Ethical models predictably involve consultation and supervision as necessary steps in the ethical decision-making process. As a consequence, it is no surprise that when feelings of sexual attraction emerge in clinical and professional relationships, reaching out to colleagues and mentors is recommended. However, researchers have noted that exploring sexual attraction during supervision is all too often avoided (Ladany, Hill, Corbett, & Nutt, 1996; Ladany et al., 1997). For example, in a review of quantitative and qualitative research, Ladany (2004) reflected on the puzzling fact that supervisors appeared to rarely bring up the possibility of sexual attraction, ‘… even when there were clear signs that sexual attraction was present’ (p. 13).

Herein lies the gap: although interpersonal and sexual attraction is acknowledged as common in counselling and psychotherapy, there is also evidence that training and supervision norms make direct discussion of sexual attraction taboo (Ladany, Klinger, & Kulp, 2011; Pope, Sonne, & Greene, 2006; Rodolfa, Kitzrow, Vohra, & Wilson, 1990). As an illustration, some supervision texts in the helping professions do not even include references to sex, sexuality or attraction. In contrast, in this chapter, we deal with the issue directly and offer suggestions on how to address sexual attraction in training and supervision. It should be noted that many layers of relationships are encountered in supervision (examples include relationships between supervisor and supervisee, supervisee and client, and even supervisor and client). For the purposes of this chapter, our primary focus is on supervising the attraction that occurs in the supervisee–client relationship. As most other chapters highlight, effective supervision is fundamental to the management of sexual attraction. In addition, sexual attraction is examined as a common and natural response that can inform a continuum of action, from nonaction to boundary transgressions and multiple relationships. Finally, practical models and strategies for addressing sexual attraction in supervision are introduced and applied to case examples.

Sexual Attraction in the Supervisee–Client Relationship

In their writings on ethics, Pope and Vasquez (2007) have referred to sexual attraction in the supervisee–client relationship as ‘very common’ (p. 209). More specifically, in a survey of 585 psychotherapists, Pope, Keith-Spiegel, and Tabachnick (2006) reported that 95% of men and 76% of women reported feeling sexually attracted to a client on at least one occasion. They further reported that a minority of therapists acted on their sexual attraction (9.4% of men, 2.5% of women), but that a majority of therapists (63%) indicated they felt distress over their feelings of sexual attraction. Interestingly, only 9% of respondents believed their training had been adequate enough to help them deal effectively with feelings of sexual attraction towards clients.

It appears that supervisee sexual attraction can develop immediately during an initial therapeutic encounter or follow a slower trajectory based on repeated personal contacts during longer-term therapy. Either way, sexual attraction has been reported as having the potential to influence therapy in both positive and negative ways. For example, based on quantitative and qualitative research, Ladany et al. (1997) noted that some therapists ‘believed that they were more invested, caring, and attentive than usual because of the sexual attraction’ (p. 418). Although this positive influence was possible, more often therapists considered sexual attraction as a source of tension, distance, distraction and bias in the therapeutic relationship.

Although the whole concept of sexual attraction is both idiosyncratic and a culturally constructed biopsychosocial phenomenon, there appear to be common client factors that therapists tend to find attractive. Specifically, Pope and his colleagues (2006) reported, based on their survey data, the top five attractive client qualities:

• Physical attractiveness
  
• Positive mental/cognitive traits or abilities
  
• Sexual
  
• Vulnerabilities (e.g., childlike, needy)
  
• Positive overall character/personality (Pope, Keith-Spiegel, & Tabachnick, 2006, p. 105).

These results are generally consistent with Ladany et al.’s (1997) findings that therapists primarily described themselves as either physically or interpersonally attracted to clients. Generally, male and female therapists used similar terms to describe the qualities they found attractive; exceptions included males identifying ‘physical attractiveness’ and females identifying ‘successful’ much more frequently.

