I’ve read a lot of posts on here about real, imagined or potential sexual relationships between psychotherapists and clients. All licensing agencies prohibit sexual relationships between a therapist and a client – at least while there is an ongoing therapeutic relationship (and most discourage it even after that relationship has ended)...and, in some states, it’s illegal.

I’ve seen it argued that, if both parties are consenting adults, there should be no such prohibition. At the same time, there is (usually) an inherent power imbalance in the client-therapist relationship that calls into question whether or not a client can truly consent to a sexual relationship.

So my question is: can a psychotherapy client truly consent to a sexual relationship? If you believe yes, are there cases where this would not be true? For example, can a schizophrenic client consent? What about someone who is fully competent and seeking CBT therapy to quit smoking?

[DP_2017]

I get why some clients would have that restrictions based on their issues but yes plenty of clients who are perfectly capable of consent. What states is it illegal? O hust assumed the 2 yr thing was USA standard

According to this website, Sexual Exploitation Laws - AdvocateWeb, therapist/client sexual relationships have been criminalized in the following states: Alaska, Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Iowa, Kansas, Maine, Maryland, Michigan, Minnesota, Mississippi, New Hampshire, New Mexico, North Dakota, South Dakota, Texas, Utah, Washington, and Wisconsin.

In North Carolina, for example, sexual exploitation by a psychotherapist (defined as a license professional counselor, a substance abuse professional, a clinical social worker, a fee-based pastoral counselor, a licensed marriage counselor, or a mental health service provider who performs psychotherapy) is a civil offense. Sexual exploitation is defined as:

Either of the following, whether or not it occurred with the consent of a client or during any treatment, consultation, evaluation, interview, or examination: a. Sexual contact which includes any of the following actions:

1. Sexual intercourse, cunnilingus, fellatio, **** intercourse, or any intrusion, however slight, into the oral, genital, or **** openings of the client's body by any part of the psychotherapist's body or by any object used by the psychotherapist for the purpose of sexual stimulation or gratification of either the psychotherapist or the client; or any intrusion, however slight, into the oral, genital, or **** openings of the psychotherapist's body by any part of the client's body or by any object used by the client for the purpose of sexual stimulation or gratification of either the psychotherapist or the client, if agreed to, or not resisted by the psychotherapist.

2. Kissing of, or the intentional touching by the psychotherapist of, the client's lips, genital area, groin, inner thigh, buttocks, or breast, or of the clothing covering any of these body parts, for the purpose of sexual stimulation or gratification of either the psychotherapist or the client, or kissing of, or the intentional touching by the client of, the psychotherapist's lips, genital area, groin, inner thigh, buttocks, or breast, or of the clothing covering any of these body parts, if agreed to or not resisted by the psychotherapist, for the purpose of sexual stimulation or gratification to either the psychotherapist or the client.

It's considered an offense if it occurs any time during treatment or within 3 years following termination.

[DP_2017]

Oh ya i know it is when its during treatment. I thought it was 2 years but still. Anyway... Weird they consider kissing sexual. I still think a good chunk of adult clients can consent

I think the idea behind regulating this is not because clients have so impaired judgment that they don't know what is happening to them, I think the majority of psychotherapy clients do and are capable of making the decision and consent. I think it's more that people, when they are entranced in desires in the moment, often don't consider or foresee the potential consequences (short- and long-term) of a sexual relationship with the therapist. Clearly some therapists don't evaluate it carefully and responsibly either.

I personally think it's good that there is regulation for the years after termination as well. Termination is just the end of the formal treatment, it does not erase the emotional factors and in many cases does not mean that the client got better either. People that really want to have this kind of relationships will find a way without telling anyone anyway.

[DP_2017]

i guess but realistically there is a potential for risk in ANY relationship, especially for emotional people... so its not really any different to me, just a different career.

that being said, i have no interest in sleeping with my T, i am just one who thinks that it is possible that real love/connections can happen at times.... and it should not be "banned" if it is something both want... i mean obviously AFTER treatment

and you are right, they will find a way without anyone knowing LOL. sorry i missed that at first, I'm sure there is a few out there who are in relationships and i am ok with it as long as its consenting adults and no one had to lose a marriage or anything for it

[SalingerEsme]

I can't help but think that once in a while there might be a real love story(?). Life is so infinitely complex, and many times the client is just as bright, accomplished, creative , and insightful as the therapist. Both are adult. As much as I can never imagine my professional and ethical T having any kind of patient affair, I still wouldn't want to be his wife if I had any awareness of the closeness of the bonds he experienced daily with women, lol.

