Therapy Harm: A Look at the Research

Research on therapy harm, its prevalence, its repercussions, and its prevention is fairly limited in scope and is rather outdated. However, the studies we do have are vital in helping us understand this insidious form of abuse. For this post, I reviewed therapy abuse studies and journal articles and compiled their findings into the following categories: prevalence, risk factors, damage and healing, reporting, and prevention. I will continue to update this article as I discover more in the literature.

Before getting started, one finding that has proven consistent amongst the research is that male therapists are typically the perpetrators of therapy harm, with female clients being the victims. (see Brodsky, 1989; Gartrell et al., 1986, 1989; Gechtman, 1989; Holroyd & Brodsky, 1977; Pope, 1994) Prevalence studies, for example, indicate that men are the transgressors in 80% of the incidents of sexual boundary violations in the therapy relationship (Garrett, 2002). A study by Becker-Fischer and Fischer done in Germany adds, “The therapists are on average 10-15 years older than their female victims” [3,11,13-16]. While another study done in the U.S. found the offending therapists to be about 12 to 16 years older than the patient (e.g., Bouhoutsos et al., 1983; Holzman, 1984).

This is only one piece of the puzzle, however. Women are frequently abused by female therapists, as well. The reason for this oversight could be that the researchers limited their view of therapy harm to sexual abuse, overlooking the equally damaging emotional and psychological abuse components. In the future, we need studies to include all the ways mental health professionals can abuse clients: sexually, emotionally, psychologically, and spiritually, to name a few. I believe this more extensive study would present a more balanced view of the offenders as being both male and female.

How Common is Therapy Harm?

One of the earliest studies on therapy harm was done by Kardener, Fuller, and Mensh in 1973, and they polled 114 male psychiatrists in Los Angeles. 10% of those psychiatrists admitted to having sexual involvement with patients.

One of the largest studies on this topic was done by Gartrell et al. (1986), and they surveyed a little over 5,500 psychiatrists nationwide. 26% of those selected returned the questionnaire, and 6.4% of them admitted to sex with a client.

According to the article, Prior Therapist-Patient Sexual Involvement Among Patients Seen by Psychologists by Kenneth S. Pope and Valerie A. Vetter:

• Two of the earliest studies done on the prevalence of therapy harm were done using anonymous surveys of a group of psychologists (Holroyd & Brodsky, 1977; Pope, Levenson & Schover, 1979). These survey findings suggest that as many as 12% of male therapists and 3% of female therapists have engaged in sexual intimacies with at least one patient.
• In 1983, Bouhoutsos and colleagues found that about 45% of the psychologists surveyed reported treating patients who had been sexually intimate with a therapist. However, their survey was limited to California, and few psychologists participated.
• Finally, Pope & Vetter asked 1,320 psychologists nationwide if they had treated a patient who had been sexually involved with a therapist, and about half of the psychologists responded. Of those 654 who answered the survey, about 50% (or 323 psychologists) reported working with at least one patient who had been sexually intimate with a prior therapist. In total, 958 sexual intimacy cases were reported. (It is important to note that a majority of these cases involved female patients, most of the abuse took place while the therapeutic relationship was ongoing, and most of the women experienced harm as a result. Harm was also reported when the sexual interaction took place after therapy had terminated.)

According to Dr. Andrea Celenza in her article, Sexual Boundary Violations: Therapeutic, Supervisory and Academic Contexts, 9%-12% of mental health professionals admitted in surveys that they’d had sexual contact with a patient, but she suggests that number is higher because the data was collected via anonymous self-report questionnaires.

