Awake People: Sexual Boundaries and Therapeutic Opportunity

Woman pushing away manIt is customary for a therapist to facilitate a client’s thinking and feeling “outside the box”, to “wake up and smell the coffee”. Therapists want to assist clients to release the constraints of what is “customary” or “normal” for them and explore the world of thoughts and feelings that have been taboo or off limits. The other end of the spectrum is also, sometimes, the therapeutic focus i.e. learning to self-regulate and develop the skills for expressing feelings such as anger in socially appropriate, non-abusive ways. Certainly there are clients who need such therapeutic assistance.

I remember a colleague commenting “I make it very clear to each and every one of my clients that I will not be sexual with them and that my office is not a place for expressing rage and anger.” Sometimes, in some situations, for some clients such clear and definite boundaries are appropriate or necessary.

Years ago I had a television set with a rabbit ear antenna. The signal was often blurred and I would get headaches as my eyes tried to reconcile the blurred images. It often is the distress of blurred boundaries and tangled experiences that brings people to therapy.

Some state’s credentialing requirements or guidelines or those of some professional groups may require a therapist to include in their office policy very clear language about, for example, sexual boundaries. Heeding such directives or advice may be legally necessary and professionally appropriate. In the intricacies and dynamic processes of the therapy session what was printed in an office policy is likely to fade out of awareness for the client. If a therapist recognizes that a client is having romantic or sexual feelings for the therapist it would not be appropriate for the therapist to kindle the client’s affections for the therapist. In the interest of properly tending professional boundaries, throwing the proverbial bucket of cold water on the client may be “safe” but counter-therapeutic.

Perhaps the client has a history of not just well-contained but repressed feelings. As the client’s trust and rapport with the therapist builds these feelings may begin to manifest. Some clients have learned the best defense is a good offense. Being offensive, in spades, may be both their safe haven and a primary consternation. A skilled and well-resourced therapist may help the client to open to an interior universe of terror, constriction, avoidance and denial. That the client may have very angry, romantic or sexual feelings for the therapist may be an opening for the therapist into the client’s interior miasma. If the therapist is brave and skilled enough they may help the client discover exiled parts of themselves that can become elements of a robust, vibrant and healthy person.

I remember a senior colleague comment that “all relationships have a sexual element. When we go to our office we can’t exclude it as though it were a set of car keys we forgot or a puppy we left at a kennel.” So if sex is always here, is always a part of every relationship, perhaps it would serve us well to be aware of it and make wise choices about it. Can we do this if sexuality is not allowed into the therapeutic relationship? If or when a client manifests angry, sexual or romantic feelings for the therapist an opportunity may be presenting itself to help the client learn to manage the complex realities of relationships. Can I, do I help the client learn to differentiate caring, being emotionally vulnerable and seen in a compassionate way from a romantic or sexual advance, interest or activity? Is it not the therapist’s responsibility to help the client learn that being seen and known emotionally is safe, that being compassionate, curious and committed to their healing and the emergence of their real self (see J. Masterson) is part of a healing, loving and vibrant relationship and not grooming and exploitation?

Skilled therapists we’ve heard of, known, been trained by, therapists such as Virginia Satir, Carl Rogers, and Jay Haley showed us that it was at this moment of authentic connection that deep, rich healing can happen. Current researchers such as Alan Schore (The Neurobiology of Affect Regulation) have shown us that self awareness and self image have their roots in the dyadic relationship of infant and parent. Martin Buber, decades before, wrote of the relationship of two people as the calling of one another into being. What “I” of the client do I evoke and what “you” in me is evoked by my client? It may be when my hands feel clammy and my mouth is dry that I have an opportunity present. An opportunity is present for healing, actually helping the client move from the darkness of shame, trepidation and anger to the light and vitality of being here and now in a connected and healthy way.