[SummerTime12]

I agree with the idea that the client cannot fully consent due to power differentials. I think the laws in place are good for protecting clients, since many have been hurt by therapists who took advantage of them being vulnerable. That being said, I do thinks that there should be some exceptions, like if a client and T meet only once for an initial session, realize they are attracted to each other, and decide to be friends/date and terminate the professional relation immediately. In most cases like that, I don’t think the T is being unethical because no therapeutic relationship has been formed yet. Obviously for some cases, even after just one visit, it could still be unethical if the T is clearly taking advantage. But I think in a lot of cases it should be alright after just meeting once. But that’s just my opinion.

I also believe that genuine connection and love can develop between T-client in some cases and that it is not all that different from other ways people meet. And there are so many other scenarios of (initially) professional constructs that at least start with imbalance and hierarchy, and those are not regulated formally. Boss/employee, mentor/mentee, etc. Also, there isn't harm, or potential harm, in such relationships for everyone and some turn out really good - e.g. I had relationships with mentors in my youth where there was no imbalance or harm whatsoever, we just originally met in such a way and I was drawn to mentor types by default and found the relations very satisfying, we connected and interacted as equals. I also often feel that if I went to therapy in my youth, I likely would have crossed professional boundaries and formal ethics if I liked the T, disregarding rules and expectations the way I kinda considered myself exempt in my numerous relationships with mentors, married people etc, when I was young. Also, when I hear and read about destructive T-client sexual involvement, I tend to think it would not have happened to me (the destructive part) and I would have managed well, just like the other stories. But who knows and now I don't have that sort of drive, no intention to find out either.

Anyhow, I think there are always exceptions, but even just reading this forum, a large number of people don't seem to manage it well and do get seriously harmed by getting involved with therapists (even if it is no longer formal therapy time) - those reports and cases are very real and sometimes the effects last for many years of even a lifetime. Of course similar happens with other relationships as well that are not regulated or don't even have professional elements. I see the regulations regarding sexual/romantic engagement in therapy similarly to other safety rules and regulations in a workplace, sexuality is just an especially personal and charged area. Sometimes rules can be exaggerated, annoying, unnecessary or counterproductive; people break rules, even the law, all the time. Sometimes nothing bad comes of it but other times *** happens.

Another analogy is perhaps regulating the availability and use of mind-altering substances. Most people who experiment with drugs at first believe they will be able to take it or leave it, and won't get in trouble. But then... Some are indeed able to use them responsibly and moderately and even benefit from the experiences. Some people think drug regulations are still too liberal and should be stricter, other feel that the restrictions are useless or even harmful and some (or all) drugs should be legalized for adults, then they would not be associated with so much violence, crime and abuse. I think society has tried a variety of these things and none work perfectly. Of course regulating relationships easily feels unfair, but many existing examples demonstrate that crossing those boundaries can indeed turn very harmful for many people and often they become aware of it only much later.

[DP_2017]

^ many good points/examples there, I agree with you.

I would not be one to judge anyone's relationship if they were consenting adults and happy, regardless of how they met. All relationships have risk. There might even be examples out there of former T/Clients who married and stayed married..... no idea... but ya, its hard to say, its risky but it's also a personal choice for everyone, as long as therapy is not being done at the time....

I think the times when the T takes advantage is often something that begins dURING therapy, they start to groom them and then by the time they end, its easier for the former client to fall for things or want them etc.... its sad in those cases and I totally get why it would be long term damaging.

It seems like the responses have veered into the area of whether or not a sexual relationship is either understandable or acceptable...but I'm curious about the idea of consent. I think most of the licensing guidance and legal prohibitions are based on the idea that a psychotherapy client is not capable of fully consenting to a sexual relationship.

On the one hand, I think it's a bit paternalistic and infantilizing to regulate the relationship between two adults. On the other hand, I think the "therapeutic" relationship sets up a situation where, in some cases, even the most competent of adults can lose a sense of what's really going on, leaving them more vulnerable than they might be in a "real life" situation.

I think Xynesthesia touches on this a bit with the examples of regulating recreational drug use. Similar example might be seat belt or motorcycle helmet laws.

[DP_2017]

"I think it's a bit paternalistic and infantilizing to regulate the relationship between two adults. On the other hand, I think the "therapeutic" relationship sets up a situation where, in some cases, even the most competent of adults can lose a sense of what's really going on, leaving them more vulnerable than they might be in a "real life" situation."

This exactly. I think good examples of the latter is, usually people with a traumatic past and are more easily vulnerable. Also another good "no consent" example is someone who has a mental handicap. I know as I live with one... they are usually not able to consent properly to such things. So yes there is exceptions where I truly believe they can consent and everything is ok, then there is many examples otherwise. The rules should be a bit more specific on types of people I guess but like someone posted earlier, if they really want it, they can get around it by not saying anything.