Another article, entitled Sexual violence perpetrated by health professionals states:

• Approximately 16% of male professionals and 3% of female professionals confessed to having sex with their clients (Pope et al., 1979; Borys and Pope, 1989).
• A different study focused on 1,000 clinical psychologists, and it showed that 3.6% of them had been involved sexually with a client. Furthermore, 22.7% of the psychologists polled stated they had worked with patients who were victims of sexual violence by a mental health professional. 38% of participants revealed knowing a psychologist who sexually abused a patient (Melville-Wiseman, 2012).
• Studies conducted in the U.S. and Canada in the 1990s found that about 10% of psychotherapists were sexually intimate with patients during their careers. The results were similar among physicians from other non-mental health fields (Gartrell et al., 1992).

In National Survey of Psychologists’ Sexual and Physical Abuse History and Their Evaluation of Training and Competence in These Areas by Pope and Summers, which looked at licensed California psychologists, it was shown that:

• About 45% of the licensed California psychologists polled reported working with at least one patient who had been sexually involved with a prior therapist; about 90% of these sexually abused patients were women (Bouhoutsos, Holroyd, Lerman, Forer, & Greenberg, 1983).

Sexual Attraction to Clients: The Human Therapist and the (Sometimes) Inhuman Training System by Pope et al. notes:

• Forer, in an unpublished 1968 survey (B. Forer, personal communication) of the members of the Los Angeles County Psychological Association, found: 17% of the males who were in private practice reported sexual involvement with a client.
  • In the 1990 article, Therapist-Patient Sex as Sex Abuse: Six Scientific, Professional, and Practical Dilemmas in Addressing Victimization and Rehabilitation, Pope points out a disturbing reaction to Forer’s findings when he states: “On October 28, 1968, having reviewed his research data with organizational leadership, the Board of Directors decided to prohibit disclosing the findings either at professional conventions or through journal publication (an interesting decision in light of the mandate of the American Psychological Association’s [APA’s] Ethical Principle 1 a that psychologists never suppress data disconfirming their favored hypotheses; APA, 1981), maintaining that it was ‘not in the best interests of psychology to present it publicly’” (B. Forer, personal communication, November 1984; see also Forer, 1980)
• Holroyd and Brodsky (1977) found that 7.7% of their sample of psychologists who were providing psychotherapy said they had been intimate with clients during treatment (pp. 847-848).
• Pope, Levenson, and Schover (1979) looked at therapy harm and found that 7% of their sample of psychologists conducting psychotherapy reported engaging in sexual intimacies with their clients.
• “Previous research has suggested that of therapists who become sexually involved with a client, 75% to 80% do so repeatedly; one therapist was reported to have been involved with over 100 clients” (Pope & Bouhoutsos, 1986; Pope, 1994; 2000; Pope & Vasquez, 1999).
• However, in the current study, of those who engaged in sexual intimacies with their clients, 86% did so once or twice, 10% did so between 3 and 10 times, and only one psychologist (female) reported a frequency of over 10 times. 

Vinson’s (1987) article, Use of complaint procedures in cases of therapist–patient sexual contact demonstrated how widespread therapy harm is when it states:

• “In 1982 there were 31,300 licensed psychotherapists in California, and if one projects that approximately 7% of the total, or 2,200 therapists, have sexually abused a patient, and some of those have abused several patients, then one could expect there to be around 6,000 patients who have been harmed in therapy.”
• Yet, that same year, the California boards only reported 12-16 therapists who received some form of disciplinary action.

MacIntyre, M. and Appel, J. (2020) note that in one study, 80 percent of psychologists who had intimate relationships with patients reported encounters with multiple patients. When pooling the data from multiple studies of the prevalence of sexual relationships between all types of psychotherapists (psychologists, social workers, and psychiatrists), 7 percent of male providers and 1.5 percent of female providers have had sex with at least one patient.

