Ed., Psychotherapists’ Sexual Involvement with Clients: Intervention and Prevention, Walk-In Counseling Center, Minneapolis, 51-64.
[9]	Parsons, J. and Wincze, J. (1995) A survey of client- therapist sexual involvement in Rhode Island as reported by subsequent treating therapists. Professional Psychology Research Practice, 26(2), 171-175.
[10]	Becker-Fischer, M. and Fischer, G. (1997) Sexuelle übergriffe in Psychotherapie und Psychiatrie. Schriftenreihe des Bundesministeriums für Familie, Senioren, Frauen und Jugend, Band 107. Kohlhammer, K?ln.
[11]	Gartrell, N., Herman, J., Olarte, S., et al. (1986) Psy- chiatrist-patient sexual contact: Results of a national survey, I: Prevalence. American Journal of Psychiatry, 143(9), 1126-1131.
[12]	Schoener, G., Milgrom, J. and Gonsiorek, J. (1984) Sexual exploitation of clients by therapists. Women & Therapy, 3(3-4), 63-69.
[13]	Chesler, P. (1986) Sexuelle Beziehungen zwischen Patientin und Therapeut. In: Chesler, P., Ed., Frauen— das Verrrückte Geschlecht? Rowohlt, Reinbek, 134-157.
[14]	Disch, E. and Avery, N. (2001) Sex in the consulting room, the examining room, and the sacristy: Survivors of sexual abuse by professionals. American Journal of Orthopsychiatry, 71(2), 204-217.
[15]	Somer, E. and Nachmani, I. (2005) Constructions of therapist-client sex: A comparative analysis of retros- pective reports. Sex Abuse, 17(1), 47-62.
[16]	Somer, E. and Saadon, M. (1999) Therapist-client sex: Clients’ retrospective reports. Professional Psychology Research Practice, 30(5), 504-509.
[17]	Pope, K. and Bajt, T. (1988) When laws and values conflict: A dilemma for psychologists. American Psychologist, 43(10), 828-829.
[18]	Lamb, D., Catanzaro, S. and Moorman, A. (2003) Psychologists reflect on their sexual relationships with clients, supervisees and students: Occurrence, impact, rationales, and collegial intervention. Professional Psy- chology Research Practice, 34(1), 102-107.
[19]	Reschke, K. and Kranich, U. (1996) Sexuelle gefühle und phantasien in der psychotherapie. Verhaltenstherapie und Psychosoziale Praxis, 28(2), 251-271.
[20]	Thoreson, R., Shaughnessy, P., Heppner, P., Cook, S. (1993) Sexual contact before and after the professional relationship: Attitudes and practices. Journal of Coun- seling and Development, 71, 429-434.
[21]	Butler, S. and Zelen, S. (1977) Sexual intimacies between therapists and patients. Psychotherapy: Theory, Research and Practice, 14(2), 139-145.
[22]	Rodolfa, E., Hall, T., Holms, V., et al. (1994) The management of sexual feelings in therapy. Professional Psychology Research Practice, 25(2), 168-172.
[23]	Celenza, A. (1991) The misuse of countertransference love in sexual intimacies between therapists and patients. Psychoanalytic Psychology, 8(4), 501-509.
[24]	Dahlberg, C. (1970) Sexual contact between patient and therapist. Contemporary Psychoanalysis, 6, 107-124.
[25]	Schmidbauer W. (1997) Wenn helfer fehler machen. Rowohlt, Reinbek.
[26]	Wirtz, U. (1994) Therapie als sexuelles Agierfeld. In: Bachmann, K. and B?ker, W., Eds., Sexueller Mi?brauch in Psychotherapie und Psychiatrie, Huber, Bern, 33-44.
[27]	Jackson, H. and Nuttall, R. (2001) A relationship between childhood sexual abuse and professional sexual misconduct. Professional Psychology Research Practice, 32(2), 200-204.
[28]	Pope, K., Levenson, H. and Schover, L. (1979) Sexual intimacy in psychology training: Results and implications of a national survey. American Psychologist, 34(8), 682- 689.
[29]	Becker-Fischer, M. and Fischer, G. (1996) Sexueller Missbrauch in der Psychotherapie was tun? Orien- tierungshilfen für Therapeut und Klientin. Asanger, Heidelberg, 2008.
[30]	Apfel, R. and Simon, B. (1985) Patient-therapist sexual contact. I.: Psychodynamic perspectives on the causes and results. Psychotherapy Psychosomatics, 43(2), 57- 62.
