Friday, November 30, 2007

No sex please

'No Sex Please, We're British' says the movie/play title. Apparently that's due for an update, with a re-edit to ' No Sex Please, We're Therapists'.

Of course, it's no joke. There are very strict ethical guidelines with regard to therapist-patient relationships. Yet according to psychiatrist Professor Carolyn Quadrio from the University of NSW, one in every ten male therapists will have sex or develop an intimate link with a female client. Between one and three percent of female therapists will do the same.

Maybe I'm naive but these figures really surprised me. Anyone have any thoughts on this?

I understand that in the therapeutic process, particularly in the setting of good rapport and the discussion of often very intimate subjects, the potential for a blurring of boundaries can be great. When the therapist is the one person who has listened, seemed to understand or appeared to care for the patient, patients can come form a close bond with their therapist. This is a situation that requires very careful management.

Professor Quadrio's research is important in that it gives some indicators of the therapists most likely to be at risk of letting things get out of hand - those who were dealing with their own depression or experiencing difficult times and thus vulnerable to the adoring client, bad eggs who "prey" on clients and "ego maniacs". Professor Quadrio explains that this last group are the hardest to identify because these individuals are often highly talented and admired by colleagues and patients alike.

Professor Carolyn Quadrio will present her findings today at the World Psychiatric Association conference in Melbourne. It looks like a very interesting conference with many interesting speakers, including a personal favourite of mine, Professor Paul Salkovskis, who has undertaken extensive work on hypochondriasis/health anxiety (an area of particular interest) and obsessive-compulsive disorder. You may have seen his recent series "The OCD House" on the ABC.

Ah, if only I was in Melbourne...


Psychgrad said...

Wow. That number is higher than I would have guessed. My supervisor was recently telling me about a colleague of his who "prescribed" sex with him as a treatment. Eww (sounds like bad porn). This was decades ago...and I thought most of the unethical behaviour was too. 10%. Wow.

Adiemus said...

Great topic for debate. I can understand how it could develop but hope it never happens to me... It's a good reason not to ever have my personal address/phone available, and to have really good supervision to discuss any potential blurring of boundaries. Especially when feeling vulnerable yourself...
I imagine studying the subject would be fraught with difficulty too - what a challenge to get people to feel free to disclose.

Dr. Deb said...

In the states, I think it is even higher. Most of my doctoral and postdoctoral training emphasized the ethics and morals within this subject. In my analytic community there has been much ado with several therapists as they broke boundaries with patients/supervisees.

Sad, really.

Evan said...

1. Why shouldn't adults sleep with who they want to?

2. Imagine a therapist having an intimate relationship with a client! This is what the relationship is about (I'm pointing out the childish euphemisms).

3. I'm well aware of the dangers of therapists using clients to meet their own needs. My problem is that it's only clients who have had sex with their therapist who are seen as having a complaint. What about the person who goes to a therapist for years and isn't helped. Not a word about this from the professional associations (funny that). Apparently this falls well within the realms of ethical practice! Are these figures of those who complained? If not are there figures on whether those involved regarded the relationship as helpful or unhelpful?

4. There are simple things to be done to remedy this. Make groups the default option instead of individual therapy. Haven't seen any professional associations advocating this. Why not do you suppose.

5. The people who sleep with their clients tend to be older and more senior. It looks like they are educated into this by the current forms of practice doesn't it?

6. I think this is a fascinating and very important topic because thinking about it could lead to us changing the usual way(s) therapy is done. Don't expect to hear proposals from those in professional association who profit form the current set up though.