Mirror Hunger in the Psychodynamics of Sexually Abusing therapists

While the sexual abuse of patients in psychotherapy has unquestionably come out of the closet, little is known of the psychodynamics of those therapists involved (Marmor, 1976; Saul, 1962; Dahlberg, 1970). In point of fact, most of the discussion regarding psychodynamics within these encounters has focused on the patients and the question of their unique vulnerabilities to sexual intimacy with their therapists (Saul, 1962; Chesler, 1972; Finney, 1975; Holzman, 1984; Zelen, 1985). This emphasis seems somewhat unbalanced in view of the depth of our understanding and virtual expectation of erotic transference by patients for their therapists. Indeed, one could argue that the development of the fundamental psychoanalytic concept of the transference and the importance of its interpretation rested on Freud's early twentieth-century encounter with it in its eroticized form (Malcolm, 1981).

The question pursued in this paper is about the sexually abusing therapist: How can we understand the phenomenon wherein a seasoned, well-trained professional, inculcated through training with the concept of the inevitability of the transference and all of its manifestations, is found to be sexually intimate with his female patients? What dynamics lurk within the psychological world of a therapist, whose presumed reason for entering the field is a basic desire to help others, which compel him to run such high legal, professional, and ethical risks and to engage his patients in a manner against their best interests?

An attempt to answer this question will be made with a speculative model based upon (1) established characteristics of therapists sexually intimate with patients and (2) ideas borrowed from the psychoanalytic school of self-psychology.

Available information regarding the characteristics of therapists involved in sexual acts with patients has been well reviewed by Zelen (1985). At the time of the erotic contact the mean age of the almost invariably male