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Sexual intimacies between psychologists and their clients have been prohibited by the American Psychological Association (APA) since 1977. Standard 4.05 of the American Psychological Association's Ethical Standards for Psychologists and Code of Conduct clearly states, "Psychologists do not engage in sexual intimacies with current patients or clients" (APA, 1992, p. 9). Regardless of who initiates the sexual relationship, it is the responsibility of the therapist to refrain from engaging in such behavior. Therapists, by their position, are attributed significant social power in the therapy dyad, and so they are enjoined by the profession from taking personal advantage of a potential sexual situation. Nevertheless, litigation increasingly shows that infractions of this prohibition are a significant problem for the profession. The most frequently filed ethics complaints are related to sexual misconduct on the part of therapists (APA, 1996). Although Pope's (1990) research suggests that the frequency with which therapists become sexually involved with clients has been decreasing in recent years, malpractice suits for therapist sexual misconduct have shown a steady increase, as have actions taken by state psychology boards against therapists for engaging in sexual intimacies with clients (Pope & Vasquez, 1991).
The article is based in part on the first author's master's thesis. Correspondence regarding this article should be sent to James W. Lichtenberg, Department of Counseling Psychology, University of Kansas, 116 Bailey Hall, Lawrence, KS 66045-2336; e-mail: email@example.com
According to Pope, Keith-Speigel, and Tabachnick (1986), 6.5% of therapists report engaging in sexually intimate behavior with a client on at least one occasion. At the same time, Noel (1988) reported that 84% of clinical psychologists reported that they know colleagues who claim to have been sexually intimate with clients. Regardless of whether those sampled were speaking of some of the same individuals, that 84% knew of colleagues who had been intimate with clients is disturbing.
Although a small minority of therapists engage in sexual behavior with their clients, approximately 87.5% of practicing psychologists report feelings of sexual attraction to at least one client during their professional career (Pope et al., 1986; Rodolfa et al., 1994). Of those practicing psychologists, 63% report feeling guilty or anxious for such attraction (Pope et al., 1986). One reason for such guilt may be that the profession historically has resisted acknowledging the problem of sexual intimacies as well as the topic of sexual feelings. The subject is generally considered to be taboo.
Unfortunately, there appears to be little research that examines these sexual feelings or that studies how most therapists generally react to them. Also, there appears to be minimal training that offers ways to cope with these initial feelings and consequential reactions. Supporting this notion, Pope and Tabachnick (1993) reported in a survey of 285 psychologists that 27% felt they had virtually no graduate training in dealing with sexual arousal in therapy, 23% thought their training was poor, 19.6% reported adequate training, 14.7% felt their training was good, and 10.9% reported their training for handling sexual arousal in therapy as excellent Summarizing these results, it appears that more than half (54.8%) of the psychologists felt they had not received adequate training in these matters. Pope (1988) proposed that such a deficiency may have occurred because "the sexualization of the student-teacher and student-supervisor relationships in training programs tends to prohibit open and honest discussion of the sexual feelings that are a normal part of many therapies" (p. 222). This is discouraging when one considers how many psychologists deal with these emotions at least once.
Although Pope and Tabachnick (1993) found that 55% of those surveyed reported their preparation to deal with their own sexual feelings toward clients to be inadequate, 45% did not. What differentiated these two groups was not clear from that study. Certainly, there may be a variety of individual or even professional specialty (counseling vs. clinical) differences that might contribute to differences in perceptions of the adequacy of training in this area; but although such variables should not be discounted, it seems most parsimonious to look straightforwardly at the training programs themselves for an answer. In this regard, Rodolfa et al. (1994) have suggested that it would be useful to examine the current training practices in graduate programs with regard to this issue. Additionally, exploring the effects of training on therapists' emotional and behavioral responses would provide important information on whether programs are providing helpful information to their students--information that better prepares them for the sexual feelings the), inevitably will encounter at some point in their careers.
In light of the above, the purpose of our study was to investigate the nature of counseling psychology doctoral training regarding the issue of therapist sexual feelings toward clients and how training in doctoral programs relates to counseling psychologists' comfort levels for dealing with sexual feelings in psychotherapy. Specifically, to provide a glimpse of how academic training programs are addressing this issue within their curricula and how such training may be perceived by program graduates, our study examined counseling psychology program training directors' perceptions of the importance of this issue in graduate training and whether and how the issue was addressed in those programs. We also examined the perceived adequacy of training regarding this issue, the perceived need for additional training among program graduates, the prevalence of graduates' experience of sexual feelings toward clients, and their level of …