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Do no Harm

Updated: Aug 22, 2023

A client told me that his family had serious concerns about him seeing a female Life Coach. The reason wasn’t because he was embarrassed to be asking for support/ help/ direction with regards to his presenting problem, but rather because certain family members felt he was in the midst of a mid-life crisis and at risk of falling in love and having an extra-marital affair. Unfortunately this isn’t as absurd or obscure as it may first seem, and as such, I feel it is necessary to address this sexual taboo!

Unfortunately there are a couple of rotten apples that call the ethics and professionalism of the entire therapeutic community into question and damage the reputation of the helping profession!

Non-maleficence means to “do no harm.” This is one of the 6 ethical principles that govern any therapeutic or helping practice, and certainly most would agree that engaging in an affair with a client goes beyond mere malpractice…. it is a gross abuse of trust and power (violating the roles and boundaries of the therapeutic relationship, since it takes advantage of a client’s vulnerability and trust). It is accepted that sensual intimacy and/or sexual relations is prohibited and cannot be considered acceptable or consensual based on the very nature of the therapeutic relationship. Simply put, an intimate sexual involvement between therapist and client results in HARM and victimization, irrespective of whether it was the client or the therapist who initiated the affair.

William Masters and Virginia Johnson reports: Human Sexual Response (1966) and Human Sexual Inadequacy (1970) stated "We feel that when sexual seduction of patients can be firmly established by due legal process, regardless of whether the seduction was initiated by the patient or the therapist, the therapist should be sued for rape rather than malpractice, i.e., the legal process should be criminal rather than civil.” Pope and Vetter’s national study of almost 1000 patients who had been sexually involved with a therapist. The findings suggest that about 90% of patients are harmed by sex with a therapist; 80% are harmed when the sexual involvement begins only after termination of therapy. About 11% required hospitalization; 14% attempted suicide; and 1% committed suicide. About 10% had experienced rape prior to sexual involvement with the therapist, and about a third had experienced incest or other child sex abuse. About 5% of these patients were minors at the time of the sexual involvement with the therapist. Of those harmed, only 17% recovered fully. The common reactions to therapist-client sexual relations are: ambivalence, cognitive dysfunction, emotional lability, emptiness and isolation, impaired ability to trust, guilt, increased suicidal risk, role reversal and boundary confusion, sexual confusion, and suppressed anger.

Clients often become infatuated with their therapist because that therapist is perhaps one of the only people with whom they can open up honestly without jeopardizing the relationship. The therapist listens openly, offers no judgement, has a client’s best interests at heart and this may feel very much like love to some clients. An experienced grounded therapist looks for evidence of transference in the form of repeated patterns of relationship, as described by the client. When people meet a new person who reminds them of someone else, they unconsciously infer that the new person has traits similar to the person previously known, this association can be positive or negative. People tend to repeat relationship patterns from the past in the present. Transference is likely at play when it is clear that a client’s response to the therapist has similarities with other important relationships. The therapist must be aware of this process and has to understand that the client is NOT in love with him/ her, just what he/she represents. This awareness enables the therapist to approach the therapeutic relationship in an ethical, dispassionate and professional manner. An attraction in itself is not an unnatural or uncommon occurrence, the therapist must be able to recognize these feelings and deal with them in a healthy, constructive and professionally ethical manner to prevent the development of an inappropriate relationship with the client. Mature, emotionally-grounded therapists know not to take any infatuation personally. A therapist who then acts on their own feelings of attraction toward a client or engages in inappropriate behaviour is taking advantage of the client’s transference and not effectively managing their own countertransference. Strict sanctions are in place to protect clients against Therapist-client sexual relations because such misconduct is deeply immoral and a disgusting violation of ethics which take undue advantage of the very nature of a therapeutic relationship. Shame on any therapist who allows him/herself to fall in love with a client.

As a therapist, I have to be constantly aware of the boundary between myself and a client. I'm there for my client… (S)he is not here for me. While I know may know my client more intimately than most, my client only knows my professional persona. It is not a balanced relationship nor will it ever be. it is an unequal power balance, the therapist has too much power to manipulate both the client and the relationship. I provide my clients with a Code of Conduct and their rights and responsibilities as a client. Boundaries are there to protect both parties in the therapeutic relationship and ensure that the therapeutic relationship remains inviolable and sacrosanct.

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