A study of Christian counselors noted 2% of counselors admitted to sexual contact with a patient, and 6% admitted to sex with a former client. (McMinn & Meek, 1996; 1997)

Risk Factors for Therapy Harm

Therapy Educators Abusing Their Students

Research by Pope, Levenson, and Schover (1979) published in the article, Sexual Attraction to Clients: The Human Therapist and the (Sometimes) Inhuman Training System revealed that:

• Throughout the U.S., 10% of the students in psychology graduate training programs had sexual involvement with their teachers and clinical supervisors.
• 1 out of every 4 recent female graduates had engaged in such sexual relationships.
• 13% of the educators were sexually involved with their students and supervisees.
• Only 2%, however, thought this sexual involvement was beneficial (Pope, Schover, & Levenson, 1980).

This begs the question: When students are taken advantage of by their educators, are they more likely to perpetuate therapy harm themselves? More research is needed on this subject, but the initial research by Pope, Levenson & Schover (1979) suggests that there is a correlation.

• 23% of the female students who had sexual contact with their educators in graduate school reported later sexual contact with clients, while only 6% of those who had no sexual involvement with their educators in graduate school noted sexual contact with clients.
• Male students were also sexually exploited by educators in grad school, but the sample was too small to determine a correlation between that experience and future sexual contact with clients.

In Sexual Intimacy in Psychology Training: Results and Implications of a National Survey by Pope, Levenson, and Schover (1979), researchers studied sexual intimacy between counseling students and their professors, and they found:

• 12% of the psychology teachers, 4% of the supervisors, and 3% of the administrators reported sexual contact with their students. These figures may be compared with the 7% of psychotherapists in the current survey who reported such sexual contact with their clients and with the 7.7% in a previous survey of those psychologists “who answered positively any of the questions regarding erotic-contact behaviors or intercourse during treatment” (Holroyd & Brodsky, 1977).

The Desire to Protect Their Own

In Sexual Intimacy in Psychology Training: Results and Implications of a National Survey by Pope, Levenson, and Schover (1979), researchers studied sexual intimacy between counseling students and their professors, and they found a tendency among practitioners to protect their colleagues and their profession. They point out:

• Providers feel torn between advocating for victims of therapy harm and their personal concern for keeping insurance premiums low by preventing these cases from going to court.
• A former president of the American Psychiatric Association and current professor of law and psychiatry at Harvard, for example, wrote that “we should all realize that there is a serious conflict of interest between APA’s [American Psychiatric Association’s] professional concerns for the victims of sexual exploitation in therapy and its financial concerns when the associations’ economic interests are at serious risk” (Stone, 1990, p. 26).

The Therapeutic Environment

The study, Sexual Boundary Violations: A Century of Violations and a Time to Analyze, points out that the therapy setting and the relationship between therapist and client are an environment conducive to sexual violence by professionals. It goes on to say that the issue of transference is one of the main reasons clients remain quiet and struggle to report the abuse (Alpert and Steinberg, 2017).

In The Harmful Effects of Psychotherapy (2019), Jean Knox points out the inherent dangers of transference:

• “Berk and Parker (2009) suggest that psychodynamic psychotherapy carries particular dangers in this respect, arising out of the focus on the transference, with its inevitable parent–child dynamics, which can make the patient feel inadequate and frail compared with the seemingly mature and ‘adult’ therapist.”

Therapy can be hugely successful, but we can’t ignore the inherent risk. In the case of an abusive therapist, any future reporting by the client will be a “he said, she said” scenario with zero witnesses. Not to mention, the client, with or without a mental illness diagnosis, would likely be up against an older, seasoned professional who could be well-loved in the community.

In 2014, I reported my exploitative psychiatrist. He had been in practice for 36 years and maintained an unblemished record at the medical board. He had also received an APA Outstanding Psychiatrist Award at some point in his career. Yet, he was secretly abusing vulnerable patients for his own sadistic pleasure. Fortunately, he was investigated and found guilty and lost his license permanently in my state, but many reported therapy abuse situations do not have positive outcomes.

