Vulnerability to Attraction? The Psychotherapist’s Characteristics

Characteristics that influence the handling of sexual attraction include therapists’ personal and professional identities (i.e., values, moral and ethical principles, boundaries, beliefs), which, in turn, are influenced by maturational characteristics, training history, theoretical orientation, relationship status and gender.

A poignant example of the influence of personal and professional identities was Corey’s revelation that, because of his ‘naturally looser boundaries around sex and monogamy’ and his previously held belief that it is common for psychotherapists to have sex with their clients, he currently relies heavily on ethical guidelines for psychologists. Recently acquired professional beliefs about the best interests of clients powerfully shape his decision making regarding sexual attraction.

Rebecca experienced a different incongruity: her personal values are more stringent than the ethical guidelines regarding sexual contact with former clients. She believes that psychotherapists should not engage in sexual relationships with former clients under any circumstances, while her registration board’s ethical guidelines suggest psychologists may in limited circumstances have sexual relationships with former clients at least 2 years following termination of psychotherapy.

The interview data sharpened the issue under investigation, from the start, distinguishing between the feeling of attraction and what is done in consequence of that feeling. Our participants expressed unanimously the belief that the initial experience of sexual attraction cannot be controlled and therefore is not unethical. However, ethicality became pertinent when assessing psychotherapists’ intrapsychic and behavioural responses to their sexual attraction. These beliefs are consistent with those expressed by participants in previous research (e.g., Nickell et al., 1995; Pope, Tabachnick, & Keith-Spiegel, 1987) and by the few scholars who have explored this issue in the literature (Herring, 2001; Ladany et al., 1997; Pope et al., 1993).

Ethical guidelines should communicate that, while the experience of sexual attraction to clients is not unethical, it must be handled ethically, ensuring no sexual misconduct or hindering of psychotherapy. Handling the sexual attraction may also require consultation with senior colleagues and/or supervisors.

Participants expressed considerable personal guilt about experiences even of attraction, and this guilt may be a barrier to being quickly able to see that attraction is happening. While Rachel and Anita suggested that psychotherapists’ sexual attraction to clients was ethical, they saw their own experiences of such attraction as ‘wrong’, invoking a cultural ‘taboo’. So, psychotherapists’ views about the ethicality of sexual attraction to clients in general may differ from their views of their own attraction in particular. The latter is consistent with the myth identified by Pope, Sonne, and Greene (2006, p. 28) that

Perhaps the intended message of scholars and educators that sexual attraction to clients is natural, common and even expectable has not penetrated deeply into the minds of psychotherapists. There is still considerable inner judgement.

Greater age and experience as a psychotherapist increase one’s felt ability to handle sexual attraction to clients, perhaps due to learning gained from handling past attractions, and the development of more general knowledge, confidence, competence, professional boundaries and emotional awareness.

Psychotherapists’ age was seen as important to some, where, for the men, increasing age was associated with decreasing ‘libido’ or ‘sexual charge’, making sexual attraction feel less difficult to manage. This finding concurs with previous research on sexuality and ageing (e.g., Morley, 2001; Segraves & Segraves, 1995). Participants’ accounts of their changing libido or ‘sexual drive’ may reflect social discourse as well as biological behavioural determinants.

Women therapists noted challenges different from males’. Younger women, Bridget noted, frequently feel like ‘everybody’s property’, which may interfere with their ability to confront sexual attraction to clients. She added that as women’s ‘confidence’ increases with age, they become able to explore more freely their options for handling their sexual attraction. Gender differences are likely to go well beyond those revealed here. Sehl (1998) found that men were more likely than women to report frequent use of their sexual attraction for therapeutic ends.

Most participants reported no training in handling sexual attraction to clients, consistent with previous research (e.g., Blanchard & Lichtenberg, 1998; Paxton, Lovett, & Riggs, 2001; Pope et al., 1986; Sehl, 1998). This omission often leads psychotherapists to display erroneous beliefs about such attraction (Housman & Stake, 1999) and may unintentionally reinforce the view that it ‘is abnormal, and is not to be acknowledged, let alone studied and discussed’ (Pope, 2000, p. 608). In keeping with previous research, past education was often presented in the context of ethical decision making with a black-and-white focus proscribing sexual relationships with clients.

So, psychotherapists develop their beliefs based partly on their ethics training regarding the prohibition of sexual contact with clients. As Corey’s case shows, this remains a crucially important area of education. It is not nuanced enough. Our participants voiced difficulty distinguishing taboos, feelings and ethics associated with sexual contact versus attraction. As Nickell et al. (1995, p. 325) suggest, ‘Assessments of student and therapist beliefs about issues of sexual attraction to clients should be included as a component of training programmes and in supervision’.

Psychotherapists’ theoretical orientations contribute to their con­ceptualizations of their sexual attraction to clients. Bridget’s training in systems therapy, Edward’s psychodynamic approach and Trevor’s identification with Gestalt therapy allow them to understand some instances of sexual attraction as products of the therapeutic interaction and to use them therapeutically. This is in keeping with Gerber (1995, p. 118), who notes,

Indeed, other than with reference to psychodynamic concepts, our participants were unable to articulate how their favoured theoretical constructs conceptualize and suggest handling sexual attraction to clients. Similarly, the extant literature appears devoid of non-psychodynamic theoretical explanations of, or potential responses to, the phenomenon (Pope et al., 1986).