Strategies for Training and Supervision

The potential for sexual attraction within clinical relationships is both natural and ordinary. Nevertheless, specific methods for addressing these attractions remain on the periphery of professional training and supervision. Instructions on how to move forward when attraction develops remain broad. When attraction surfaces, therapists report several strategies: (1) seeking consultation, (2) obtaining supervision, (3) client referral and (4) obtaining therapy (Ladany et al., 1997). Although not incorrect and potentially helpful, these strategies are descriptively simplistic, and the nuances and details necessary for them to be successful tend to be ignored.

This section focuses on how to facilitate exploration, reduction and management of sexual attraction. Our focus is on reduction and management, primarily because completely eliminating sexual attraction is unrealistic and unattainable. In fact, therapists typically report that sexual attraction is never completely resolved (Ladany et al., 1997). Consequently, we endorse and describe processes where greater understanding and insight is used to reduce sexual thoughts and feelings (Bridges, 1994). The strategies described next focus on managing sexual attraction in ways likely to reduce or eliminate inappropriate or unethical therapist behaviours.

Training

Ethical principles related to sexual attraction and strategies for dealing effectively with attraction should be integrated into graduate training programs and workshops or continuing education sessions. Three primary goals of group trainings on clinician sexual attraction include (1) creating a safe environment for discussion and normalizing sexual attraction, (2) exploring appropriate behavioural responses and (3) establishing professional relationships for future consultation. The teaching methods are as important (if not more so) as curriculum goals and content. Experiential learning using role play, coaching and application to case vignettes is recommended across helping professional contexts (Ladany et al., 1997; Rodolfa et al., 1990). Specifically, Downs (2003) reported that when counsellor educators had experienced prior role playing or coaching in response to sexual attraction dilemmas, they ‘were significantly more comfortable bringing up the topic of sexuality in the clinic or classroom’ (p. 9). Facilitating trainings of this nature often become more about the experience created than reciting of academic content and recommendations. Concrete opportunities to try out different words when broaching sexual attraction while remaining open and accepting to disclosures are invaluable and, we would argue, more effective in preparing therapists, supervisors and educators to respond to such dilemmas in real-world settings.

Creating a safe environment for discussing and exploring sexual attraction is challenging and complex. Just as we have set the tone and context for this chapter (e.g., that attraction is normative and the aim of interventions is to manage sexual attraction), the same contextualization must occur to develop a safe learning environment. In a recent study, Ladany and colleagues reported that two qualities of the ‘best supervisors’ were being open and skilful in facilitating discussions (Ladany, Mori, & Mehr, 2013, p. 28). As a consequence, it is strongly recommended that pro­fessionals who facilitate supervision trainings set a tone that is open, accepting and explorative regarding sexual attraction. This is especially important in group situations where ‘trust may be wanting’ (Rodolfa et al., 1990, p. 315). When contextualizing trainings that include content about sexual attraction, statements of focus might include the following:

• Let’s all try to remember that thoughts and feelings related to attraction are common in clinical settings and that having sexual thoughts and feelings is much different from acting on sexual impulses.
  
• During this training, I hope you will all openly reflect on your feelings, behaviours and values. I recognize this sort of open exploration involves risk and courage.
  
• As a group, we will work to be open and accepting of all disclosures, including those focusing on sexual attraction; at the same time, our goal is to support each other in achieving ethical and therapeutic responses.
  
• The confidentiality of what you say in here is limited. I encourage all of you to respect each other’s confidentiality. But in the end, you all need to judge for yourselves how open you want to be during our time together.
  
• When faced with sexual attraction dilemmas, we will work to think flexibly and develop a multitude of options that comply with ethical standards and practical realities.
  
• If a performance evaluation is connected to this experience for you, your evaluation will not be based on the depth or frequency of disclosure but rather on active engagement in the learning process.
  
• (In cases where participation is not voluntary) This training is mandatory, but I still hope we can explore how this training can best meet your needs for a useful learning experience (Pope et al., 1993; Rodolfa et al., 1990).