The Therapeutic Method

Another risk factor for therapy harm is the type of therapy itself. In the article Sexual violence perpetrated by health professionals, it states: “Some theoretical models allow for greater proximity with the patient. For example, a psychoanalyst may consider an out-of-office consultation inappropriate, whereas a behaviorist may request the context/environment as a therapeutic setting (Gutheil and Gabbard, 1993; Smith and Fitzpatrick, 1995), and the psycho dramatists use physical contact in specific situations in the dramatization stage” (Hudgins, 2022).

Bioenergetics therapy, founded by Dr. Alexander Lowen, was a therapy I encountered in 2003 and is a modality I would use with caution. While it can provide great benefit due to its use of frequent physical contact with the therapist and an attempt to access emotion through a focus on the body, this same benefit comes with great risk. In the hands of an inexperienced or unethical therapist, this physical contact between therapist and client can cause dependency and harm. Miray Kayacan describes it this way: “Therapeutic touch is a tool that requires cautious limits and a well-established approach as it can cause some unintended harm to some” (Phillips, 2002).

The Mental Health of the Provider

Jackson & Nuttall’s 2001 study analyzed therapists’ background of childhood sexual abuse and the likelihood they would go on to abuse their patients. They found that therapists who were abused as children were more likely to sexually abuse their patients.

Gary Schoener (1995) writes in Assessment of Professionals Who Have Engaged in Boundary Violations that he and John Gonsiorek looked at hundreds of therapy harm cases and developed a typology for offenders. These were the categories they found most often:

1. Psychotic and severe borderline disorders: Difficulty maintaining boundaries as a result of issues surrounding impulse control and thinking. This could include practitioners who go off medications for mania.
2. Sociopaths and severe narcissistic personality disorders: Self-centered predators who exploit as it benefits them.
3. Impulse control disorders
4. Chronic neurotic and isolated: Emotionally needy people who look to their clients for unmet needs.
5. Situational offenders: Personal life crisis causes a lapse in judgment.
6. Naive: Deficits in social awareness.

Damage Caused by Therapy Harm and Subsequent Healing

According to the study, Prior Therapist-Patient Sexual Involvement Among Patients Seen by Psychologists by Kenneth S. Pope and Valerie A. Vetter:

• Holroyd and Bouhoutsos (1985) found that therapists who reported sexual contact with clients minimized the damage it caused. This is not surprising.
• A study by Gabbard in 1989 pointed out the fact that the harm caused by therapist-patient sexual involvement can be delayed for months or even years before it is recognized. Luckily, courts are beginning to recognize that there may be issues with the statute of limitations as a result of this delay. “Indeed, what evidence there is in the record suggests [plaintiffs] injury did not occur at the time of the alleged sexual relations…. [Plaintiff’s] description of delayed symptoms is consistent with the view of clinicians who have described the injury caused by patient-therapist sexual relations as posttraumatic stress.” (Mason v. Marriage and Family Center, 1991, p. 3071).

Sexual assaults in therapeutic relationships: prevalence, risk factors and consequences by Eichenberg et al. (2010) explains that patients claimed it was the therapists who initiated sexual contact. They also found:

• In around 86.5% of the cases, sexual involvement between therapists and clients resulted in serious damage to the clients. The findings emphasized different feelings and symptoms precipitated by the sexual violence, including “(…) mistrust, isolation, feelings of shame and guilt, fear, depression and suicidal tendencies, anger and symptoms of post-traumatic stress disorder” (Eichenberg et al., 2010, p. 1,019).
• Additional symptoms included: anxiety, addiction, regression, and depersonalization. Uncontrolled spending, poor time management, as well as recollection of some previously repressed memories/feelings, were also reported after sexual abuse by a therapist (Hook and Devereux, 2018).

Another study suggests that “regardless of the strategy and/or behavior used by the perpetrator during the sexual violence, it causes significant harm to both the patient and the therapeutic relationship” (Alpert and Steinberg, 2017).