I also do think that regulating the T relationship in this way is a bit infantilizing/degrading and assumes that adult mental health clients have somewhat impaired judgments, like minors or even more. But I personally see it just as much control over therapist behavior and faulty judgment - it is very much part of human nature that people tend to abuse their influence/power, use it irresponsibly and make destructive decisions. I think that adults with a responsible mindset and intention usually see these decisions as personal ethical dilemmas, but that assumes an intact, well-developed sense of morality and certainly not every therapist has it. I think we can see the regulations as limiting the acts of irresponsible professionals that are not capable of healthy consent themselves if triggered in certain ways, in spite of having passed generic licensing requirements.

I think the seat belt and helmet examples are also good ones - the idea behind all this is prevention of harm I believe. Of course the ban in some cases might mean that people are prevented from experiencing a really good, fulfilling relationship and a sense of personal freedom, as well as it is distrust in their capability to make independent decisions about their lives. In any case, the regulations limit personal freedom for sure, whatever the reason. I imagine that perhaps for some people it even discourages developing self-confidence - like someone else needs to guard them at all times, as young children. I think that ideally these things should be evaluated on an individual basis, but that would be pretty impossible to carry out, and it would be hard to reprimand irresponsible people and extreme cases as well.

I guess some of the people that decide to experience these relationships in secret and then find a way to come out later or move on with their lives when it ends are the ones that are fully competent and capable of making own decisions and managing it privately. I am sure there are many such cases but they are never discussed, what we tend to hear about are the harmful ones with negative effects and consequences.

[magicalprince]

Unfortunately even in the healthiest and most loving of relationships that happen to occur between a client and therapist, the existence of the stigma, the therapy culture and all the practical, ethical, legal barriers do put extensive strain on the ability to continue that relationship in a stable and healthy way. I think tbh that if a relationship can successfully navigate all those limitations and still remain on good terms, that in itself is all the justification it should need. So in my mind the limitations are a good thing, it's true that in the vast majority of cases it's just not healthy. But I think the rare exceptions, if they are meant to, will find a way, and I don't think at that point it makes sense or is realistic to further prohibit it.

[TeaVicar?]

I think consent is possible between two adults, in a client/therapist relationship. I would imagine however, that there are quite a few situations where consent isn't possible, even between adults, in the therapy setting i.e. if the client is very disturbed etc. I think in psychoanalytic therapy they view therapist/patient transgressions as incestuous, so maybe that's where the idea that a client can't give consent comes from.

I've thought about this a lot over the last few years and have come to the conclusion that there is no definitive answer. Seemingly the majority of transgressions cause a lot of pain for everyone involved but especially for the client. So perhaps, a blanket rule is a good idea. In the UK, a reasonably well known therapist came out as being in a long term relationship with a former patient. They met 3 years after her therapy had ended and were around the same age. There was uproar from the organisation that he had been part of because there is a general blanket rule that you cannot have a relationship with past patients. He published some very interesting responses to his and his partner's treatment at the time. They had been together for a few years before it come out.

Therapy isn't the be-all and end-all. Life is too short. I'm sure some relationships work and are happy. I also think that there's a big taboo around the subject, especially as the majority of transgressions seem to happen between an older male therapist and a younger female client.

[mostlylurking]

The thing about therapy is that it's so apt to bring forward young, child parts of a person. Child parts who often want desperately to be taken care of by, and to please in some way, the adults in their lives-- which in the present day means the T. This, to me, complicates the issue of consent quite a lot. I would also find it creepy as a therapist to contemplate such a relationship. How would you know the client is fully in their adult mind and that their behavior isn't influenced by (say) young teenaged feelings that got stirred up during therapy?

Some have also suggested that because maternal / paternal transference is quite common, in many cases such a relationship would feel vaguely incestuous. (ETA: I see TeaVicar? just said that above!)

Another issue is that unconscious or subconscious processes can be stirred up in therapy and a client may be pushed toward such a relationship by unhealthy (meaning unsafe for the client) but unconscious processes that neither party is aware of.

These things can happen in anyone's private life too, but therapy is sort of designed to tap into these hidden psychological currents. Which, combined with the power differential (which in interpersonal terms is quite extreme -- they know all about us, we know little about them) seems like a recipe for disaster.

I think all the emphasis on consensual adult sexual relationships is ridiculous considering all the psychological damage done to cleints by these people--most of which is ignored. Swept under the rug. Abuse is abuse whether sex is incolved or not.

It's similar to the thinking of the 'war on opioids'. There are countless drugs killing people; while only a small percentage of people who take a cheap and effective opioid drug get addicted, yet an abundance of resources are devoted to the issue and the sickening practice of overmedicating people with harmful drugs instead if addressing the cause of symptoms is swept under the rug.

[junkDNA]

I do not believe in consent to have sex from a client is valid in any therapy relationship. I also believe it should be illegal in every state. Did you know some insurances that therapists get have a clause that States they will not pay out for any sexual misconduct?