If a client manifests an element of sexual or romantic interest in me or is angry toward me and I respond with clear, strong language marking distinct boundaries and propriety I may feel safe and that I’ve taught the client an important lesson. But, have I helped them find and develop their Real Self and navigate the tidewaters of interpersonal and interpersonal dynamics? The recognition and maintenance of clear boundaries and skilled and compassionate address of a client’s sexual, romantic, or angry feelings toward their therapist are a client’s right and the therapist’s responsibility. The work of luminaries preceding us serves not only as an example of their remarkable skills both as a person and as a therapist but also they beckon us along the same path. They call us into being in our fullness. They encourage us to leave the refuge of absolutes and engage in the vibrant, dynamic processes of living now. Jon Kabat-Zinn called it “full catastrophe living”. Will you?

The record of therapist sexual impropriety with clients is testament that prohibition (by itself) is insufficient or ineffectual and it is essential that therapists gain further training and consultation regarding these matters. James Masterson teaches that the therapist is the “guardian of the client’s Real Self”. I believe he is speaking of the same core reality that has been elucidated by therapists, researchers, poets and philosophers including Martin Buber and Alan Schore.

William Stafford, the late poet laureate of Oregon closed his poem “A Ritual To Read To Each Other” with these lines:

Tho’ we could fool each other we should consider-
lest the parade of our mutual lives get lost in the dark-
for it is important that awake people remain awake
or a breaking line may discourage everyone back to sleep.
The signals we give, yes, no or maybe,
they should be clear
for the darkness around us is deep.

© Copyright 2009 by Dennis Thoennes, PhD, ABPP, therapist in Redmond, Washington. All Rights Reserved. Permission to publish granted to GoodTherapy.org.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 17 comments
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  • Jeff

    Jeff

    January 16th, 2009 at 4:16 AM

    I guess this is just a sad reality that speaks volumes about society today when these issues have to be clearly addressed or at least alluded to between therapist and patient. I cannot imagine acting out in that way or even have someone reciprocate those actions but I guess maybe I am in the minority. Perhaps there are those who cannot help themsleves but I do not think that is the norm. I think that stems from people cannot clearly see and abide by boundaries anymore which can make for some very complicated encounters.

  • Katie

    Katie

    January 18th, 2009 at 9:33 AM

    I have to agree with Jeff… I just don’t see this as normal, and although I’m not in the therapy field, I cannot imagine issues as these even being a problem with a therapist and a client.

  • Molly

    Molly

    January 21st, 2009 at 3:08 AM

    It never crossed my mind that people would show sexual intimacy or interest in a therapist, but I guess there are certain individuals who do do this. Is is a good idea to set these individuals straight up front? I think there need to be boundaries as well.

  • Sheila

    Sheila

    January 21st, 2009 at 3:11 AM

    I have actually heard of this before and it makes me wonder if these people are reaching out for attention that they may not be getting elsewhere. It doesn’t give them the right to act out toward a therapist. It seems to me they are missing something in their lives and looking, hopefully to someone who understands. I do believe, tho, that they do not need to act out toward the help they are getting.

  • Hillary

    Hillary

    January 23rd, 2009 at 2:42 AM

    I wonder if this is what they call Catch 22. It is definitely difficult for the therapist to be effective in this case. I think people who are lonely and who need attention would be those seeking a non professional relationship with a therapist.

  • Kelli

    Kelli

    January 27th, 2009 at 4:07 AM

    Again this all comes down to the therapist being able to remian a professional in situations like this that you know have to arise from time to time. Of course the clients may be needy but the professional has to be the one to say that this is not appropriate and to not engage in any of this type of behavior. I would think that if this kind of engagement did arise during a client’s treatment it could be very detrimental to his or her overall healing process.