Psychotherapy outcomes are not always positive. Approximately 40–60% of patients do not reach a recovery criterion (Fisher and Durham, 1999; Gyani et al., 2013; HSCIS, 2018) and between 5% to 8.2% have a negative outcome, with worse mental health at the end of therapy than at intake (Barkham et al., 2001; Hansen et al., 2002).

According to Intimate attractions and sexual misconduct in the therapeutic relationship: Implications for socially just practice by Michael Capawana, Pope (Citation 2001):

• The most common reactions that are frequently associated with therapy harm or therapist–client sex are: ambivalence; cognitive dysfunction; emotional lability; emptiness and isolation; impaired ability to trust; guilt; increased suicidal risk; role reversal and boundary confusion; sexual confusion; and suppressed anger (Pope, Citation2001). It is important to note that he compares these symptoms to those experienced after incest or rape.
• A majority of clients surveyed reported sex with therapists as damaging; even those who found it pleasurable at first, eventually viewed it as exploitative (Koocher & Keith-Spiegel, Citation2008).

Because sexual abuse seems to be the only type of therapy harm studied, it is important to note that the psychological harm caused to the client precedes the sexual abuse that follows. In other words, once the therapeutic relationship has deteriorated into a sexual relationship, the damage to the client has already been done.

• Dr. Robert Simon (1991) says it best: “The psychological boundary violation precursors of therapist-patient sex can be as psychologically damaging as the actual sexual involvement itself.” He goes on to say that even if sex had never occurred, the harm to the patient was already done.
• In addition, Simon lists some of the psychological trauma that the clients experience simply from the grooming process itself, a precursor to the sexual abuse:

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

Healing for Patients Harmed in Therapy

According to Prior Therapist-Patient Sexual Involvement Among Patients Seen by Psychologists by Kenneth S. Pope and Valerie A. Vetter:

• The treatment for therapy harm may prove challenging as 14% of the patients previously abused by therapists attempted suicide, 11% required hospitalization (the same percentage that were reported to have required hospitalization in the pioneering California study by Bouhoutsos and her colleagues [1983]), and only 17% of those who were harmed were reported to have recovered completely at least by the time this study concluded.
• More education is needed both in graduate schools and in continuing education so that mental health professionals can be equipped to successfully treat therapist abuse victims. Only 15% of the psychologists who participated in this study noted that they were adequately prepared to handle these cases as a result of their graduate training.

It is key, then, that mental health professionals educate themselves on therapy harm so that they can successfully treat therapy abuse survivors who come to them for help. Failing to do so can result in further trauma for the victims.

Finally, Joyce L. Smith in her article Boundary Violations and Subsequent Treatment writes: According to Wahlberg (1997), in her work as the founder of Therapy Exploitation Link Line, after a client recognizes the harm, healing takes at least 3-5 years. Having experienced therapy harm myself, I can attest to this timeframe.

Why Victims Fail to Report Therapy Harm?

Fear of Further Victimization

According to the study, Prior Therapist-Patient Sexual Involvement Among Patients Seen by Psychologists by Kenneth S. Pope and Valerie A. Vetter:

• Prior research has noted several reasons why therapy-harm victims fail to report their abusers:
  • Not recognizing that therapist-patient sexual involvement was wrong according to the ethical standards of the profession (Vinson, 1984)
  • The feeling that their reports will be disregarded (Bouhoutsos et al., 1983)
• About 12% of the victims in the study went on to file formal complaints with licensing boards or ethics committees, and many reported that they were further harmed by the reporting process. I can attest that while filing a civil suit against my abusive psychiatrist brought me some semblance of justice and healing, it was almost as stressful and damaging as the abuse itself.

