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Andrea Celenza has written an informative and thoughtful overview and assessment of the literature and recent research, some of it her own, on transgressors and victims of sexual boundary violations and how to treat this vexing problem in our institutes. Building on the growing conviction, due largely to Gabbard and Lester's trailblazing work (1995), that we are
all subject to the temptations to which some therapists succumb, Celenza, an assistant clinical professor at Harvard Medical School, both broadens and advances our understanding of the problems surroundings erotic encounters and their aftermath. She broadens her scope beyond most previous studies by including the erotic misconduct of other trusted authorities in helping professions characterized by affectively intense asymmetrical dyads—for example, supervisor/supervisee, teacher/student, clergy/parishioner. Sexual Boundary Violations helpfully advances work on this troublesome moral issue by moving beyond the causes of therapist sexual misconduct and the consequences for victims to a concern with preventive, teaching, reporting, and rehabilitation programs. Her own work with sexual transgressors provides insightful clinical illustrations of her main points, notably in chapters 3 and 11, which sketch a composite psychological portrait of a transgressing therapist and his treatment, drawn from her work with over seventy transgressors.
Clearly, the proportion of transgressing therapists and clergy is way too high. Sexual boundary violations are among the most egregious ethical wrongs, because the betrayal of trust is so deep and the psychic harm so long-lasting and significant. Research based on self-reports, which probably underrepresent the true prevalence rate, consistently reveals an unacceptably high incidence rate (7 to 12 percent) of erotic contact between therapists and patients in the U.S. Female therapists, who are more likely to engage in sexual misconduct with female patients, account for only 2