  • Dennis Thoennes

    Dennis Thoennes

    February 25th, 2009 at 1:26 PM

    Hello all and thanks first of all for reading the article and secondly for your comments.
    It has been my experience that I need all the resources I can get and I want ready access to them. Clients want me to use all of my resources to serve them. This, to me, means that they want, need and deserve me to be a professional psychologist and a real person simultaneously. If the client presents with a servere headache he/she wants my professional evaluation (is this a tension headache or perhaps a brain tumor, drug or food related) and they want a living, breathing compassionate person to be meeting with them.
    Likewise when they come to see me is all of them welome? This does not mean they have license to act out severely e.g. do physical damage to me, property or others in the parking lot or waiting room. It does mean they can manifest aspects of them, their thinking and feeling they might keep under lock and key otherwise.
    Alan Schore (the brilliant pscyhologist from UC Medical School) speaks of the left brain being that part of us that is logical, verbal, and cognitive. The right brain is that part of us that is warm, affectionate, compassionate, affiliative. My clients need all of me. I need all of me to be able to relate to all of them. A part of my job is to help them recognize, relate to and utilize all of them. This doesn’t happen if I and/or they predetermine parts of me or them are, by definition, not welcome, not part of the whole person. Such partitioning is more a part of pathologizing, polarizing and dysfunction. When all parts are welcome and found a role in healthy functioning we have more vitality, freedom and both intrapersonal and interpersonal collaboration.

  • Allison

    Allison

    May 4th, 2009 at 2:38 AM

    I fell in love with my therapist 5 years ago and we have discussed it. I don’t call it transference; if I had met him anywhere else, I would have felt the same.

    Unfortunately my t has led me on; this is more common than you realize. Statistics are that a 100 psychotherapists lose their licenses every year for sexual impropriety; I am sure the number is much higher. Rarely, do psychotherapists/psychiatrists self-report.

    The most common reason therapists act out sexually, is because of “love-sickness.”

  • Marcia

    Marcia

    June 15th, 2009 at 9:07 PM

    Don’t you think that there is something human and normal about falling in love with a therapist? Throughout the ages, therapists ( and a lot of famous ones) and their clients have fallen prey to the most human of emotions – love. No, it is not ok to act out on these feelings but we can’t confine our opinion to wrong/right, black/white- people fall in love regardless of where they are and what profession they are in. I think we have to find more ways to help therapists who find themselves in this place so that they know they can get help that won’t be judgmental and punitive.

  • Dennis Thoennes

    Dennis Thoennes

    June 16th, 2009 at 8:28 AM

    Good Morning Marcia,
    Thank you for taking the time to provide your perspective and share your thoughts.
    I agree that we, as a profession, need to move beyond right/wrong. I believe that as we do we find that what may have looked simple initially begins to be realized as rather complex. “Falling in love” has many elements. As mental health professionals perhaps it’s a fair expectation our clients and the public have, that we have awareness of this and are vigilant in attending to this as we attend as well to our clients processes, needs and wants. As the poet William Stafford notes (A Poem To Read To Each Other) “… it is important that awake people remain awake lest we loose our path”. If I find myself “falling in love” with a client it is likely important that I ask “What’s this saying to me about me?” and then discuss this with a close friend and/or my therapist. Those who cross this boundary rarely do these three things.
    Dennis Thoennes Ph.D.

  • Allison

    Allison

    June 16th, 2009 at 2:44 PM

    For Dr. Thoennes: I think some things in life are simple….why would falling in love with a client mean “what is this saying about me?”—the therapist..

    Like Freud said: “Sometimes a cigar, is just a cigar.”

    Unfortunately, I fell in love with my therapist 5 years ago; even more unfortunately he has feelings for me and has led me on (physically and verbally). I have done a “ton” of research on client/therapist relationships, boundaries, etc., etc….the best book I read: “Sex in the Forbidden Zone” by peter Rutter….when professionals violate boundaries.

    Kind Regards, Allison

    P.S. I have written to Dr. Andrea Celenza (expert in dealing with therapists who violate boundaries)…..

    Just a few of the hundreds of things my therapist has said: “If I were not married, I would probably go for it.” You are in my heart and in my head.” He has wrestled with me and thrown me on the couch….I could write a book…sexual innuendoes…I know that no one can help me, because I see what is going on, but am not ready to confront him yet.

  • Allison

    Allison

    June 16th, 2009 at 2:45 PM

    P.S. Unfortunately, it doesn’t matter how much training therapists have, there will always be therapists who cross boundaries, since what goes on behind closed doors will rarely be reported by the therapist.

