Mental health articles

Sexual abuse by professionals Who will protect us from those who would help us? (DeYoung, 1981, p. 92) This statement was made by one of three members in a 10-member adult incest support group who had been sexually abused by their therapists. This section addresses the frequency with which mental health professionals abuse their clients, especially when the victim has a previous history of childhood sexual abuse. First to be reviewed are studies that evaluate the prevalence of sexual abuse by clinicians, followed by the few studies discussing the sexual abuse of clients previously sexually abused. Several studies now indicate that a significant minority of professionals have sex with a client. In a review of six studies using national samples of psychologists, Pope (1993) found that 1% to 12.1% (an average of 7%) of male and 0.4% to 3% (an average of 2%) of female psychologists and psychiatrists admitted to having had sex on at least one occasion with a client; 87% to 94% of the victims were female. Further, 44% to 65% of professionals across studies had worked with a client who was previously involved with a therapist. In the study with the largest percentage (65%) (Gartrell, Herman, Olarte, Feldstein, & Localio, 1987), only 8% of the psychiatrists had filed a report against the offending professional. Of the female offenders, none had sexual contact with more than one client, whereas 38% of the male offenders had done so. Interestingly, repeat offenders (psychiatrists having sex with more than one client) were most likely to have treated victims of previous abuse by a professional, and nonoffenders were least likely to have treated a previous victim. Repeat offenders were also significantly more likely to know colleagues who were sexually involved with their clients. The authors suggest that offending therapists might refer their abused patients only to colleagues known to be sympathetic. In another survey of 110 hospitals with inpatient psychiatric units, 36% of the units reported that a staff member had been accused of sexually abusing a patient between 1985 and 1990 (Berland & Guskin, 1994). More than 90% of the allegations accused a male staff member of being the offender, and 71% of the victims were female. Thirteen percent of all allegations occurred on an adolescent unit, and 25% of all victims were under the age of 20. Other studies consider the issue of revictimization by therapists of sexual abuse survivors. Kluft (1990), who is known for his work with survivors of childhood abuse with dissociative identity disorder, published a study of all of his clients who were incest victims and who had been sexually exploited by their therapists. Of the 83 therapists these 12 patients had seen, 23 (28%) had initiated sexual contact with their patients, most of which culminated in intercourse. Of the 23 offenders, 22 (95%) were male. Although Kluft (1990) does not specify the ages of the clients, at least one was an adolescent when the revictimization occurred. Another study of female inpatients on a psychosomatic psychiatric inpatient unit in Austria found that four of nine patients who had previously undergone psychotherapy were sexually abused by their therapists (Kinzl & Biebl, 1992). In another study, three of 10 incest survivors currently in group therapy had been sexually involved or pressured to become involved with a professional (deYoung, 1981). This rate is similar to that of Armsworth (1989), who found that 23% of members in a support group for incest survivors had been sexually involved with their therapists. Seven percent of all helping professionals (i.e., counselors, ministers and support group leaders, and traditional clinicians) the clients had encountered initiated sexual contact, 77% of whom were spiritual or religious counselors. In Kluft’s (1990) study, however, only 4% of offenders were pastoral counselors but 48% were psychiatrists. Armsworth (1990) content analyzed interviews of six adult incest survivors who had been sexually abused by their therapists. The results portray the severity of these experiences. Only one of the six victims was able to terminate with the therapist after the first approach. The other five clients employed self-talk to cope with the trauma and to rationalize returning to therapy each week. Self-talk employed during the sexual interaction was in one of three categories: transference statements (e.g., "Did I make you happy, daddy?"; "Will you let me stay with you now?"); statements reflecting being trapped or helpless (e.g., "Just do it then you'll be free."; "I cannot escape—I have to stay."); or dissociative statements (e.g., "Look at the light—see only the light."; "Make your mind blank—hide until it's over.") (p. 547). To rationalize their weekly return, three types of self-talk were used that: reflected the trust or worthiness of the therapist (e.g., "Everyone I ask says he's the best."); their desperate need for help (e.g., "Unless I do what he wants, I'll never get any help."); or their feelings of being a nonperson (e.g., "This is your fate forever—so get used to it.") (p. 547). Therapist rationalizations for the abuse encompassed misrepresentations of moral or ethical standards. For example, one therapist told the client, "In therapy sexual intercourse is acceptable; outside of therapy this would be adultery" (p. 550). How damaging is abuse by a therapist? All studies agree that this type of abuse is extremely harmful (Armsworth, 1990; DeYoung, 1981; Kluft, 1990). Indeed, one study of therapists working with clients sexually abused by another therapist found that the strongest predictor of impact on the client was a history of prior sexual victimization of the victim (adult or childhood) (Feldman-Summers & Jones, 1984). Victims in Armsworth’s study also reported symptoms of posttraumatic stress disorder, deterioration in their lives, difficulty in interpersonal relationships, and problems in parenting. Of the four survivors seeking help for marriage-related problems, all marriages ended within the year. One survivor attempted suicide, and three others considered it. In summary, studies suggest that sexual abuse by clinicians working with survivors of childhood sexual abuse is a real threat. In these studies, 23% to 44% of survivors of childhood sexual abuse were also sexually abused by clinicians from whom they sought treatment. Sample sizes were small in these studies (ranging in size from nine to 30), however, suggesting caution in interpreting these percentages. As with all sexual abuse, victimization of a client by a professional is damaging to clients, “especially if the client already has significant psychological problems" (Feldman-Summers & Jones, 1984, p. 1061). It is a tragic consequence of our society that those who are supposed to help on occasion abuse instead. As Kluft (1 990) says, "No matter how flagrant the temptation, it is the therapist's task to maintain a therapeutic atmosphere rather than to enter into a gross breach of ethics, however well rationalized" (p. 276). It is of great concern that so many clinicians abuse. It is of greater concern that they revictimize some of the more wounded members of society.

Tags: sexual abuse