Sexual Acting-Out in Psychotherapy*

EROTIC transference reactions on the part of patients and problems dealing with seductive female patients have been dealt with frequently in psychiatric and psychoanalytic literature. There has been relatively little written, however, about seductive psychotherapists and counter-transference sexual acting-out. Masters and Johnson make passing references to sexual relations between patients and therapists,5 and more recently Dahlberg1 and Marmor,4 independently have dealt with this issue.

Although no profession involving intimate contacts with clients or patients of the opposite sex is immune to heterosexual temptation, psychoanalysts and psychotherapists are put to the test more often and more stringently than most because, by its very nature, an intensive psychotherapeutic transaction over a long period of time tends to foster a special quality of emotional intimacy.

The erotized idealization of the therapist that often develops in the course of such a transaction can be a heady wine,3 and when combined with a physically attractive patient of the opposite sex, often creates a powerfully seductive mixture.

For his own part, the psychoanalyst or psychotherapist, is himself beset by deeply rooted, often unconscious, needs that tend to foster or stimulate impulses toward physical closeness towards his patients. First, there is the obvious factor of the strength of his own biological needs. These are by no means constant, and will vary in urgency at any point in time, depending on a number of factors such as age, physical health, the satisfactory or unsatisfactory state of his own sex life and marriage, recency of drive satisfaction, and the relative attractiveness and/or seductiveness of his patient. Second, the therapist's psychological need to be a helping figure, (a factor in his choice of profession), is reinforced by the actual needs and dependency of his help-seeking patient. Thus, just as the patient often reacts to the therapist in the transference as a wise, good