Some participants saw their relationship status as partly influencing their handling of sexual attraction to clients. Being in a committed romantic relationship might render such attraction less acceptable, while being single and/or sexually unfulfilled might create a stronger investment in the sexual attraction [which echoed Berry & Worthington’s (2001) findings].

Appraisal of the Sexual Attraction and Its Manageability

Our participants handled sexual attraction to clients first by appraising its qualities, and consequently its manageability, to evaluate options for managing it, prior to implementation. Psychotherapists engage in appraisals of at least some of the following elements of their attraction: its intensity, degree of interference with psychotherapy, mutuality, timing, reasons for its emergence and client characteristics.

Markers of a minimally intense sexual attraction identified by our participants included admiration, curiosity, feelings of warmth and desire to engage in nonsexual touch. In contrast, a highly intense sexual attraction might entail sexual fantasy, preoccupation with the client, feelings of love, care and concern, and desire for a romantic and/or sexual relationship. In addition, highly intense experiences of sexual attraction were associated with experiences of anxiety, guilt, unsettlement and self-doubt.

Appraisals of intensity strongly influence therapists’ choice of methods for handling it. Minimally intense sexual attractions might be handled using autonomous coping such as psychic management techniques alone, whereas highly intense sexual attractions might require more interpersonally oriented coping with one’s supervisor or by discontinuing therapy.

Of major concern to practitioners is appraising how much sexual attraction interferes with psychotherapy, particularly regarding its intensity. At low levels, it might interfere minimally or might even be of therapeutic benefit (e.g., by enhancing therapeutic effort), while at high levels, it might interfere greatly (e.g., by impairing judgement, objectivity and the ability to implement specific therapeutic interventions).

Our participants appraised the mutuality of their sexual attraction by observing verbal and/or non-verbal signals from clients, and/or verbal confirmations of mutuality. Existing literature indicates that between 64% and 83% of psychotherapists report that at least one past instance of sexual attraction was mutual (Bernsen, Tabachnick, & Pope, 1994; Pope et al., 1986; Rodolfa et al., 1994).

The clients’ attributes taken seriously in terms of attraction were their presenting problems (including history), emotional stability and age. Existing research suggests that particular care should be taken when psychotherapists experience sexual feelings towards sex offenders (Gerber, 1995), sexual abuse victims (including psychotherapist–client sexual abuse; Sonne & Pope, 1991) and older clients (Hillman & Stricker, 2001).

Discovering the meanings of the felt attraction and its relevance to therapy – that is, has it emanated primarily from the therapist, is it predominantly indicative of clients’ issues, or has it emerged from key elements of the therapeutic relationship – shapes decisions about how to handle it. Some consider when it began during psychotherapy. For Edward, early occurrence suggests its development from ‘his own issues’, while later occurrence implicates the ‘transference relationship’. Simon, who would likely discontinue therapy involving mutual attraction, would not terminate a therapy when this attraction emerged near the therapy’s expected ending. Others consider where sexual thoughts occur, with some viewing the occurrence of such thoughts while not in the presence of clients as more likely due to their own characteristics.

Decisions regarding how to handle sexual attraction depend on the perceived manageability of the attraction, in turn influenced by the therapists’ personal characteristics (e.g., self-efficacy, self-control), appraisals of their sexual attraction, and prior incomplete or unsuccessful attempts at managing it.

Most challenging and least manageable, according to most of our participants, are intense levels of sexual attraction (e.g., Rachel noted that she ‘just couldn’t work’ if the attraction were strong) and mutual sexual attraction.

Some saw the presence of certain client characteristics (such as ‘borderline features’ or emotional instability) as making sexual attraction more difficult to manage, requiring particular objectivity and sensitivity. Some believed that they could manage their sexual attraction in most, if not all, circumstances.

Handling the Sexual Attraction: Evaluating Options

Participants indicated that they would next evaluate the ethicality and potential consequences of their options for handling their sexual attraction, including autonomous coping strategies, therapeutic use of the sexual attraction, guidance seeking, privileging the sexual attraction (i.e., expressing it in a personally gratifying way, such as inviting sexual contact) and discontinuation of psychotherapy.

Psychotherapists are likely to attempt to manage their sexual attraction to clients using autonomous coping strategies (psychic and/or behavioural). Commonly favoured psychic management techniques included acknowledgement and awareness of the sexual attraction, as also reported in previous research (e.g., Giovazolias & Davis, 2001; Ladany et al., 1997) and recommended by scholars (e.g., Searles, 1959; Solomon, 1997).

Other techniques employed included self-analysis, ‘self-talk’, ‘self-control’/‘willpower’, mindfulness and – particularly among beginning therapists – compartmentalizing, disregarding or shutting off the sexual attraction. Psychotherapists are likely to use psychic management techniques that are consistent with their theoretical orientations (e.g., psychodynamic therapists might employ self-analysis, whereas dialectical behavioural therapists might use mindfulness).

