Jacob and colleagues (2022) reviewed counselor liability claims over a 5-year period ending in 2019 and found that 43.9% of all closed claims were related to sexual/romantic relationships with current clients or their family members, sexual/romantic relationships with current supervisees, and sexual/romantic relationships with former clients or their family members before the mandated waiting period. Vesentini and colleagues (2022) surveyed therapists about the frequency of intimate feelings related to friendship and sexuality on the part of the therapist toward a client. Therapist Warning Signs Levine and Courtois (2021), in their work with therapists who commit sexual misconduct, found that the reasons why sexual violations occur may be therapist-related situational factors, for example, the therapist feels lonely, depressed, or unhappily married and encounters a client who is sensitive to the distress and provides comfort, or there may also be characterological issues such as when the therapist is a serial offender who takes advantage of power imbalances. Schoener (2021), in his work with therapists, found a variety of reasons associated with violation of boundaries of sexual misconduct. These included overinvolvement with the client, including social contacts outside of the therapy relationship or excessive therapist self-disclosure, therapists who do not maintain awareness of countertransference responses including anger and resentment toward the client, lack of insight into personal vulnerabilities, excessive need for client approval, emotional immaturity, poor social judgment, compulsive exploitation of others due to narcissistic traits, and/or substance abuse. He also notes that many cases involve the “wounded healer”; the clinician is struggling with their own divorce or relationship problems or the death Attraction to Clients Jacob and colleagues (2022) note that very limited time is spent in training programs discussing the issue of therapist attraction to their client or teaching strategies to manage it. They offer suggestions for managing these feelings: 1. Do not act on the attraction. This is a clear abuse of power and unethical and likely illegal. 2. Do not disclose the feelings to the client. This places an unnecessary burden on the client and is being done for the therapist’s benefit and not the client’s. 3. Do not dismiss, minimize, or ignore the feelings, but also do not obsessively focus on them. Careful scrutiny of thoughts and feelings in a mindful way is recommended. Sexual Harassment Sexual harassment of a client by the therapist is also specifically addressed in professional codes of ethics and is a prohibited behavior: ● APA (2017) prohibits sexual harassment, defined as sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, is offensive and unwelcome, and is sufficiently intense to be considered abusive in the context (Standard 3.02). ● NASW (2021) states that social workers should not sexually harass clients. This includes sexual advances, sexual solicitation, requests for sexual favors and any other verbal, written, electronic, or physical contact of a sexual nature (Standard 1.11). ● ACA (2014) states that counselors do not engage in or condone sexual harassment (Standard C.6.a).
They found that 70% of respondents had felt attraction toward a client at some point in their career, and 70% reported emotionality toward a client, for example, feelings of sympathy. However, they found that starting a sexual relationship with a current or former client was infrequent at 3%, and starting a friendship after therapy terminated was more common at 13.4%. Jacob and colleagues (2022) reviewed historical research data and found that between 72% and 88% of practicing therapists reported feeling attraction toward a client at some point in their careers. of a close person, they are emotionally needy, or they have exceptionally high dependency needs. The California Department of Consumer Affairs (2019) has published a detailed booklet addressing sexual misconduct by therapists. Therapist warning signs suggesting misconduct include: ● Telling sexual jokes or stories ● Sending obscene images or messages to clients ● Unwanted physical contact ● Excessive out-of-session communications ● Inviting a client to lunch, dinner, or other social events ● Confiding in a client about the therapist’s personal love life ● Telling the client that they are special to the therapist ● Relying on the client for personal or emotional support ● Suggesting or supporting the client’s isolation from support systems or fostering dependency on the therapist ● Providing alcohol or drugs during therapy sessions 4. Consult with a supervisor or colleague. Do not let feelings of embarrassment, guilt, or shame prevent consultation for the purpose of processing, reflecting, and resolving the situation. Self-Assessment Quiz Question #5 A sexual relationship with a current client: a. Is not always a boundary violation ● AAMFT (2015) states that therapists do not engage in sexual or other forms of harassment of clients (Standard 3.7). Clinical Consideration : Verbal, nonverbal, or physical contact with a current client that is sexual in nature is a firm boundary violation that can result in serious personal, professional, and legal consequences to the clinician. ● NBCC (2023) states that counselors do not engage in any type of harassing behavior toward clients, defined as any verbal, nonverbal, electronic, or physical act that is unwelcome or of a severity that it would be perceived as harassment (Standard 25). b. May be legal in some states c. Has clear potential for harm d. Is not considered exploitative
BOUNDARY CROSSINGS AND ETHICAL DECISION-MAKING
Whenever a boundary crossing is considered, the clinician must evaluate whether it is ethical and appropriate. Clinicians tend to use a variety of methods to make these decisions. Professional codes of conduct provide guidelines
for behavior based on professional values, but they often are aspirational and do not address the specific situation being faced by the provider.
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