Therapist self awareness: sexuality, attraction, and boundaries Penny A. Norford, Ph.D., L.P.C. SASH 2010

Goals : Generating interest Provoking thoughts Assessing needs Quasi-focus group format

Professional guidelines in all counseling professions forbid dual relationships specific to sexual relations Sexual relations / dual relationships

Nonmaleficence- do no harm Beneficence- always benefit client Ethical Issues Involved

Self awareness Graduate schools of study do not adequately prepare students (future clinicians) for potential sexual attraction to clients. The topic remains taboo, despite adverse consequences. Similarly, supervisors have little training to discuss sexual attraction experiences or may unconsciously avoid the topic often brought to them peripherally (i.e. overinvestment)

Occur in intimate relationships and psychotherapy IS an intimate relationship 95% of therapists acknowledged sexual attraction to clients (Pope) Sexual Emotions In Psychotherapy

Occur in intimate relationships : 95% of therapists Can create negative emotions such as anxiety, guilt, fear, shame, repulsion. 76% of therapists (Pope) Sexual Emotions In Psychotherapy

Can create negative emotions such as anxiety, guilt, fear, shame, repulsion. 76% of therapists Frequently are not talked about which contributes to acting upon the feelings Sexual Emotions In Psychotherapy

Countertransference referred to as the therapist’s “emotional time warp” around their client’s transference issues (Conner, internet) the counselor’s conscious and unconscious responses to the client’s real or imagined attitudes and behaviors

Potential Issues of Countertransference (Bridges, N) Sexualized, it might mean defensive effort to protect against the experience of particular affects in the development of the transference i.e. feeling sexual instead of disappointed, or identifying with some role in client scenario that triggers emotion

Issues (continued) Therapist may substitute one emotion for another: Rage into sexual feelings Anger into disappointment Sexual feelings into rage Inadequacy with ambivalence

Issues (continued) Interest in client’s sex life/relationships (beyond needed) may indicate objection to content behind countertransference is so strong as to have moved into behavioral realm

Issues (continued) When therapist’s issue resembles some aspect of the client’s, sexualized transference may serve to protect the therapist as well as the client from addressing painful material.

Self awareness and Boundaries Underinvestment can be as harmful as overinvestment overinvestedunderinvested Therapeutic range

Overinvestment (Approach- Approach) Feeling responsible FOR the client not responsible TO the client Therapist’s unconscious and conscious ego needs/issues often more important than client’s self-efficacy or empowerment Feelings of inadequacy with client’s failure to make progress

Exercise In what other ways do therapists and supervisors indicate overinvestment as it pertains to unhealthy boundaries setting?

Underinvestment Avoidance- Avoidance Feeling annoyed that clients place ongoing (yet typical) demands on time Forgetting or not following through with obtaining an assignment or article, etc. Not keeping good records or reviewing client goals Keeping certain clients simply because of self-pay Not returning phone calls

Exercise In what other ways do therapists and supervisors indicate underinvestment as it pertains to unhealthy boundaries setting?

Therapeutic Boundaries Resolving boundary issues (even attraction) therapeutically Balancing between separation and connection, teaching safety through self- soothing and comfort Being available, genuinely caring, and deeply engaging, without either inappropriate limits or underinvolvement, creates hope of possibly trusting others Acknowledging own shortcomings, processing client disappointment in our humanness, teaches that it’s okay to be both bad and good inside, teaches realistic love

#1 Indicator of sexual relationship with client Lack of boundaries in others areas

Exercise Attraction exercise: At certain times with clients, we have found ourselves emotionally or physically attracted to them. Please take a minute to recall the specifics of one such attraction What were the issues for your countertransference? What qualities did the client have that attracted or repealed you? What was the scenario? Did you discuss it with anyone? How did it effect the client relationship?

Shifting the paradigm How do we establish or continue (in a deeper way) a culture among SASH community that openly, honestly, shares and confronts when needed those countertransference issues that effect our reputations as a professional entity?

Exercise Discussion: Where do we go from here? What other workshops do we need? What training do supervisors need? What other questions or thoughts are provoked? Please feel free to me or write on the evaluation any suggestions or Thank you!

References/Reading List Bernsen, A. Tabachnick, K. & Pope, K (1994). National survey of social workers’ sexual attraction to their clients: Results, implications, and comparisons to psychologists.Ethics and Behavior (4) Bridges, N.A. (1994). Meaning and management of attraction: neglected areas of psychotherapy training and practice, 31(3). Pp Carnes, P.& Adams, K (eds.) (2002). Clinical management of sex addiction. Taylor &Francis Books, Inc NY:NY Edelwich J. & Brodsky, A. (1991). Sexual dilemmas for the helping professional. NY:NY Brunner/Mazel Folman, R. (1991). Therapist-patient sex: Attraction and boundary problems Psychotherapy, 28, Kinsler, P.(1992). The centrality of relationship: What’s not being said. Dissociation Vol v(3) Pope, K. Keith-Speigel, P, Tabachnick, B. (1986). Sexual attraction to clients: The human therapist and the (sometimes) inhuman training system. American Psychologist, 41, Scaturo, D. (2002), Fundamentals dilemmas in contemporary psychotherapy: A transtheorectical concept. American Journal of Psycholtherapy, 56, Scaturo, d. (2003), Fundamental Dilemma in contemporary psychotherapy: An overview Ethical Issues in mental Health Counseling 6(10) Hatherleigh Company