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Section 7
Responding to Client Sexual Behaviors

Question 7 | Test | Table of Contents

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In the last section, we discussed training supervisees in ten steps that can help a therapist cope with a client who might be at risk for suicide.

In this section, we will discuss sexual attraction to clients, and determining appropriate levels of nonsexual physical contact with clients. You might consider playing this section for your clinical supervisee early in your supervisor relationship, as a means to open the discussion, should issues arise later.

I find it beneficial to provide my supervisees with the following statistics regarding sexual attraction towards clients. You might consider playing this section during one of your sessions.

As you may be aware, sexual attraction to clients is a common occurrence. A national study by Pope found that 87% of therapists reported that they had experienced attraction towards a client during their practice. The study found that this was more commonly experienced by male therapists, 95% of whom experienced attraction to a client. Attraction to clients was also common among female therapists, 76% of whom had at one time felt attracted to a client.

However, 82% of these therapists reporting an experience of attraction noted that they had never seriously considered engaging in sex with that client. I find by providing this information up front, at the beginning of the supervisor relationship, the topic becomes less taboo and the door has been opened for future discussion.

Pope’s study also found that 63% of therapists surveyed who felt attraction to a client felt guilty, anxious, and confused because of the attraction. Because of this, one fifth of the therapists kept the attraction a complete secret, and did not mention the attraction to the client, to their supervisor, or to their own therapists. However, over one fourth of these same therapists reported having sexual fantasies about the client while engaging in sex with someone else. 

♦ Helping Supervisees Deal with Sexual Attraction to Clients
Pope’s study also found that the topic of sexual attraction towards clients was largely absent from graduate school, internship, and supervision for the therapists in his study. Only 9% of those surveyed believed that they received appropriate education and preparation on the topic of attraction to clients.  

I feel that it is an ethical responsibility of supervisors to provide training regarding attraction to clients.  To enhance training regarding attraction to clients, I try to ensure that the supervisory relationship is a safe and supportive environment in which these issues can be disclosed and discussed. I also feel that it is important to tell my supervisees that it is not unethical to feel attracted to a client, and is in fact a common experience. What is an important ethical responsibility is to acknowledge and address the attraction right away, to act carefully, and to take appropriate action to address the issue thoroughly.

3 Mechanisms for Helping Supervisees Deal with Sexual Attraction
-- #1 Consultation through supervision,
-- #2 Increasing formal supervision of the interaction with the specific client, and
-- #3 For the therapist to enter or reenter counseling.

I also feel that it is necessary to discuss the issue of physical-contact-with-clients with my supervisees. As you know, many therapists go to great lengths to ensure a complete absence of physical contact with their clients, in case a physical touch might be misinterpreted. Take a few seconds to assess where you are at regarding physical contact with your clients.

♦ Appropriate Physical Contact
One question I find my supervisees ask frequently is whether there is a correlation between the nonsexual touching of clients and the occurrence of therapist-client sexual intimacy. A study by Brodsky (Brode’-skee) found no indication that nonsexual physical contact with clients made physical sexual intimacy more likely. This study did find, however, that sexual intercourse with patients was associated with therapists who would engage in physical contact with opposite-sex patients, but not engage in physical contact with members of the same sex.

I also feel that it is important to discuss openly with my supervisees what may be considered appropriate physical contact with clients. Of course, it is important first to become familiar with state or organizational regulations regarding physical contact. Outside of these guidelines, I explain to my supervisees that there are three conditions for determining whether therapist-client physical contact is appropriate.

3 Conditions for Determining if Physical Contact is Appropriate
-- #1 If the therapist is personally comfortable with engaging in nonsexual physical contact,
-- #2 If the therapist maintains a theoretical orientation in which therapist-client contact is appropriate, and
-- #3 If the therapist has competence through training and supervised experience in the use of touch.

If these conditions regarding the appropriateness of physical contact with clients are met, then the decision, clearly, hinges on the clinical needs of each individual client at a particular moment. I explain to my supervisees that, when rational and based upon clinical needs, touch can be caring, reassuring, and healing for a client.

Obviously, when not based upon clinical needs, even nonsexual touch can be experienced by the client as intrusive, demeaning, or even frightening. However, I realize many agencies have a no-touch policy, which may have legal precedence in your state due to specific client-therapist sexual harassment litigation.

I have found that many clinical supervisees who have in the past not had a chance to discuss and explore the issues of nonsexual touch and sexual attraction to clients react in two distinct ways. Here’s an example. My supervisee Danielle’s unresolved concerns over client-therapist sexual intimacies resulted in her avoiding any contact or physical closeness or proximity with her clients, often in an exaggerated manner.

Via a two-way mirror observation, I noted Danielle’s unusual distance from the client as she would clearly step far away in seeing her to the door, so as to stay greater than an arm’s-length away from her client. You might even say Danielle reacted in a phobic sort of fear.

However, my supervisee Trisha reacted counterphobically.  By that, I mean Trisha overcompensated for her fear of client contact.  I observed that Trisha engaged in handshaking and nonsexual hugs excessively. Trisha stated, "By hugging my clients, they can see that I’m comfortable with physical touching, and I don’t have any sexual impulses towards them!"

In addition to phobic avoidance of client contact and counterphobic overcompensation, I have observed that if supervisees have unresolved concerns regarding sexual attraction and physical intimacy, these concerns may result in the supervisee’s focusing on sexual issues within sessions with their clients to an extent that is not based on the client’s clinical needs.

Think of a supervisee you are currently supervising, or perhaps one you have supervised in the past. Would a discussion early in your supervision relationship have been beneficial regarding the potential for over avoidance of physical contact; overuse of physical contact; or inappropriate over emphasis of sexual issues during a session?   For me, I find it is necessary to create an open place for discussion about these issues with my supervisees in order to ethically, authentically, and therapeutically respond  to unresolved feelings and fears of sexual attraction to clients.

In this section, we have discussed sexual attraction to clients, determining appropriate levels of nonsexual physical contact with clients, and ways supervisees might react to feelings or fears of sexual attraction towards a client. These three reactions were over avoidance of physical contact, overuse of physical contact, or inappropriate emphasis of sexual issues during a session.

- Pope PhD, Kenneth S. and Melba J.T. Vasquez PhD; Ethics in Psychotherapy and Counseling: A Practical Guide for Psychologists; Jossey-Bass Publishers: California; 1991.

Peer-Reviewed Journal Article References:
Contrastano, C. M. (2020). Trainee’s perspective of reciprocal vulnerability and boundaries in supervision. Journal of Psychotherapy Integration, 30(1), 44–51.

Danzi, B. A., Tawfik, S. H., Mora Ringle, V. A., & Saez-Flores, E. (2020). Enhancing profession-wide competencies in supervision and assessment: An evaluation of a peer mentorship approach. Training and Education in Professional Psychology, 14(3), 176–184. 

Pope, K. S. (1987). Preventing therapist-patient sexual intimacy: Therapy for a therapist at risk. Professional Psychology: Research and Practice, 18(6), 624–628.

Summers, F. (2017). Sexual relationships between patient and therapist: Boundary violation or collapse of the therapeutic space? Psychoanalytic Psychology, 34(2), 175–181. 

Thompson, S. M. (2020). Responding to inappropriate client sexual behaviors: Perspectives on effective supervision. Journal of Psychotherapy Integration, 30(1), 122–129. 

According to Pope’s study, 87% of therapists surveyed experienced sexual attraction towards a client. What are three ways supervisees may react to feelings or fears of sexual attraction towards a client? To select and enter your answer go to Test.

Section 8
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