Case Study of Sexual Abuse and Dual Relationship With a Psychotherapist

I had a client who came into my office who was stating that she felt suicidal because she’d had a sexual relationship with her former therapist. The evaluation and management of a suicidal client is frightening to say the least. As I approached the suicide assessment, I kept in mind three things: 1) I need to consult with a colleague for another opinion. 2) I make sure I document, document, document everything. 3) I evaluate the client’s risk for actually killing herself. The risk factors for suicide are:

1. A client with a mental diagnosis, especially depression and substance abuse, or Borderline Personality Disorder that increases risk.

2. People over 45 years old are higher risk.

3. Gender – men will use more lethal means such as a gun, women will try more often such as using pills.

4. People who have never married, who are divorced, widowed, recently separated are highest risk.

5. Recent loss of a loved one increases risk.

6. Have there been any previous suicide attempts?

7. Has there been a recent job loss?

8. Is there a history of suicide in the family?

9. Does the client have a history of violent outbursts or impulsive behavior?

10.Does the client have a specific plan?

This was the time that I had her sign a no-suicide contract. In the contract, she agreed to not hurt herself and that if she felt she couldn’t stop herself, she’d call 911, or another person who was close to her. She also agreed to return for help at her next appointment. I also asked her to talk with her family about her feelings. She did not need to tell them any specifics about what had caused her distress, but she told them that she was extremely depressed and is feeling suicidal.

I explained to her at length about dual relationships. I explained to her that usually when there is an ethical violation such as a therapist having a sexual relationship with a client, the relationship actually begins with a non-sexual relationship. The relationship begins in good faith and as time passes, the boundaries between the client and the therapist begin to deteriorate. I told her that the risk of harm occurring to the client increases as the therapist and client become more intimate and there is a greater power differential between the client and therapist just as there exists between men and women in general. Researchers have found that a subset of nonsexual dual relationships ‘accurately predicted’ the ‘erotic practitioners’ in more than three fourths of the cases. I talked to her about how predatory professionals will exploit and seduce female clients deliberately for their own satisfactions.

I proceeded to educate her about the Therapist-Patient Sex Syndrome. Some of the identified10 aspects of the syndrome may be experienced by the client, or all aspects may be experienced, such as ambivalence; a sense of guilt; feelings of emptiness and isolation; sexual confusion; impaired ability to trust; identity, boundary, and role confusion; emotional liability (frequently involving severe depression and acute anxiety); suppressed rage; increased suicidal risk; and cognitive dysfunction (especially in the areas of attention and concentration, frequently involving flashbacks, nightmares, intrusive thoughts, and unbidden images. My client was indeed experiencing almost all of the symptoms described. These symptoms are all symptoms of Post Traumatic Stress Syndrome.

I pulled out my copy of the American Counseling Associations ethical standards and read her,

“A.4.a. Avoiding Harm: Counselors act to avoid harming their clients.

A.5.a. Current Clients: Sexual or romantic counselor-client interactions or relationships with current clients, their romantic partners, or their family members are prohibited”

I told her that the former therapist needed to be reported to the state licensing board. I warned her that her confidentiality could be breached as a part of the reporting process. I also told her that she needed to engage a reputable attorney because there was a strong possibility that the former therapist might try to lie his way out of the accusation and blame her by saying she was making false claims.

She asked me what would happen to him and I told her that he could be the target of a lawsuit. He could have his license revoked or suspended as well as lose his insurance coverage and his job. In the State of California there is even criminal liability when a therapist initiates a sexual encounter with a client. My client finally understood that this ethical violation was the most egregious and damaging thing that a counselor could do to an unsuspecting client.

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Managing Sexual Affairs in the Workplace

Some things change — people get older — some things don’t – when men and women operate in close quarters on a daily basis, they are in a constant state of sexual confusion and tensions.

Workplaces are simply high schools (a place teeming with adolescence testosterone and pheromones) for grown ups. The high school hidden curriculum (how to find a girl or boy to be with) overwhelms the curriculum that teachers are trying to teach.

Managers, like high school teachers, have to get the job done amid all of this sexual tension.