After laying the groundwork for safety and openness, instructors are responsible for these words not becoming empty; that is, instructors must be prepared to enforce these ideals when challenged. For example, judgemental responses to disclosures or vignettes of attraction must be stopped and explored (What values and feelings are provoking the judgemental response? How is the group affected when sexual attractions are met with judgement?). Although these ground rules and ideals can form a clean and concrete list, enacting them is a complex effort of responding flexibly in the moment and attending to group process and group needs rather than the next item on the lesson plan. Demonstrating leadership that is not afraid to attend to deeper processes, relationships in the room and sustaining the concrete expectations of the group instils trust in the leadership; the instructor is backing up his or her expectations in the immediate lived experience – even when content and process become difficult. Being able to trust in leadership is especially critical when exploring topics like sexual attraction.

Because sexual attraction is often accompanied by shame and guilt (Ladany et al., 1997; Pope et al., 1993), a safe training environment for exploring dilemmas that trigger these feelings requires that participants be responsive and accepting. Pope et al. (1993) further delineated this as an acceptance-of-content process. It needs to be clear that being responsive to participant disclosures does not imply agreement or support for specific behaviours. Instead, the emphasis is on carefully attending to participants and peers and on exploring and understanding meanings of specific disclosures. With this in mind, instructors model norms where group participants take on roles that are supportive, encouraging and direct. When facilitating ethics trainings that include discussions of sexual attraction, it is critical that leaders model and maintain honest and direct communication, as the risks for a benign group and learning experience are high when participants fulfil only supportive, empathetic and open roles. Engineering this balance can be as simple as asking participants about what is not being said or acknowledged by themselves and other group members (Pope et al., 1993).

Once a safe environment is established, exploring appropriate behavioural responses to sexual attraction can ensue. Specifically, it is especially important for facilitators to move beyond general solution statements like ‘refer’ or ‘seek supervision’ and to engage participants in rich and specific responses to case vignettes, role plays or even personal disclosures (Ladany et al., 2013). When exploring behavioural responses to sexual attraction, instructors or facilitators can integrate behaviourally specific solutions guided by literature, ethical codes, research and self-disclosure. These may include the following:

• Practising the language one might use when disclosing an experi­­ence of sexual attraction during therapy to a supervisor or trusted colleague
  
• Role-playing responses that minimize shame and embarrassment when peers seek out consultation to disclose issues of sexual attraction
  
• Exploring methods for identifying attraction that may lie outside of awareness
  
• Brainstorming and practising specific coping and containing skills to use in sessions where attraction is present
  
• Supporting the general practice of nondisclosure to the client/supervisee when the clinician/supervisor experiences sexual attraction in the relationship to prevent harm and exploitation (Bridges, 1994; Ladany et al., 1996; Pope et al., 1993).

Additional recommendations for experiential training design include using (1) gender neutral vignettes, (2) small groups for reflection using structured question prompts to facilitate a safe and guided discussion, and (3) employing recorded critical incident vignettes that have the power to evoke and stimulate more challenging clinical realities than written cases (Bridges, 1994; Rodolfa et al., 1990). Although our endorsement of experiential learning and its effects is clear, professional resources and references also remain an important component of professional and pre-professional trainings. Connecting participants with detailed bibliographies, educational material, professional contacts and consultants from professional and licensing boards are vital resources.

When providing trainings that include a focus on sexual attraction, an important goal is to build trusting relationships among participants. This is because after graduate school, participants may rely heavily on peer consultation when addressing sensitive issues like sexual attraction. As an example, in their 1996 study, Ladany and colleagues found peer supervision to be a prominent alternative to disclosing critical issues to supervisors, or as they concluded, ‘people with the least amount of supervision and counselling experience may be offering the most supervision’ (p. 21). In light of these findings, it is critical that trainings address not only personal responses to attraction in professional contexts but also how one may respond as a supervisor or consultant in these situations.