In Sexual Violence Perpetrated by Health Professionals, it reads:

• Pioneer studies from the 1990s (Plaut, 1997) show that most cases of sexual violence perpetrated by health professionals are not disclosed by clients/patients (Krahé, 2016).
• One major reason for this lack of reporting is the fear and likely realization that they will be discredited if they try to tell.
• Also, Krahé (2016) points out the almost non-existence of civil liability insurance covering sexual exploitation. However, when I filed a civil malpractice lawsuit against my abusive therapist in 2014, sexual misconduct amongst physicians (psychiatrists) was so prevalent that most doctors had sexual misconduct clauses in their insurance, which paid such tiny amounts that it made filing a sexual misconduct claim almost pointless.
• Finally, the study showed that clients rarely receive justice upon filing a report (Ventura, 2018).

Recognizing the Relationship as Abuse

Also in Sexual Violence Perpetrated by Health Professionals, we learn that:

• The fact that sexual violence does not always start with more obvious sexual behavior, such as sexual intercourse, also makes it difficult for the victim to report it (Fávero et al., 2022).
• It might start in a more subtle way and only when it becomes more evident does the victim realize it and, then, feels simultaneously ashamed and afraid that people will question them as to why they did not notice the situation before and report it (DuBois et al., 2019).
• In addition to this, victims are up against victim blaming as our society tends to blame victims and support abusers (Krahé, 2016). It’s no wonder, then, that many survivors fail to disclose. And often when they do come forward, they are met with judgment and criticism, causing a retraumatization (Krahé, 2016). This secondary victimization can lead to a decrease in self-esteem and emotional commitment (Costa de Souza et al., 2013). Many cases of sexual violence perpetrated by health professionals remain hidden, leaving the perpetrators unpunished (Krahé, 2016).

Flaws in the Reporting Process

According to the study, Prior Therapist-Patient Sexual Involvement Among Patients Seen by Psychologists by Kenneth S. Pope and Valerie A. Vetter:

• Prior research has noted several reasons why therapy-harm victims fail to report their abusers:
  • Not being able to find the appropriate licensure board (Center for Public Interest Law, 1989)
  • And subsequent treating therapists discouraging clients from reporting to protect colleagues (Gartrell et al., 1987).
• As previously stated, about 12% of the victims in the study went on to file formal complaints with licensing boards or ethics committees, and many reported that they were further harmed by the reporting process. I found this to be true when I reported my abusive psychiatrist.

In Boundary violations in therapy: the patient’s experience of harm, Hook & Devereux note that mental health providers’ responses to allegations of abuse are frequently “dismissive, disrespectful and frankly abusive” (Devereux Reference Devereux, Subotsky, Bewley and Crowe2010). The article discussed how clients who reported their abusive therapists found themselves labeled or “diagnosed with new conditions such as borderline personality disorder or erotomania.” It went on to say that these clients who spoke out later found themselves referred to in their clinical notes as “delusional” or “serial complainers.” When I reported my abusive psychiatrist in 2014, I learned from some of the abuser’s colleagues that he labeled me “delusional” and said that “I had imagined it all.” Likely story.

Therapy Harm Prevention

Recognizing the Limitations of Rehabilitation

In Therapist-Patient Sex as Sex Abuse: Six Scientific, Professional, and Practical Dilemmas in Addressing Victimization and Rehabilitation (see Pope, 1990b; Pope & Vasquez, 1998), Pope points out that a therapist who has so gravely mishandled his or her position of power should not be allowed to return to that same position even after paying a penalty or undergoing some form of treatment just like a convicted child abuser, after prosecution and punishment, should not be allowed to open a daycare.

• Kenneth Pope states: “Violation of a clearly understood prohibition against such a grave abuse of power and trust precludes further opportunity to hold these special positions in the legal or educational professions, although numerous other opportunities in law or education … remain available to the rehabilitated perpetrator.”
• Another study done by the California boards says: “…in cases involving therapists who became sexually intimate with a patient, ‘prospects for rehabilitation are minimal and it is doubtful that they should be given the opportunity to ever practice psychotherapy again’” (Callanan & O’Connor, 1988, p. 11).

