Sexual Exploitation in Professional Relationships: edited by Glen O. Gabbard, M.D.,  American Psychiatric Press, Washington, D.C., 1989,  224 pp., $31.50.

This book covers every conceivable aspect of sexual relations between therapist and patient, as well as between other professionals and their clients or patients, with whom a fiduciary relationship has been established. The book reports whatever is available on the incidence and prevalence of this phenomenon and attempts to understand the meaning of it from a number of viewpoints; it also contains some suggestions on the individual and group treatment of people who have been thus abused. The tone of the book is an unqualified condemnation of sexual intimacies of any kind between professionals and their clients or patients, on moral, ethical, and legal grounds, and it is a firm insistence that such intimacies are invariably harmful to the patient or client, although the data to prove such harm remains somewhat equivocal. There is nothing equivocal about the insistence that there is no excuse whatsoever for such behavior on the part of any therapist or professional with a patient or client.

In this review I will concentrate on Gabbard's description of the dynamics of the “lovesick therapist,” an area of special interest to psychoanalysts. In brief, he describes the therapist who has fallen in love with his patient (in Gabbard's experience it is usually a male therapist and female patient) as follows. A male middle-aged therapist gets sexually involved with a female patient an average of 16.5 years younger than he is. They have a great need for each other's presence. Intrusive thoughts of the loved one force their way into the therapist's dream and waking life, and the same is true for the patient. The therapist tells himself this is something so special that it transcends all ordinary ethical and professional rules. The basis of it is not oedipal but preoedipal, for it is primarily dyadic, writes Gabbard.

The therapist is sometimes in a “drugged” or dreamlike state when with his loved one and so takes extraordinary risks with her in terms of damaging his career, incurri