Companies are filled with “grown-ups” — at least by age – of professional men and women, who are living in a powerful mix of testosterone and pheromones. The irrational (sexual attraction) is in an arm wrestling match with rational (be professional).

The difference between high school and the adult environment is that in the company environment, people are older, some are married, others are divorced, a few are either homosexual or lesbian and everyone has the money and freedom to make decisions that can be helpful or destructive in a moments notice. One wrong touch, comment or sexual encounter and the workplace dynamics can change in a New York minute.

In the workplace, the currency of attraction is power. Women’s power is in their bodies and how much they do or do not reveal. A man’s mind can go to mushy stupidity at the slight whiff of a fragrance, a quick glance at cleavage or an assumed gesture of interest. Many a mans’ career has been expensively interrupted by his little head overwhelming the more rational big head.

Men’s attraction lies in our financial and positional status. Women have a keen eye for the sexual power dynamics. Some are not above taking advantage of the situation and entering the dangerously exciting territory of the office affair.

Managers are often vulnerable in this sexual maelstrom in our cultural of political correctness. They simply have not been taught to deal with this stuff.

Our North American culture is fundamentally misinformed about the sexual power differentials and approaches between men and women and the eventual “do-do” that can ensue.

So what’s a manager to do?

First, do not under any circumstances get romantically involved with one of your direct reports or anyone that you have some real or implied authority over. That route can be a road to ruin for yourself or the other person.

Second, a manager must rely on her/his company’s policy on sexual harassment and affairs in the office. Without such a policy a manager is put in a very difficult position because there are no rules to get through it. It will be messy.

Third, with or without a company policy on sexually harassment or affairs, the next action for a manager is to go to her/his boss to talk about what is going on. Be very clear that you have the facts, not gossip, rumours or innuendos. It is likely that a labour lawyer will be consulted. Consider finding a psychologist who has experience in this area.

Fourth, once you’ve gathered the facts and options, it is time to figure out a strategy for dealing with the situation. If you are going to talk with either party always do it with another person present. This is an absolute must (bring in a woman with you, the HR person if you have one) if you are a man dealing with a female employee.

Fifth, recognize that everyone in the office already knows something about the situation. However do not discuss anything with other employees until the situation is completely resolved. After resolution, talk with people to briefly and factually explain the situation and what actions have been taken. Distribute the company policy for people to read.

Sixth, if you have any leftover feelings, concerns, disturbances about what has gone on, go see a counsellor to get clear so you can move one. A couple of sessions can really help to clear your mind of the mess, particularly if the situation turned a bit ugly, as they often do.

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Human Sexuality and Gender Identity Is Different

A Transexual is an umbrella term, which includes cross-dressers, transgender and transsexual individuals. It is important to differentiate between sex and gender. Sex has biological foundations and is connected to hormones, genitalia and hormones among other things. Gender is a social construct, and it has to do with the internal sense of self and your chosen self-expression.

Cross-dressing individuals like to wear clothes associated with the opposite gender. Some of them just feel more comfortable in those clothes, while others consider it as another form of expression of their personality. Cross-dressing does not make you a transsexual.

Transsexuals usually have conflicting physical and psychological genders. The difference makes their lives quite hard, and leaves them with an important decision to make. They can choose to live with their biological sex, (which is the more difficult path for them) or they might choose to undergo rather radical procedures, such as hormone therapy or surgery, so they can live with their preferred gender.

A small vocabulary of sexual confusion:
FTM: Female to Male, a. k. a. Trans Man.
MTF: Male to Female, a. k. a. Tran’s Woman.
Gender Queer: Someone who identifies as other than male or female or who does not believe in binary gender.
Coming Out: Telling the truth about your sexual preferences for the first time.
Passing: Being perceived as the gender you are presenting.
Disclosure: Revealing your transsexual status to someone.
Stealth: Passing as non-trans without revealing Trans status.
Binding: Flattening your chest to create a male torso.
Packing: Wearing a device to create an external appearance of male genitalia.
Drag: Wearing clothes appropriate for the opposite sex.