Psychotherapists differed markedly in their views about the consequences of disallowing sexual thoughts about clients. Some suggested that allowing such sexual thoughts could encourage inappropriate cognitions that lead to unethical behaviours, a line of reasoning first identified by Pope et al. (1993). Others conceptualized the forbidding of these sexual thoughts as psychic repression (removing them from awareness due to the pain of felt guilt), which could endanger themselves, psychotherapy and the clients (this was also the prevailing sentiment among scholars; e.g., Mann, 1994; Pope et al., 1993; Searles, 1959; Tansey, 1994).

Such a divergence in beliefs seemed to stem from identification with different theoretical orientations: those in favour of disallowing sexual thoughts were from cognitive-behavioural (or learning theory-based) backgrounds and those in favour of allowing these thoughts were from psychodynamic backgrounds. More research is needed given the divergence of beliefs on this thorny issue.

Behavioural management strategies – either used alone or supplementary to psychic management techniques – include psychotherapists’: attempting to behave as they would with other clients, steering the therapy away from content that might evoke sexual thoughts or feelings, and not scheduling these clients in the last appointment of the day to minimize the likelihood of the relationship continuing after-hours. Moving the direction of therapy away from certain issues seems a problematic choice in that therapy is diverging to manage therapist issues rather than being focused on client issues, but it may be a useful short-term solution.

Therapeutic Use of the Sexual Attraction

When psychotherapists appraise their sexual attraction as relevant to psychotherapy, they may attempt to use it to enhance understanding of therapeutic issues and/or as points of discussion with these clients.

Our participants suggested they might reflect on their attraction’s meanings regarding the client’s needs and ways of relating to people, and use it to guide treatment and elucidate areas of therapeutic focus (as also recommended by several theorists; e.g., Gabbard, 1994; Pope et al., 1993; Rosiello, 2003).

Whether to discuss one’s sexual attraction with clients is a hotly debated issue in the literature, which produced mixed opinions among our sample. Consistent with most participants in past research (e.g., Gibson & Pope, 1993; Pope et al., 1987), our therapists who viewed their sexual attraction as never relevant to psychotherapy saw self-disclosing sexual attraction as always unethical and potentially harmful to the client, the therapeutic relationship and their professional reputations. A number of scholars have argued that psychotherapists should never share or explore openly their sexual attraction with clients (Gabbard, 1994; Gorkin, 1985; Kernberg, 1994).

So, it is of interest that some participants in our research saw disclosure as unethical and risky only when (1) the client is emotionally unstable or not mature enough to engage in sexual relationships generally; (2) the sexual attraction emerges primarily from the psychotherapist’s characteristics and not from those of the client; or (3) the psychotherapist discusses the sexual attraction in a direct – or ‘raw’ – manner. These views echo those expressed by only a minority of participants in past research (e.g., Gibson & Pope, 1993; Goodyear & Shumate, 1996; Harris, 2001).

Nonetheless, Dalenberg (2000) discovered via her survey of former clients whose psychotherapists had self-disclosed sexual attraction to them that clients are most likely to benefit from such self-disclosures when their psychotherapists make clear statements of boundaries and acknowledge the normalcy of the human sexual response in intimate settings, and when the clients understand why the topic is being discussed (i.e., in response to their, rather than the psychotherapists’, needs).

How directly therapists discuss their sexual attraction with clients is a consideration that has attracted debate among theorists and one that arose for several of our participants. Jørstad (2002) argues that direct disclosures of sexual attraction to clients can sometimes be beneficial to these clients, whereas Bridges (1998) and Fisher (2004) argue that such disclosures are unethical and risk harm to these clients, the therapeutic process, the psychotherapists’ careers and the mental health profession.

In our study, Trevor indicated that, after careful consideration, he might directly discuss his sexual attraction with a client for the client’s benefit. Anita suggested that direct disclosure of sexual attraction to clients would be unethical but that indirect disclosure with reference to ‘approved language’, such as transference and countertransference, would be appropriate. Similarly, Edward suggested that he might discuss sexual attraction with clients in a non-sexualized way in terms of intimacy and closeness within the therapeutic relationship.

These approaches are consistent with Fisher’s (2004, p. 117) acknowledgement of ‘a therapeutic middle ground’, in which explicit disclosures of sexual feelings are avoided in favour of indirect disclosures, such as acknowledgements of caring and warmth within the therapeutic relationship. Nonetheless, Trevor and Anita thought that supervision should be sought before psychotherapists discuss their sexual attraction with clients, a stance strongly supported by Fisher (2004) and Pope et al. (1993).

None of our participants had ever received guidance or training regarding the therapeutic use of sexual attraction to clients, even though some indicated that they would implement, or have implemented, such an intervention. However, participants trained in theoretical orientations that construct the therapy relationship as a therapeutic tool (such as psychodynamic orientations) were much more likely to view their sexual attractions as therapeutically useful than were those trained in other theoretical orientations.