Treating Victims of Therapist-Patient Sexual Involvement by Pope & Sonne (1991) points out:

• Clearly, allowing perpetrators to return to practice after therapy-harm was committed negatively impacts victims (Sonne & Pope, 1991). It is interesting to note that research has shown that sexually abusive therapists are more likely to treat patients who have been harmed by a therapist in the past. In 1987, Gartrell and colleagues found that repeat offenders were more likely than non-offenders to see victims of therapist abuse in their practice (p. 289).
• Patients who were harmed by a therapist and later treated by offenders who are undergoing rehabilitation are at great risk for re-victimization. In addition, supervision or monitoring of these offenders has proven to be ineffective in protecting patients from further harm (see Pope, 1990b; 1991, 1994; Sonne & Pope, 1991).
• The executive directors for the licensing boards for psychologists, social workers, marriage and family counselors, etc. in California (which has had the largest number of perpetrators and so has the most experience with a variety of rehabilitation techniques) stated that, “in cases involving therapists who became sexually involved with a patient ‘prospects for rehabilitation are minimal and it is doubtful that they should be given the opportunity to ever practice psychotherapy again.’” (Callanan & O’Connor, 1988, p. 11).
• The article goes on to say that it is virtually impossible to test if these supposed rehabilitation programs are even working, leaving subsequent patients at risk. I love how Bates and Brodsky put it as a result of their research: “The best single predictor of exploitation in therapy is a therapist who has exploited another patient in the past” (p. 141). What is the phrase? When somebody shows you who they are, believe them.

Research by Celenza & Gabbard (2003) contradicts this, however. In Analysts Who Commit Sexual Boundary Violations, Celenza & Gabbard analyze abusive therapists and the possibility of rehabilitating them. They explain that most cases of therapist-client sexual exploitation do not fit the “untreatable” psychopathic profile.

• They go on to say that “Schoener et al. (1989) have found, as we have, that a myriad of complex factors go into sexual misconduct and that psychopathic predators constitute a minority of transgressors.” Gabbard worked with over 150 therapists who were sexually intimate with clients, and fewer than 25% were psychopathic or narcissistic predators.
• The article explains that predators abuse multiple victims, but Gartrell et al. (1987) found that 66% of the therapist abuse cases they looked at involved only one victim.
• While this study suggests that most abusive therapists are a good fit for rehabilitation, they do admit that rehabilitation can not take place until the abuser takes full responsibility for the transgression and feels genuine remorse.

Therapist-Patient Sex as Sex Abuse: Six Scientific, Professional, and Practical Dilemmas in Addressing Victimization and Rehabilitation (1990) by Pope describes a more pessimistic view of therapist rehabilitation.

• “Neither education nor psychotherapy has shown any evidence in published research studies of inhibiting sexual abuse of patients, and according to some studies, they actually appear to be positively associated with tendencies to abuse” (Pope, 1990).
• “For example, a national study of psychiatrists revealed that ‘offenders were more likely [than nonoffenders] … to have completed an accredited residency …, and to have undergone personal psychotherapy or psychoanalysis’” (Gartrell et al., 1989, p. 7).
• Another study that looked at social workers showed the same thing—undergoing personal therapy was not linked to lower rates of sexually abusing patients. Even worse, abusers were more likely than non-abusers to have completed the extra requirements needed for inclusion into the National Academy of Certified Social Workers (Gechtman, 1989).
• Again, in the field of psychologists, the more highly skilled and educated psychologists abused clients at a higher rate than their lesser-trained counterparts (Pope & Bajt, 1988).
• Lanyon (1986) suggests that high educational accomplishment and professional status may help abusive psychologists avoid detection and contribute to a sense of privilege and superiority that allows them to consider themselves above the law.

Lack of Education Surrounding Sexual Attraction Toward Clients

Another risk factor for therapy exploitation is the lack of awareness and discussion surrounding therapists and sexual attraction to clients.

