Though there are useful guides and tried-and-true methods for finding a therapist that is right for you, feeling comfortable enough to really trust and open up to the new therapist can still be a challenge. This is especially true if you have been a victim of psychological, emotional, or sexual abuse. You may wonder: Is it safe here? Can I let myself be vulnerable? Might the therapist violates my boundaries and take advantage of me?
The reality is that many therapists have experienced occasional sexual or romantic feelings toward their clients—but only a small percentage do anything to act on them. Indeed, this is what a recent study of mental health professionals in Belgium, by Vesentini et al., has found. The study, published in the January 2022 issue of Archives of Sexual Behavior, is discussed below. (Note, the terms “client” and “patient” will be used interchangeably, as will the terms “therapist” and “psychotherapist”).
An Investigation of Therapists’ Intimate Feelings and Behaviors
From 2016 to 2018, the researchers sent questionnaires to licensed psychotherapists in Belgium. The survey was anonymous. Completing the questionnaires took roughly 15 minutes.
The first section of the questionnaire comprised 15 items. These described “intimate feelings and behaviors (IFB) related to friendship and sexuality toward clients.” For example: “I find a client sexually attractive,” and “I want a client to find me attractive.” were instructed to respond to the frequency of these occurrences (eg, never, sometimes, regularly, often) and their subjective evaluation of them (eg, positive, neutral, negative).
The second section asked if the participants had sexual relationships or formed friendships with patients and with how many of them—in the past year and during their whole career. The last section requested demographic information (eg, age, gender, sexual orientation, education).
Therapists’ Feelings and Behaviors Toward Clients
The response rate was 40 percent, ranging from 35 percent of one group (psychiatrists) to 57 percent of another (members of the Flemish Association for Person-Centered Psychotherapy). The final sample comprised 758 mental health professionals; most were female (69 percent), heterosexual (89 percent), and between the ages of 20 and 59 years old (83 percent). Only in the age group of 60 years of age or older were there more male than female therapists
The majority of respondents were psychologists (55 percent) or psychiatrists (39 percent). Roughly 23 percent had received person-centered training, 40 percent behavioral training, and 20 percent psychoanalytic training or systemic therapy training—whether alone or combined with other approaches.
Feelings and behaviors toward clients
Most therapists (71 percent) said they, either sometimes or regularly, found a client sexually attractive. Approximately 23 percent had fantasized about being in a romantic relationship and 27 percent about having sexual contact with a patient.
Also common were friendship-related feelings and behaviors, such as accepting gifts (80 percent) or the perception that “a client feels like a friend” (72 percent).
How did therapists judge their intimate feelings and behaviors? “In more than half of the investigated 15 IFB items, at least 20 percent of therapists indicated they evaluated it negatively.” Nearly half of those surveyed negatively evaluated their experience of sexual tension and arousal during therapy.
Analysis of data also showed 15 percent of psychotherapists had started a friendship with a patient, but mostly after therapy had ended (13 percent). Only 3 percent had started a sexual relationship with a client (less than 1 percent during therapy).
Other findings of interest were that psychiatrists, compared to psychologists, reported experiencing sexual feelings or fantasies less often. In addition, behavioral therapists, compared to person-centered or psychoanalytic clinicians, reported more emotional involvement and friendships, but less sexual feelings and fantasies.
Boundary Violations by Therapists
The results of this survey showed that many therapists have experienced periodic sexual feelings, thoughts, or fantasies about people they were treating: Approximately 7 in 10 therapists (more men than women) found a patient sexually attractive; Nearly a quarter had fantasies about being in a romantic relationship with their patients.
Interaction, very few therapists actually started a sexual relationship (less than 1 in 30)—and typically with only one client. These rates are comparable with other studies, though some suggest slightly higher rates.
In summary, sexual feelings or fantasies might be fairly common but they rarely led to sexual relationships with clients.
Much more common were the following behaviors: Forming a friendship with a client—particularly by older therapists and after therapy had ended (1 in 8)—accepting gifts (8 in 10), and giving goodbye hugs (1 in 5).
Why Therapists Feel Such Connections with Clients
So, why do so many mental health professionals (over 70 percent) report being emotionally involved with their clients or experiencing sexual feelings and fantasies about them?
Perhaps because therapists and patients spend hours alone, during which patients share very personal feelings—feelings they may not share even with their partner or most trusted friends—to which therapists attend with empathy and without judgment. Such an environment is conducive to the development of intimacy.
Indeed, like therapists, patients may develop sexual or romantic feelings for the person with whom they are working so closely and intimately, sometimes for months or years.
As noted earlier, the study also found that compared to female therapists, male therapists reported greater sexual feelings and fantasies and were more likely to start a sexual relationship with a client. Why?
Perhaps it is because men tend to experience stronger and more frequent sexual desires. Or they are exposed to a greater number of opportunities for sexual attraction—most male therapists are heterosexual and the majority of therapy clients are women.
A third possibility, as the authors note, involves power: “The need or ability to dominate and control can also play a role in cases of sexual abuse. Studies of gender differences have shown that men overall desire power more and possess higher levels of power.”