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The inclusion in the Hippocratic oath of a specific injunction against a physician's having sexual relationships with patients indicates that this concern has a venerable history among physicians. Elaboration of these same ethical proscriptions in the current annotated version of medical ethics applicable to psychiatrists confirms that this concern exists into the present.1 Moral outrage is regularly expressed by physicians toward those physicians who, in spite of the ethical restraints imposed by the above-mentioned codes, nonetheless indulge themselves sexually with their patients. Yet the force and sincerity of the call for integrity among physicians2-4 does not appear to have much deterrent effect on that segment of the profession that chooses to have sex with their patients.
How can this ethical stance be reconciled with the increasing evidence that indicates therapist-patient sex may be far more prevalent than previously thought? Writers who have dealt with this topic have comforted themselves and their audiences with the hopeful observation that serious forms of unethical behavior—such as having sex with one's patients—exists only among a few practitioners.5-7 One writer, finding the idea “absurd” that any well-qualified analyst could not refrain from being carried away by physical contact with an attractive patient, commented that such an impulse-ridden person would scarcely be safe on a dance floor.8 The more serious question is whether there are a considerable number of male therapists who are not safe, with women patients, in the consulting room.
The idea that women patients may develop intense sexual feelings toward their male therapists during treatment for psychological illness did not originate with psychoanalysis, although it has been during the past seventy-five years that this relationship, in the metaphor of transference-countertransference, has been extensively studied. Before that, the magnetizers of the eighteenth century were well aware of the e