• Many therapists experience sexual attraction to clients, and this needs to be addressed among mental health professionals. (Pope, Keith-Spiegel & Tabachnick, 1986; Pope, Sonne, & Holroyd, 1993) In addition, the concept of therapists having sexual fantasies about patients needs to be discussed Pope et al., 1986; Pope, Tabachnick & Keith-Spiegel, 1987).

A 1992 article by Strasburger, Jorgenson & Sutherland suggests that part of the therapist’s education should include information on: boundary violations, the power imbalance that exists between therapist and client, and the potential for sexual exploitation. Professional and ethical standards should be reviewed, as well as the damage they cause a client when these standards are not upheld. They also point out that many practicing therapists have not been trained in the sexual exploitation of patients, and continuing education is necessary to make this happen.

In Understanding Transference and Countertransference: Risk Management Strategies for Preventing Sexual Misconduct and Other Boundary Violations
in Social Work Practice, Ann A. Abbott Berkman et al. (2000) asked 349 students during the final semester of their MSW education what they thought about sexual contact with clients, as well as their academic preparation for this subject. Sadly, 35% of them stated that their training was lacking when it came to recognizing and dealing with their personal sexual attraction to clients, almost a half of the students admitted they did not know how to handle sexual intimacy with clients, and an even bigger percentage (61.7%) indicated that they would not know what to do if sex was ever initiated by a client.

Recognizing Therapist-Client Sex as Abusive

Sexual Violence Perpetrated by Health Professionals points out that:

• Some practitioners believe sexual intercourse between a psychiatrist (or doctor) and the patient can have therapeutic benefits, while others don’t even see it as sexual violence (Dahlberg, 2014).
• They also describe the importance of quality supervision as well as a needs assessment for job applicants (Faulkner and Regehr, 2011).
• Finally, they discovered that researchers had little interest in looking at sexual violence perpetrated by doctors (psychiatrists). As stated by Dahlberg (2014), this is a known topic among other researchers, however, it has been left out of the literature for a long time.

More education is needed so that potential clients coming into therapy know what to expect and so they are more likely to spot abusive scenarios. The Minnesota State Task Force on Sexual Exploitation by Counselors and Therapists discovered that one of the main reasons clients get exploited is that they are not aware of what to expect in therapy. As a result, they trust the therapist knows best.

Addressing the Issue of Abuse in Counseling Graduate Programs

National Survey of Psychologists’ Sexual and Physical Abuse History and Their Evaluation of Training and Competence in These Areas explains that:

• A subsequent survey of female psychologists showed that student-teacher sexual contact was quite common (17%) and that, in hindsight, women believed that they were negatively affected by such contact (Glaser & Thorpe, 1986).
• Most participants believed that student-educator sexual contact was unethical regardless of whether it occurred during (96.2%) or outside (72.8%) of the working relationship.
• Only 2.5% of the participants believed that such involvements were not at all coercive if they occurred in the working relationship; only 17% believed involvements were not at all coercive if they occurred outside of the working relationship.
• Finally, as noted earlier, a national survey of clinical and counseling psychologists indicated that only 15% believed they had received adequate training in school to assist patients who have been exploited by therapists. (Pope & Vetter, 1991).

Pope, Levenson, and Schover (1979) found that 17% of the female respondents and 3% of the male respondents reported sexual contact with at least one of their educators; however, Pope et al. did not obtain any information about whether those contacts were experienced as abusive. For female students, these relationships were later connected to sexual involvement with patients.

Therapy Harm: Final Thoughts

Regardless of the findings, we as a society have a long way to go in understanding the complexities and insidious nature of therapy abuse. Statistics barely touch the surface of the immense damage caused when a mental health professional chooses to use their power to harm a patient.

Advocates like me will continue to shine a light on this barbaric misuse of power. Hopefully, researchers will begin to take note so that the underlying systems can change, and we can better protect those who seek help for their mental health.