    I read that there are at least 100 therapists who lose their licenses every year, due to sexual impropiety. Just imagine the therapists (whose behavior) we know nothing about…..staggering, I will bet.

  • Dennis Thoennes

    Dennis Thoennes

    June 16th, 2009 at 2:58 PM

    Allison,
    Yes, staggering and sad. I regret that you have been so severely and (apparently) repeatedly abused.
    Yes, it is OK for a client to fall in love with his or her therapist. For many of us this is a normal response to being with someone who pays us such close, compassionate care, who gives us time, interest and attention. It is the therapist’s responsibility to moniter him/herself and refer the client to someone who can provide the appropriate care if he/she cannot do so. It is the THERAPIST’S responsibility to seek their own therapy, consultation and/or supervision.
    From your email message it appears you may still be seeing this therapist. There are a number of steps you can, should take. 1) Terminate therapy now. Your trust has already been violated by this person. Further sessions or meeting with him is not likely to be to your benefit. 2) Find another therapist. You can call the state psychological society/association or the American Board of Professional Psychology for a referral. You can also talk with friends aND see if any of them are seeing a therapist they know to be competent and ethical. Also, you could use the goodtherapy “find a therapist” for leads for a good therapist. 3) You could report this person to the state licensing board, the state psychological association and American Psychological Association (assuming your therapist is a psychologist).
    Allison, we all make mistakes. What you described is a blatent violation of professional ethics and constitutes a pattern of abuse. A cigar may be just a cigar but abuse should never be tolerated or treated in a cavelier manner. YOU deserve better.
    Dennis Thoennes

  • Jen

    Jen

    December 13th, 2009 at 5:46 PM

    In My program of study while training to be a clinical social worker, in all of my course work, one professor mentioned and acknowledged this reality–that is, the reality of how people develop romantic attractions. Therapy is a very intimate relationship–clients may say things to you they don’t even say to their spouses; things they might never have told anyone else. The good therapist responds with compassion and acceptance, without judgment–perhaps the first person in the client’s life to have ever done so. That anyone would be surprised when clients develop attraction to their therapist (or vice-versa) is bewildering to me.
    The funny thing is, this one professor who brought it up was not teaching a “clinical” course. He was teaching a course about the history of public policy around mental health services. NONE of my clinical professors brought this up, and I think it does a disservice to students and their future clients, alike. I have to wonder if it is denial or just discomfort that prevented this. Perhaps none of them would want to invite questions from students as to whether their own emotions have gotten the better of them with clients (and I don’t even mean acting out sexual desire. I mean, are they afraid to admit if they ever had feelings for a client?). It’s human for a client or a therapist to develop such feelings. But it’s unprofessional, unethical, and occasionally downright predatory to act upon or encourage those feelings in a client.
    The mental health profession has to talk about this more openly and clearly to prevent people like Allison from being taken advantage of.
    He is wrestling with you on the couch? He is Married? He’s a licensed professional? Whose needs is this man serving? Certainly not yours. He is encouraging you in a direction in which he himself cannot go. What does that say to you? I hope you will stand up for yourself and prevent him from doing this to others (and don’t doubt he is capable of it, and perhaps even already doing it). Please report him to the licensing board in your state. Please find a therapist who is actually worthy of your trust. Please do it right away.
    And please, please begin to see this man for what he really is.

    Jen

  • CG

    CG

    July 17th, 2013 at 8:20 AM

    I think it’s really normal to have feelings of intimacy with someone that you bare your soul to, and vice versa. It’s just human nature. How it’s dealt with (after being discussed) is where the real boundaries are set, and perhaps some healing can begin to start because there’s no more “secrets” out there! You people here seem to think it’s a travesty to be human and normal. It’s not, it happens, and just keep it out in the open – then it’s not a problem.

  • Jessica

    Jessica

    December 8th, 2014 at 8:53 PM

    I have feelings for my therapist I want to tell her.

  • Jessica

    Jessica

    December 8th, 2014 at 8:54 PM

    I think about her all the time and I just want to get it out of my chest but I’m scared she would drop me.

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