Is it Illegal for a Therapist to Sleep with a Patient?

Before answering the question—is it illegal for a therapist to sleep with a patient, we need to decipher between illegal and unethical. It is ALWAYS unethical for a therapist to sleep with a client. We will address that in a bit. But whether the abuse is illegal depends on what state you live in. Sadly, a little more than half of the states in the U.S. have criminal legislation against therapist abuse or therapist sexual involvement with a patient. Also discouraging, the laws limit therapy abuse to sexual contact only, ignoring the equally damaging emotional and psychological components.

According to Advocate Web, 24 U.S. states have laws making it illegal for a therapist to sleep with a patient. To see where your state stands on this issue, click here: https://amynordhues.com/states-with-laws-outlawing-psychiatrist-patient-and-psychotherapist-patient-sexual-relationships/

Even more complicated, of these 24 states, some do not require criminal background checks. Yes, you heard that correctly. Minnesota, Michigan, Iowa, and Illinois, for example, have laws that make it illegal for a therapist to sleep with a patient, yet they do not require therapists to undergo criminal background checks! This makes no sense.

Finally, many of the states without legislation do require background checks. I suppose a client can learn that the therapist they are about to see is a convicted felon, but they will still be in the dark about whether the therapist has a pattern of exploiting patients in therapy.

It is Illegal for a Therapist to Sleep With a Patient in Some States

Colorado is one of those states. Let’s take a look at Colorado’s Therapist Abuse Legislation which makes it illegal for a therapist to sleep with a patient:

Now let’s review the therapy abuse laws in Florida:

It is Illegal for a Therapist to Sleep With a Patient Even When the Patient Thinks She is Consenting?

It is especially important to note that therapists who engage in sex with clients are considered guilty of a crime even when the clients believe they offered consent. A client in therapy (who holds no power in the relationship) cannot provide consent to the therapist (who holds all of the power). There are so many reasons that a client would feel obligated to say yes to their therapist’s advances and that pressure results in coercion not consent.

Legislators (in half of our states anyway) recognize this fact. The power differential between therapist-client is too great. The attachment too strong. The fear of loss too high. Clients may think they are consenting, but when therapists have sex with clients in Colorado and Florida, for example, they can still be charged with a crime.

Now let’s get back to our distinction between illegal and unethical. When I was abused by my therapist/psychiatrist in 2014, people asked me why he didn’t go to jail. They wanted to know why I didn’t go to the police. Simple. Because what Dr. Dolion did to me is not considered a crime in Oklahoma. In Oklahoma and many other states, as well, it is not illegal for a therapist to sleep with a patient or to be sexually involved in any manner. When I would explain this to people, bewilderment crept across their faces. I would have to reiterate, it is unethical, yes, but where I live what Dr. Dolion did to so many vulnerable women under the guise of Christian counseling is not illegal. Alabama, Delaware, Hawaii, and Indiana are a few more states that allow therapist abuse to go criminally unpunished.

What if it is Not Illegal for a Therapist to Sleep with a Patient in My State?

Victims May Report Abusive Therapists to Regulatory Boards

Are there avenues for justice if the criminal justice system cannot help? Yes. A victim can report to the regulatory board depending on the license the practitioner holds. Psychologists, psychiatrists, licensed professional counselors, and social workers all have their own regulations and regulatory boards. For more on reporting options, click here: https://amynordhues.com/therapist-abuse-what-are-your-options/.

I reported my abuser to the Oklahoma Medical Board because he was a psychiatrist who practiced therapy. Just be aware that although there are many positive reasons to report—justice, standing up for yourself, stopping the offender from hurting others—it can be a very stressful and arduous process. I can say that after a nine-month long investigation, my abuser surrendered his license permanently. But many survivors walk away with less favorable outcomes.

Considering the damage this predator did to so many, he deserved to be registered as a sex offender, but I knew that criminal charges were off the table. One of the investigators from the medical board told me that he thought I might have a strong enough case to prove rape, but several attorneys skilled in therapy abuse told me, “If you file criminal charges, it will be brutal for you and your family, and the perpetrator will likely walk.” No, thank you. I had been through enough.

