Sexual Attraction to Patients

Sexual attraction to patients seems to be a prevalent experience that evokes negative reactions. National survey research suggests that over four out of five psychologists (87 percent) and social workers (81 per cent) report experiencing sexual attraction to at least one client (Pope et al., 1986; Bernsen et al., 1994). As Table 13.3 illustrates, therapists identify many aspects of patients that, according to the therapists, are the source or focus of the attraction. Yet simply experiencing the attraction (without necessarily even feeling tempted to act on it) causes most of the therapists who report such attraction (63 percent of the psychologists and 51 percent of the social workers) to feel guilty, anxious, or confused about the attraction.

That sexual attraction causes such discomfort among so many psy-

chologists and social workers and psychologists may be

a significant

Characteristics

Social Workers

Psychologists

Physical attractiveness

175

296

Positive mental/cognitive traits or abilities

84

124

Sexual

40

88

Vulnerabilities

52

85

Positive overall character/personality

58

84

Kindness

6

66

Fills therapist's needs

8

46

Successful

6

33

"Good patient"

21

31

Client's attraction

3

30

Independence

5

23

Other specific personality characteristics

27

14

Resemblance to someone in therapist's life

14

12

Availability (client unattached)

0

9

Pathological characteristics

13

8

Long-term client

7

7

Sociability (sociable, extroverted)

0

6

Miscellaneous

23

15

Same interests/philosophy/background as therapist

10

0

Table 13.3. Characteristics of Clients to Whom Psychotherapists Are Attracted.

Sources: Social work data are from Bernsen, A., Tabachnick, B. G., & Pope, K. S. (1994). National survey of social workers' sexual attraction to their clients: Results, implications, and comparison to psychologist. Ethics and Behavior, 4, 369-388. Available at http://kspope.com. Copyright 1994 Lawrence Erlbaum Associates, Inc. Adapted with permission. Psychology data are from Pope, K. S., Keith-Spiegel, P., & Tabachnick, B. G. (1986). Sexual attraction to patients: The human therapist and the (sometimes) inhuman training system. American Psychologist, 41,147-158. Available at http://kspope.com. Copyright 1986, American Psychological Association. Adapted with permission.

Table 13.3. Characteristics of Clients to Whom Psychotherapists Are Attracted.

Sources: Social work data are from Bernsen, A., Tabachnick, B. G., & Pope, K. S. (1994). National survey of social workers' sexual attraction to their clients: Results, implications, and comparison to psychologist. Ethics and Behavior, 4, 369-388. Available at http://kspope.com. Copyright 1994 Lawrence Erlbaum Associates, Inc. Adapted with permission. Psychology data are from Pope, K. S., Keith-Spiegel, P., & Tabachnick, B. G. (1986). Sexual attraction to patients: The human therapist and the (sometimes) inhuman training system. American Psychologist, 41,147-158. Available at http://kspope.com. Copyright 1986, American Psychological Association. Adapted with permission.

reason that graduate training programs and internships tend to neglect training in this area. Only 9 percent of psychologists and 10 percent of social workers surveyed in these national studies reported that their formal training on the topic in graduate school and internships had been adequate. A majority of psychologists and social workers reported receiving no training about attraction.

This discomfort may also be a significant reason that scientific and professional books seem to neglect this topic:

In light of the multitude of books in the areas of human sexuality, sexual dynamics, sex therapies, unethical therapist-patient sexual contact, management of the therapist's or patient's sexual behaviors, and so on, it is curious that sexual attraction to patients per se has not served as the primary focus of a wide range of texts. The professor, supervisor, or librarian seeking books that turn their primary attention to exploring the therapist's feelings in this regard would be hard pressed to assemble a selection from which to choose an appropriate course text. If someone unfamiliar with psychotherapy were to judge the prevalence and significance of therapists' sexual feelings on the basis of the books that focus exclusively on that topic, he or she might conclude that the phenomenon is neither wide-spread nor important [Pope, Sonne, & Holroyd, 1993, p. 23].

These and similar factors may form a vicious circle: discomfort with sexual attraction may have fostered an absence of relevant textbooks and graduate training; in turn, an absence of relevant textbooks and programs providing training in this area may sustain or intensify discomfort with the topic (Pope et al., 1993). The avoidance of the topic may produce a real impact. Koocher wrote, "How can the extant population of psychotherapists be expected to adequately address [these issues] if we pay so little attention to training in these matters?" (1994, p. viii).

These studies reveal significant gender effects in reported rates of experiencing sexual attraction to a patient. About 95 percent of the male psychologists and 92 percent of the male social workers compared with 76 percent of the female psychologists and 70 percent of the female social workers reported experiencing sexual attraction to a patient. The research suggests that just as male therapists are significantly more likely to become sexually involved with their patients, male therapists are also more likely to experience sexual attraction to their patients.

These national surveys suggest that a sizable minority of therapists carry with them—in the physical absence of the client—sexualized images of the client and that a significantly greater percentage of male than of female therapists experience such cognitions. About 27 percent of male psychologists and 30 percent of male social workers, compared with 14 percent of female psychologists and 13 percent of female social workers, reported engaging in sexual fantasies about a patient while engaging in sexual activity with another person (not the patient). National survey research has found that 46 percent of psychologists reported engaging in sexual fantasizing (regardless of the occasion) about a patient on a rare basis and that an addition 26 percent reported more frequent fantasies of this kind (Pope et al., 1987), and 6 percent have reported telling sexual fantasies to their patients (Pope & Tabachnick, 1993). Such data may be helpful in understanding not only how therapists experience and respond to sexual feelings but also how therapists and patients represent (for example, remember, anticipate, think about, fantasize about) each other when they are apart and how this affects the therapeutic process and outcome (see Geller, Cooley, & Hartley, 1981; Orlinsky & Geller, 1993; Pope & Brown, 1996; Pope & Singer, 1978b; Pope, Sonne, & Greene, 2006).

For any of us who experience sexual attraction to a client, it is important to recognize that the research suggests that this is a common experience. To feel attraction to a client is not unethical; to acknowledge and address the attraction promptly, carefully, and adequately is an important ethical responsibility. For some of us, consultation with respected colleagues will be useful. For others, obtaining formal supervision for our work with that client may be necessary. For still others, entering or reentering psychotherapy can be helpful.

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