Sexual misconduct Some states also have laws making sexual misconduct subject to lawsuits and even arrest. Practitioners need to be sure about the rules that apply to them and must be aware of how their behavior may be perceived by others. For example, Reid (1999) points out that in most situations consent will not be an effective defense against sexual misconduct allegations. The reasons Reid gives for a client’s ability to consent being called into question are: ● The fiduciary trust between clinician and patient. ● Exploitation of transference feelings. ● The right of the patient to expect clinical needs to be the overriding priority. ● Exploitation of the patient’s purported inability to resist the therapist’s influence. ● The alleged “power differential” between any patient and his or her clinician. Recorded history of sexual misconduct travels back to the 4th and 5th centuries B.C. and includes the Hippocratic Oath that states, “I will abstain from intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free.” In contrast, Sigmund Freud flagrantly demonstrated sexual misconduct when he excused such behavior by his male colleagues. For example, Carl Jung, according to historians, became sexually involved with one of his patients by the name of Sabina Spielrein, a 19-year- old medical student. When corresponding with Freud, he stated, “the continued preservation of the relationship (with Sabina) could be rounded out only by sexual acts.” As Jung became more desperate when the affair became known he was reassured by his colleague, Freud. Freud wrote to his friend not to blame himself and stated, “It was not your doing but hers” (McGuire, 1988). Kenneth S. Pope has written extensively on sexual behavior between mental health professionals and their clients. He asserts that sexually abusive psychotherapists are well represented in the mental health profession. As a matter of fact, as Jung’s letters to Freud make clear, there is nothing new about sexual contact between mental health practitioners and their clients. Assalian and Ravart (2003) have identified two types of sexually offending professionals. They are described as affective or predatory . Affective offenders tend to have unresolved emotional problems and may engage in counter- transference, be depressed, or have substance abuse issues. They may have underlying and unresolved abandonment issues. Predatory offenders tend to have personality disorders that include narcissistic, borderline, or psychopathic features. Predatory offenders have integrated their behaviors to use and exploit others in order to meet their needs. Assalian and Ravart have identified seven subtypes within the affective and predatory types. They include: ● Sadistic : Offenders who enjoy using their power and authority to control and dominate the victim, receiving marked pleasure from being cruel and provoking suffering. ● Exploitative : Offenders who purposely use their power and authority to fulfill their needs, including the need to dominate and control. ● Incidental : Offenders who have impulsively behaved in a sexually inappropriate manner one time. ● Narcissistic : Offenders who demonstrate a need for attachment, admiration, approval, validation, love, and attention.
● Angry : Offenders who persistently sexually harass and offend against women. ● Compensatory : Offenders who offend to fulfill unmet needs for closeness, affection, and sexual relations. ● Interpersonal : Offenders who are motivated to establish a close, intimate and long-lasting relationship. The relationship appears to be authentic without clear signs of exploitation or abuse. In a Swiss study, Moggi and colleagues (2000) sought to understand what risk factors might make some women more vulnerable to sexual exploitation by therapists. They found that the women who had experienced sexual exploitation had experienced more parental rejection as children than a control group of women who had been in therapy but who had not experienced the exploitation. They had also experienced more sexual violence. Most offending therapists are male and most exploited clients are female (Capawana, 2016). Ravart and Assalian (2003) reference Sealy (2002) concerning the three severity levels of professional sexual misconduct: 1. Sexual impropriety : Violations such as inappropriate sexual remarks. 2. Sexual transgressions : Violations such as inappropriate touching. 3. Sexual violations : Violations that include sexual relationships. In the same article, Ravart and Assalian report on a colorful categorical system developed by Irons and Schneider (1994, 1999) to describe mental health professionals who engage in sexual misconduct. This system – which offers another, simpler perspective on professionals who offend in this way – groups offenders into six types: ● The Naïve Prince (8% of Irons and Schneider’s sample of 137): These individuals are new to the profession and develop a privileged relationship with one or more clients, blurring the boundaries. They are psychologically healthy and feel remorse for their sexual misconduct. ● The Wounded Warrior (22%): These individuals are generally psychologically healthy, but they are trying to escape professional demands, internal struggles, and unresolved childhood and adolescent issues with their sexual relationship. They feel remorse over the relationship. ● The Self-Serving Martyr (24%): These professionals are in mid-to-late career, and have become isolated and resentful over sacrifices they have made and what they perceive as a lack of appreciation. The sexual misconduct is meant to relieve their suffering. These individuals are often dealing with addictive disorders. They may also have a personality disorder. ● The False Lover (19%): These individuals display creativity, intensity, and charm. They indulge in drama and lack impulse control. For these people sexual misconduct fills a need for excitement. They usually have a personality disorder, which is often their primary diagnosis, often with narcissistic, histrionic, and dependent features. ● The Dark King (12%): These professionals need to control and dominate and are driven by grandiosity. These people are often highly intelligent, but have a number of personality disorders. ● The Wild Card (15%): These people often have severe mental disorders and may even be suffering from dementia.
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Book Code: SWNY1224
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