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Balancing the Power Dynamic in the Therapeutic Relationship

Section 1
Therapist Boundary Violations

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This course primarily deals with balancing power concerning the violation of the personal contact boundary by therapists regarding their clients. The Institute selected this topic as a result of a survey conducted of Professional Licensure Boards in several states. The Boards were asked what ethical area they would select as having the greatest priority.

We, as therapists, would like to think that mental health professionals taking sexual advantage of their clients is a problem that was left far behind in the free love era of the 70's and 80's and in the AIDS awareness of the 90's. One would certainly feel this is not something to be concerned with, especially in this lawsuit prone new millennium. Don't you hear at least one advertisement per night on television from a lawyer pleading you to sue someone about something?

♦ 3 Rationalizations for Sexual Violation
But the truth is many mental health professions rely on a number of rationalizations and assumptions that allow us to maintain certain beliefs about balancing the power in the therapeutic relationship regarding sexual contact boundary. Here are three I've found. See where you fit.
1. Are you thinking, right now, balancing therapeutic power regarding the sexual contact with clients no longer exists?
2. Do you think that the occurrence of this contact is currently greatly exaggerated?
3. Do you think that we are able to, "so to speak," police ourselve, and that clients who complain are treated with dignity and respect?
I feel beliefs that maintain the silence about abuse of patients, clients, residents, etc. perpetuate these rationalizations.

My belief is that understanding is the first step to learning. My hope is that you feel you have a real interest in learning more about this complex and emotionally laden topic. And perhaps the gem, as mentioned earlier, that you might gain from this course is a better understanding of the dynamic of the abuse of power by those in therapeutic roles.

Thus, the content of this course will be divided into two parts. The first part deals with warning signs, risk factors, and stages of recovery. The final part deals with treatment interventions.

Peer-Reviewed Journal Article References:
Alpert, J. L., & Steinberg, A. (L.). (2017). Sexual boundary violations: A
century of violations and a time to analyze. Psychoanalytic Psychology, 34(2), 144–150.

Borelli, J. L., Sohn, L., Wang, B. A., Hong, K., DeCoste, C., & Suchman, N. E. (2019). Therapist–client language matching: Initial promise as a measure of therapist–client relationship quality. Psychoanalytic Psychology, 36(1), 9–18.

Breggin, P. R., & Stolzer, J. (2020). Psychological helplessness and feeling undeserving of love: Windows into suffering and healing. The Humanistic Psychologist, 48(2), 113–132.

Demos, V. C. (2017). When the frame breaks: Ripple effects of sexual
boundary violations. Psychoanalytic Psychology34(2), 201–207

Dimen, M. (2017). Eight topics: A conversation on sexual boundary
violations between Charles Amrhein and Muriel Dimen. Psychoanalytic Psychology, 34(2), 169–174.

Gabbard, G. O. (2017). Sexual boundary violations in psychoanalysis:
A 30-year retrospective. Psychoanalytic Psychology34(2), 151–156.

Hill, C. E., Lu, Y., Gerstenblith, J. A., Kline, K. V., Wang, R. J., & Zhu, X. (2020). Facilitating client collaboration and insight through interpretations and probes for insight in psychodynamic psychotherapy: A case study of one client with three successive therapists. Psychotherapy, 57(2), 263–272.

Pizer, B. (2017). “Why can’t we be lovers?” When the price of love is loss of love: Boundary violations in a clinical context. Psychoanalytic Psychology, 34(2), 163–168.

Roberge, E. M., Weinstein, H. R., & Bryan, C. J. (2019). Predicting response to cognitive processing therapy: Does trauma history matter? Psychological Trauma: Theory, Research, Practice, and Policy.

What is one rationalization some professionals use regarding abuse of the personal contact boundary with clients? To select and enter your answer go to Test.

Section 2
Table of Contents