The process of declaring romantic or sexual interest to anything other than the conventional heterosexual interest is called “coming out.” This process can start with fantasies, attraction to the same gender, perhaps sexual experimentation, and definitely feeling different from others in his/her peer group. This process is not easy and often leads to emotional distress and chaos.

Coming out is the process of admitting your sexual orientation to yourself and others. While coming out usually refers to the revealing of homosexual identity, heterosexuals can come out as well. Straight youth have a much easier task with “coming out,” however. LGBTQ (Lesbian, Gay, Bisexual, Transgender, and Questioning) youth must come to terms with their sexuality and resolve the fears and doubts about it. The acceptance of our own sexual preference is an integral part of our sexuality, and of our identity as well. Coming out to others provides new problems however. Adolescents may face rejection from friends or family, they could be thrown out of their homes, or face being cut off from their families – financially or emotionally. This is not necessary. Some people are honored that the coming out youngster has confidence in them, and it is not uncommon that coming out brings parents and children closer.

It is interesting that when LGBTQ young people feel an attraction to a member of the same sex, they often get the reaction, “You are too young to know,” or “It is just a phase.” While no one questions a teenager’s attraction to a member of the opposite sex the same way.

Coming out has historical aspects as well. Before the gay revolution in the 1970’s, disclosing a non-heterosexual identity could lead to police charges. The Gay Rights Movement was a catalyst to change attitudes and policies, and the coming-out of celebrity and athletic role models in subsequent years has also helped. Today, almost half of the states in the United States recognize gay marriage, and the federal government has recognized it too.

Coming out can be daunting, because there is no easy way to tell someone about your sexual difference. A good idea is to tell only your closest friend or friends about it. You may need to know first what you are going to say, because people tend to have inaccurate perceptions and information about sexual differences. The lack of initial support or positive response from friends and family should not discourage you, because people usually need some time to get used to this new information and have to learn how to show their support. If you want to tell everybody about being different, it would be a good idea to tell the mouthiest of your friends.

Each year an increasing number of gay, lesbian and bisexual adolescents come out. Coming out is no less difficult today than it was 30 years ago. We just find a little more acceptance in some parts of society. Today, gay adolescents may not label themselves as LGBTQ, because they do not feel the need of a label, or they just try to avoid homophobic stigmatization.

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Hypnosis and Sexual Confusion

Let me get this straight. Sexual confusion, at least in the context of this blog entry, does not refer to people who have made a choice to live a gay lifestyle. It refers to a mental condition of some people who think of themselves as being of the opposite sex, i.e. males who think of themselves as females and vice versa. Gay men are fully aware that they are men, they might have illusions of being female, but they do not think of themselves as women. They are men who choose a lifestyle.

Sexual confusion is listed in International Statistical Classification of Diseases and Related Health Problems (ISCD) of the World Health Organization. It is more known as gender identity disorder (GID) to describe persons who experience significant gender dysphasia (discontent with the biological sex they were born with). It is a psychiatric classification and describes the attributes related to transgenderism.

In my own practice, men and women with GID act and present themselves as members of the opposite sex. The disorder may affect self-concept, choice of sexual partners, choice of careers, and public behaviors. The negative feelings often involved inner discontentment, pain, anger, and shame. Sometimes, histories of parental dissatisfactions, school bullying, and public humiliation can damage self-esteem and add to the sexual confusion.

This is where hypnosis plays a major role. These confusion and these past experiences are often repressed which lead to a lack of self-awareness. Hypnosis provides a safe and effective process for patients to reclaim these factors so that their present decision-making is well-informed. Hypnosis releases the negative emotions as well, so that the patient will experience clarity and make a personal decision based on his or her values and goals in life.

What about you? Did you ever experience sexual confusion at some point in your life? How did you overcome it? Do you know anyone who has an obvious case of sexual confusion? What are doing to help them?

EFT is powerful. It combines treatment to physiological or psychological problems by tapping specific acupressure points with fingers. It is you who taps yourself and therefore you have full control of your body. All I do is to guide you where to tap and also what to say as you tap. EFT is so powerful that it can help in trauma treatment, pain management, addiction recovery etc.

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