SEXUAL RELATIONSHIPS WITH CLIENTS.pptxxs

This PowerPoint presentation explores the critical ethical considerations surrounding sexual relationships between professionals and their clients. It provides a comprehensive overview of why such relationships are deemed unethical and prohibited in various fields, including psychology, counseling, and social work. The presentation covers key topics such as:

Professional Boundaries: Understanding the importance of maintaining clear boundaries to preserve the integrity of the therapeutic or professional relationship.
Ethical Standards and Codes: Reviewing relevant ethical guidelines and standards from professional organizations that address the prohibition of sexual relationships with clients.
Impact on Clients: Examining the potential harm and negative consequences that sexual relationships can have on clients, including emotional and psychological effects.
Legal and Professional Implications: Outlining the legal ramifications and professional consequences of engaging in or being accused of such relationships.
Case Studies and Scenarios: Analyzing real-world examples and hypothetical scenarios to illustrate the complexities and consequences involved.

1. SEXUAL RELATIONSHIPS WITH CLIENTS

2. Prohibition against sexual involvement One of the oldest ethical mandates in the health care professions. Older than the twenty five hundred year old Hippocratic Oath Since 1977 code- no changes in standard. Prohibition remained constant over so long a time, throughout diverse cultures

3. HOW CLIENTS CAN BE INJURED Sexually involved vs not sexually involved CONSEQUENCES Ambivalence Guilt Emptiness and Isolation Sexual Confusion Impaired ability to trust Confused Roles and Boundaries Emotional liability Suppressed Rage Increased Suicidal Risk Cognitive Dysfunction

4. Patterns of Perpetrators and Victims 4.4 percent of the therapists reported becoming sexually involved with a client. Gender difference is significant- 6.8% Male therapists - 1.6% Female therapists PopE ( 1989b)- Therapist-Patient sex resembles other forms of abuse such as rape and incest . Perpetrators-male, Victims-female

5. Patterns of Perpetrators and Victims Holroyd and Brodsky’s report (1977) Male therapists are most often involved Female patients are most often the objects Therapists who disregard the sexual boundary once are likely to repeat

6. Prohibition against sexual involvement Bates and Brodsky (1989)- the most effective predictor of whether a client will become sexually involved with a therapist is whether that therapist has previously engaged in sex with a client. APA Insurance Trust (1190, p.3)- “ The recidivism rate for sexual misconduct is substantial ”

7. Characteristics of 958 Patients who had been Sexually Involved with a Therapist

8. Common Scenarios Pope and Bouhoutsos (1986, p. 4) Role Trading – Therapist becomes the “patient” and the wants and needs of the therapist become the focus Sex therapy- Therapist fraudulently presents therapist-patient sex as valid treatment for sexual or related difficulties. As if- Therapist treats positive transference as if it were not the result of the therapeutic situation.

9. Common Scenarios Pope and Bouhoutsos (1986, p. 4) Svengali -Therapist creates and exploits an exaggerated dependence on the part of the patient. Drugs- Therapist uses cocaine, alcohol or other drugs Rape -Therapist uses physical force, threats, and/or intimidation True love- Therapist rationalizes that attempt to discount professional relationship

10. Common Scenarios Pope and Bouhoutsos (1986, p. 4) It Just got out of Hand- T fails to treat the emotional closeness that develops in therapy with sufficient attention, care and respect. Time Out- T fails to take account of the fact that the therapeutic relationship does not cease to exist between scheduled sessions or outside the therapist’s office. Hold Me- T exploits patient’s desire for nonerotic physical contact and possible confusion between erotic and nonerotic contact

11. Why do Therapists refrain?

12. Confronting Daily Issues Fundamental Theme Ethics is not mindlessly following a list of do’s and dont’s but always involves active awareness, thinking and questioning.

13. Physical Contact with Clients Holroyd and Brodsky (1980) Sexual intercourse with patients is associated with the touching of opposite-sex patients but not same-sex patients It is the differential application of touching -rather than touching per se- that is related to intercourse

14. Physical Contact with Clients Therapist (engaging in physical contact)- Maintain theoretical orientation for which T-C contact is not antithetical, has competence, training and supervised experience in the use of touch. Based on careful evaluation of the clinical needs of the client at that moment the context of any relevant cultural and contextual factors. When not justified by clinical need and therapeutic rationale, nonsexual touch can also be intrusive, frightening .

15. Physical Contact with Clients Unresolved concerns with T-C sexual intimacies Response- Phobically or Counterphobically Phobically - avoiding in exaggerated manner any contact or even physical closeness. Counterphobically - engaging in apparently nonsexual touching as if to demonstrate that we are very comfortable withy physical intimacy and experience no sexual impulses.

16. Sexual Attraction to Patients

17. Sexual Attraction to Patients 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.

18. Sexual Attraction to Patients Research suggests that sexual attraction to a client 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. Consultation and Supervision may be necessary

19. When the Therapist is Unsure What to Do 1. The Fundamental Prohibition 2. The Slippery Slope 3. Consistency of Communication 4. Clarification 5. Patient’s welfare 6. Consent 7. Adopting the Patient’s view 8. Competence 9. Uncharacteristic Behaviors 10.Consultation

20. Working with Patients who have been Sexually Involved with a Therapist

21. Working with Patients who have been Sexually Involved with a Therapist

22. Working with Patients who have been Sexually Involved with a Therapist

23. Working with Patients who have been Sexually Involved with a Therapist Awareness of these reactions can prevent them from blocking the therapist from rendering effective services to the patient. The therapist can be alert for such reactions and sort through them should they occur.

24. Ethical Aspects of Rehabilitation 1 . Competence- Does the clinician possess demonstrable competence in the areas of rehabilitation and T-C sexual intimacies? Method adequately validated through independent studies Rehabilitation methods by which perpetrators are returned to practice pose difficult ethical dilemmas.

25. Informed Consent Have those who are put at risk for harm been adequately informed and been given the option of not assuming the risk, should the rehabilitation fail to be 100 percent effective?

26. Assessment Do the research trials investigating the potential effectiveness of the rehabilitation method meet at least minimal professional standards? For example, is the research conducted independently? Bates and Brodsky, 1989- Perpetrators may continue to engage in sexual intimacies with clients during or after rehabilitation efforts, even when they are supervised.

27. Assessment The abuse may come to light only when client reports it. Yet base rate of such reports is quite low- 5% report the behavior to licensing board 10 clients- 59.8% probability that none of the 10 will file a complaint. 60% chance that these research will appear to validate the approach as 100% affected

28. Power and Trust How are these factors relevant to the dilemmas of rehabilitation? Helping professions must consider ethical, practical and policy implications of allowing and enabling offenders to resume the positions of special trust that they abused. Do Psychotherapy and counseling involve or require a comparable degree of inviolable trust and ethical integrity as the positions of judge and preschool director within the legal and educational fields?

29. Hiring, Screening and Supervising Malpractice Risk management- Screening Procedures and policy implementation

30. Hiring, Screening and Supervising

31. Hiring, Screening and Supervising

32. Sample Scenario

33. Questions to ponder

34. THANK YOU!