But I thought you said it was not illegal in Oklahoma? To clarify, in Oklahoma there are no criminal repercussions when therapists have sex with clients. Rape, however, is still a crime, but these attorneys were essentially saying, good luck proving rape and good luck surviving the ordeal. Sad what victims are put through, especially when it comes to the crime of sexual assault.

Malpractice Lawsuits are Another Avenue of Justice Available to Therapist Abuse Victims

So, what did I do? I filed a medical malpractice lawsuit. Be forewarned that many attorneys are untrained in this area which can result in further trauma for victims. Find a lawyer who specializes in abuse of power, namely therapist and clergy abuse. You can find some skilled attorneys on my website, here: https://amynordhues.com/resources/

Filing this malpractice suit provided me with another opportunity to fight for myself, to stand up to the perpetrator, and to seek justice, but any victim can tell you that civil suits are not without their stressors and are not to be taken lightly. After three long years, the suit was successful, and I was glad I fought, but I can tell you that the “win” did not take away the pain and the hurt and the anger. In fact, my healing journey probably began the day that suit ended.

Let’s recap. We have concluded that it is illegal for a therapist to sleep with a patient in some states, and it is unethical everywhere. But because so many people—victims and onlookers alike—get hung up on the idea of a sexual relationship between a therapist and a client being mutual—they’re both adults—I want to look at the ethical guidelines for therapists.

Ethical Guidelines for Therapists Regarding Sexual Contact with Patients

According to the National Board for Certified Counselors, “Counselors will not engage in any form of sexual or romantic contact with a client or former client for at least five (5) years following the date of counseling service termination.”

Michael Kocet, the ACA Ethical Code Revision Task Force Chair states, “The 2005 ACA Code of Ethics continues to recognize the harm that can be impacted upon clients when they are sexually intimate with their counselor. The counseling relationship is one based on trust, so we must respect the power differential inherent in any counseling relationship regardless of the counselor’s theoretical orientation or perspective. Engaging in any type of sexual or intimate relationship with a current client is abuse of power. Clients come into counseling emotionally and psychologically vulnerable and in need of assistance, so a counselor trying to engage in such relationships would be trying to take advantage of that client and their vulnerabilities to meet their own needs.”

Why is it Illegal for a Therapist to Sleep with a Patient?

This is an obvious answer for many of us, but I’m afraid not everyone understands the complexities surrounding abuse of power, especially when it comes to adults. And the mental health profession seems to be an ideal breeding ground for this type of predator.

Issues Involving Consent

As stated earlier, clients in therapy cannot consent to such a relationship. There are many reasons for this. In Therapist-Patient Sexual Contact: A Non Consensual, Inherently Harmful Activity, Dr. Baylis (1993) explains this reality. He says that clients in therapy are not able to understand how this sexualized version of the relationship will affect them and especially the therapeutic alliance. They are also in a vulnerable emotional state and, as a result, are not in a position to make such a decision. He concludes: “At most there can be compliance, submission and acquiescence.” In other words, patients are not able to consent to a sexual relationship with their therapist. At best, they may simply “go along with it.”

He goes on to say, “For consent to be morally valid, there must be an intentional autonomous authorization based on a substantial understanding of the relevant information given in a context that is substantially free of controlling influences (for example, deceit, constraint or coercion).”

Let’s look at each of these factors in more detail:

• Intentionality: Patients in therapy cannot intentionally or willingly choose the relationship because they are in a compromised or a vulnerable state, either due to their underlying psychological issues or as a result of transference. Transference causes patients to idolize their therapists, and, as a result, the lens with which they view the relationship is skewed.
• Substantial Understanding: The client in therapy does not realize that sexualizing the relationship causes the therapeutic alliance to disintegrate. Unable to anticipate this loss, they cannot make a valid choice. Essentially, they don’t understand what they are agreeing to when they allow a therapist to engage them sexually.
• Substantial Voluntariness: Patients in therapy are dependent and emotionally vulnerable, allowing therapists to gain insight into their needs and weaknesses. Therapists may then use this information to manipulate or persuade clients into a sexual relationship. Dr. Baylis notes three ways therapists might pressure clients: “the misrepresentation of sexual contact as therapy; the false promise of an unaffected therapeutic relationship; and the threat of the withdrawal of care.”
• Autonomous Authorization: To count as consent, the client would have to choose the relationship willfully, but by its very nature, the therapist-patient relationship does not allow a client to choose freely because of the constraints we noted above.

