Sex Between Patient and Therapist

The problem of sex between patient and therapist is one which was practically unheard of as recently as ten years ago. Of course there were occasional instances, but these were so rare that most therapists went through their whole professional life without personally encountering one. In any event, there was an underlying basic assumption that this behavior was not only antitherapeutic, but constituted definite evidence of professional incompetence, as well as of moral turpitude and perhaps also psychiatric illness on the part of the offending therapist. Times have changed.

In this paper I shall consider the reasons why we are currently faced with this problem, the theoretical ethical issues, the practical ethical issues, and the challenge to clinicians treating patients who have been previously involved in such situations with former therapists.

One wonders why the incidence is now so much greater than before, and one also wonders whether the increase is real, or only apparent. There is no single answer to these questions, and no way of establishing the facts beyond controversy. Nevertheless, it seems probable that the following three factors have significantly affected the increased reporting of the problem, apart from its actual incidence.

In the wake of the feminist movement, women are less likely than before to assume that whatever their male therapists propose is to be automatically accepted; they are therefore more likely to report incidents of sexual activity than they might have been only