[31]	Ben-Ari, A. and Somer, E. (2004) The aftermath of the- rapist-client sex: Exploited women struggle with the consequences. Clinical Psychology & Psychotherapy, 11(2), 126-136.
[32]	Disch, E. (2006) Sexual victimization and revictimization of women by professionals: Client experiences and implications for subsequent treatment. Women & Therapy, 29(1-2), 41-61.
[33]	Feldman-Summers, S. and Jones, G. (1984) Psychological impacts of sexual contact between therapists or other health care practioners and their clients. Journal of Consulting & Clinical Psychology, 52(6), 1045-1061
[34]	Luepker, E. (1999) Effects of practioners’ sexual misconduct: A follow-up study. Journal of the American Academy of Psychiatry and the Law, 27(1), 51-63.
[35]	Moggi, F. and Brodbeck, J. (1997) Risikofaktoren und Konsequenzen von sexuellen übergriffen in Psycho- therapie. Zeitschrift fur Klinische Psychologie, Psychiatrie und Psychotherapie, 26(1), 50-57.
[36]	Wohlberg, J., McCraith, D. and Thomas, D. (1999) Sexual misconduct and the victim/survivor: A look from the inside out. In: Bloom, J., Nadelson, C. and Notman, M., Eds., Physician Sexual Misconduct, American Psychiatric Press, Washington, D.C., 181-204.
[37]	Pope, K. (1988) How clients are harmed by sexual contact with mental health professionals: The syndrome and its prevalence. Journal of Counseling and Development, 67(4), 222-226.
[38]	Pope, K. and Bouhoutsos, J. (1992) Als h?tte ich mit einem gott geschlafen. sexuelle beziehungen zwischen therapeuten und patienten. Hoffmann und Campe, Ham- burg.
[39]	Benowitz, M. (1991) Sexual exploitation of female Clients by female Psychotherapists: Interviews with clients and a comparison to women exploited by male psychotherapists. PhD. dissertation, University of Minnesota, Dissertation Abstracts International 52(5-B), AAT9130138.
[40]	Vinson, J. (1987) Use of complaint procedures in cases of therapist-patient sexual contact. Professional Psy- chology Research Practice, 18(2), 159-164.
[41]	Tschan, W. (2005) Missbrauchtes Vertrauen. Sexuelle Grenzverletzungen in professionellen Beziehungen. Ur- sachen und Folgen, Karger, Basel.
[42]	Eichenberg, C. (2007) Das internet als medium wissen- schaftlicher t?tigkeiteine untersuchung im fach klinische psychologie an deutschsprachigen universit?ten. VDM- Verlag, Saarbrücken.
[43]	Ott, R. and Eichenberg, C. (2003) Klinische psychologie und internet. potenziale für klinische praxis, intervention, psychotherapie und forschung. Hogrefe, G?ttingen.
[44]	Bandilla, W. (1999) WWW-Umfragen-Eine alternative datenerhebungstechnik für die empirische sozialfor-schung? In: Batinic, B., Werner, A., Gr?f, L. and Bandilla, W., Eds., Methoden, Anwendungen und Ergebnisse, Hogrefe, G?ttingen, 9-19.
[45]	Kassen?rztliche Bundesvereinigung (2002) Grunddaten zur vertrags?rztlichen versorgung in deutschland 2002. http://www.kbv.de/publikationen/125.html
[46]	Kassen?rztliche Bundesvereinigung (2004). Grunddaten zur vertrags?rztlichen versorgung in deutschland 2004. http://www.kbv.de/publikationen/125.html
[47]	Gabbard, G. (1994)Psychotherapists who transgress sexual boundaries with patients. Bull Menninger Clinic, 58(1), 124-135.
[48]	Hinckeldey, S. and Fischer, G. (2002) Psycho traumatologie der Ged?chtnisleistung. Reinhardt, München.
[49]	Kagle, J. and Giebelhausen, P. (1994) Dual relationships and professsional boundaries. Social Work, 39(2), 213- 220.
[50]	Simon, R. (1989) Sexual exploitation of patients: How it begins before it happens. Psychiatric Annals, 19(2), 104- 112.
[51]	Strasburger, L., Jorgenson, L. and Sutherland, P. (1992) The prevention of psychotherapist sexual misconduct: Avoiding the slippery slope. American Journal of Psychotherapy, 46(4), 544-555.