Potential Harm to Clients

When therapists violate boundaries by bringing sex into the therapeutic relationship, whether or not the clients want this dynamic or not, clients are almost always harmed. And because clients are clouded to these potential hazards at the time, laws are needed to protect them.

It is also important to note that when a therapist exploits a client sexually, the client is harmed long before the sexual act takes place. Dr. Robert Simon in his article, Psychological Injury Caused by Boundary Violation Precursors to Therapist-Patient Sex, explains this when he says, “the boundary violation precursors of therapist-patient sex can be as psychologically damaging as the actual sexual involvement itself.” Below, Dr. Simon lists some of the psychological damage that clients can experience before the sexual activity even begins.

1. Increased depression and dependency on the provider
2. Loss of the therapeutic alliance
3. Worsening of childhood trauma
4. Clients’ entire world becomes the provider so they become isolated from family and friends
5. Suicidal ideation
6. Loss of employment
7. Mistrust of healthcare providers
8. Illness
9. Increased need for future psychiatric care

Is it Illegal for a Therapist to Sleep With a Patient After Therapy Ends?

It is not illegal. In the state of California, however, it is a crime for a therapist to engage in sexual acts with a patient during therapy, and it is also a crime to end therapy for the sole purpose of pursuing a sexual relationship (with some exceptions-see Professional Therapy Never Involves Sex). Similarly in Florida, the law reads: Any psychotherapist who commits sexual misconduct with a client, or former client when the professional relationship was terminated primarily for the purpose of engaging in sexual contact, commits a felony of the third degree. Legislators in Florida and California, at least, seem to recognize the damage caused when therapists pursue sexual relationships with clients at any stage.

Is it Ethical to Sleep with a Patient After Therapy Has Concluded?

In a Counseling Today article entitled Romantic/sexual relationships, David Kaplan states, “As mentioned earlier, the 2005 ACA Code of Ethics increases the prohibition on sexual and romantic interactions with former clients. The old 1995 code stated that counselors were to avoid sexual intimacies with former clients within two years of termination. The revised 2005 code expands the time frame to five years.”

ACA Ethical Code Revision Task Force Chair, Michael Kocet adds, “While some may see the exact number of years delineated as arbitrary, the reason a ban on sexual/romantic relationships with former clients was increased to five years was that we wanted there to be a little more time for the counselor to be reflective and to give more time for closure of the counseling relationship. It is really important that enough time has passed for the power differential to be resolved. It is also important to recognize that counselors can decide to make the personal choice to never engage in romantic or sexual relationships with former clients even though the ACA Code of Ethics allows one to do so after a five-year waiting period.”

Where Does the American Association of Christian Counselors Stand on the Issue?

According to the article, Christian Counseling Code of Ethics found on the Hope of Survivors website:

1-130 Sexual Misconduct Forbidden
All forms of sexual misconduct, and every kind of sexual exploitation, deception, abuse, or harassment in pastoral, professional or lay relationships are unethical. This includes relations where the sexual involvement is invited or informed consent presumably exists—such apparent consent is illusory and illegitimate.

1-131 Sexual Relations with Former Clients Forbidden
All sexual relations as defined in 1-130 above with former clients are unethical. Furthermore, we do not terminate and refer clients or parishioners, even at first contact, in order to pursue sexual or romantic relations.

In my first-hand experience, the power differential between therapist and client rarely, if ever, equalizes. While waiting five years after the therapeutic relationship has ended is far better than crossing boundaries after two years or heaven forbid, during the therapy process, nothing magical happens at the five-year mark. Trying to merge the relationship into one of equals doesn’t work and usually ends up hurting the one without power, the client.

Renee Fabian explains this in her article, It’s Normal to Have Sexual Feelings for Your Therapist (But They Should Never Have Sex With You), “Keep in mind your therapist is 100% responsible for maintaining an appropriate relationship, which should never include sex. Your therapist also should not cross this boundary after you have ended the therapeutic relationship. The power imbalance doesn’t disappear when the therapy stops.”

A.N. Brodsky says it best: “Father-daughter incest does not become acceptable one year after the daughter has left home. No matter how the therapy contract ends, the imbalance of power of the initial interactions can never be erased.” (excerpt from a 1983 paper given at the APA annual meeting)