Sexual Attraction in Therapy: Managing Feelings of Desire in Clinical Practice

184 Pages·2020·6.791 MB·English

by  Michael Shelton

Sexual Attraction in Therapy
This accessible book offers effective protocol for engaging in better sexual
decision-making in clinical practice. It demonstrates that damaging sexual
behaviors are often the result of a process in which a clinician progresses
towards the crossing of a client–clinician boundary.
Sexual Attraction in Therapy explores state-of-the-art research from a multi-
tude of related fields and includes sage advice on how to recognize personal
risk factors, manage arousal, identify counterproductive sexual behaviors,
and use self-talk to exit sexual situations. Sexual boundary violations usually
follow a much longer insidious process and the book carefully discusses and
highlights the warning signs for clinicians, which can develop into sexual pre-
dicaments affecting their lives and those of their clients, their workplaces and
colleagues, and the reputation of the mental health field. Chapters provide
essential guidance so that therapists can monitor progress along the Boundary
Violation Cycle and, importantly, create organizations far more resistant to
poor sexual decision-making.
This text is an excellent teaching guide for clinicians and treatment pro-
fessionals who seek therapeutic growth for both clients and themselves.
Clinicians will be able to improve their decision-making and prevent them-
selves from engaging in damaging sexual behaviors, and organizations can
redesign their approach to include preventative practices.
Michael Shelton, MS, LPC is a Professional Counselor and faculty member
at Jefferson University.

Sexual Attraction
in Therapy
Managing Feelings of Desire
in Clinical Practice
Michael Shelton
First published 2020
by Routledge
52 Vanderbilt Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa
business
© 2020 Taylor & Francis
The right of Michael Shelton to be identified as author of this
work has been asserted by him in accordance with sections 77
and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted
or reproduced or utilized in any form or by any electronic,
mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from
the publishers.
Trademark notice: Product or corporate names may be
trademarks or registered trademarks, and are used only for
identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
A catalog record for this title has been requested
ISBN: 978-0-367-20593-5 (hbk)
ISBN: 978-0-367-20596-6 (pbk)
ISBN: 978-0-429-26245-6 (ebk)
Typeset in Avenir and Dante
by Swales & Willis, Exeter, Devon, UK
For Donald and Janice

Contents
Introduction: An Overview of the Problem 1
1 A Roadmap for Navigating the Risks of Therapy 14
2 The Boundary Violation Cycle 26
3 Risk and Vulnerability Factors 40
4 Managing Fantasies 54
5 Choosing: Talking Ourselves into (and out of)
Sexual Predicaments 70
6 Using Clients to Meet Unfulfilled Needs 87
7 Non-Sexual Boundary Crossings 99
8 Violations and Post-Violation Considerations 115
9 Education, Training, and Supervision 124
10 Organizational Change 139
11 Removal or Rehabilitation 157
Conclusion: We’re All in This Together 164
Index 167

Introduction
An Overview of the Problem
Every person employed in the mental health field, whether as a counselor,
therapist, psychologist, or social worker, knows that it is never acceptable for
a professional to engage in a sexual or romantic relationship with a patient. As
part of one’s education, training, supervision, and licensure preparation the
message that sexual and romantic activity between a practitioner and a patient
is censurable and harmful is clearly and repeatedly emphasized. Still, there is
a long history of sexual boundary violations; consider some of the pioneers in
talk therapy who became romantically involved with clients: Carl Jung, Erich
Fromm, Frieda Fromm-Reichmann, Harry Stack Sullivan, and Karen Horney
(Alpert & Steinberg, 2017; Blechner, 2014). At the time these incidents were
justified as instances of transference and countertransference gone awry or
even as true love, and the most severe outcome was professional censure.
It was not until the late 1960s that malpractice cases arising from boundary
violations began to accrue, and two hallmark cases galvanized the field to
action. Zipkin v Freeman (1968) determined the defendant had manipulated his
patient to become his mistress and leave her husband. More infamous, Roy
v Hartogs (1975) found a provider utilized sexual intercourse as a treatment
technique for the patient’s presenting problems, leading to an exacerbation of
her mental health concerns.
In the wake of this rising awareness of sexual boundary violations efforts to
elucidate the actual extent of the problem were undertaken. As one example,
Pope, Levenson, and Schover (1979) found that 12% of male and 3% of female
psychotherapists reported sexual contact with their clients. A decade later,
Simon (1989), a leader on the topic, estimated that 7%–10% of mental health
professionals sexually exploit their patients; however, he stated these figures
were likely low due to underreporting. The actual incidence, he proposed