My former T had one like that. What he did was not illegal in my state (nc).

The problem is that at the time and during those 2 years I mostly thought I was consenting. That I wanted it. That I was in love. However it was not the case. I was groomed and exploited and taken advantage of in a horrible way. Many people have likened it to incestual rape

I am living proof of the damage that comes from this type of situation

[DP_2017]

Originally Posted by junkDNA

I do not believe in consent to have sex from a client is valid in any therapy relationship. I also believe it should be illegal in every state. Did you know some insurances that therapists get have a clause that States they will not pay out for any sexual misconduct?

My former T had one like that. What he did was not illegal in my state (nc).

The problem is that at the time and during those 2 years I mostly thought I was consenting. That I wanted it. That I was in love. However it was not the case. I was groomed and exploited and taken advantage of in a horrible way. Many people have likened it to incestual rape

I am living proof of the damage that comes from this type of situation

I am sorry this happened to you, I don't know the story but I do recall reading your post about the emails and in that case, I'd agree you were groomed for sure... and it's awful but I am glad he got in trouble for it

However I still do believe in SOME cases, true love is possible, as it would be in any other situation with 2 adults... maybe not horribly often but it happens I am sure and I am totally ok with it if so. There are some people who may not be as vulernable as others in therapy....etc....

[mostlylurking]

Originally Posted by DP_2017

However I still do believe in SOME cases, true love is possible, as it would be in any other situation with 2 adults... maybe not horribly often but it happens I am sure and I am totally ok with it if so. There are some people who may not be as vulernable as others in therapy....etc....

If both parties felt there was something like that developing, I would imagine they would stop therapy immediately, let some time pass, perhaps consult with colleagues (for the T) or another therapist (for the client, because it's so likely to be transference)-- and only then proceed quite carefully. It would be a very unfortunate way for a real love relationship to begin.

[DP_2017]

How about we just assume all love is transference then? LOL... it's so annoying that it is the ONLY possible answer when its in this type of situation.

As I said earlier on this thread, I absolutely believe that genuine, healthy love can develop in a therapy relationship, in some specific, likely rare cases. Also, many good relationships in everyday life start out with transference-based attraction (therapy did not create the phenomenon, just uses it) - I had a series of these in my life and they were usually the most intense and involved, exactly because of the transference elements. The thing about romance arising in therapy though is that it is, or would likely be, problematic for most situations. I imagine that if the people involved are mature enough and independent enough to make it work, they will probably know and will find a way, and no one else needs to know the details. Also, better not to advertise it because it can indeed trigger many others negatively. Private matter for two people.

[Parva]

I'm not reading all these responses because, quite frankly, I can't handle it.

It's not just the power imbalance, it's not just the transference, and it's not just the issue that a good T will be available for consultation or re-visitation long after termination. A personal / romantic relationship deprives the patient of this resource, and it's not even that the T knows all the chinks in the armor, all the soft spots that can be used - even unconsciously - to regulate or control the relationship.

I don't know what the worst is. I'll be honest. When this happened to me, I said it was consensual, but it wasn't. Not by a long shot. It took half a year of pain to realize how wrong it was, how incredibly much I'd been used by the T, my family ripped apart, and ultimately betrayed, left feeling like *who I am* was ripped away from me. There are no happy endings here; I know we'd like to think Hollywood reflects life, but not in this case. Maybe that's black and white. But I've been there. I say all this because I know how alluring it is for a million different reasons. But sadly, until you've been through it, you'll never know how profoundly awful and destructive it is. And when you come out the far end, if you come out the far end, it's hard to imagine ever being ok again. Ever trusting anyone again. Scars on top of scars.

It almost killed me, and I'm not sure ultimately it won't. It's taken my life away, that much it has done. There were 5 other therapists who knew about this. 5. And not one did a thing to stop it. Why? Because they all believed consent between a patient and therapist is possible. And do you know what else? They're legally responsible just like the T.

There's a reason this has been criminalized in so many states - because for every one of these deals that 'works out', there are 99,999 that end catastrophically for the patient.

[DP_2017]

^ I'm sorry it was bad for you... and I agree when it is a CURRENT client, for sure a crime... but this post was about after...and I guess many of us feel it is possible. Rare for it to work, but rare for any good relationship to work. There is always exceptions.

Many people who WANT a relationship after, don't really want/need that resource anymore or have a new one lined up in case. I've never been through it, nor do I know anyone who has but I always try to advocate for real love, even if its rare, it happens... in all types of situations where people meet and get to know each other.... if it's just about sex, that's ok too if like most of us said, the adult is capable of making those decisions, not "vulnerable" and is aware of all the risks etc.

[atisketatasket]

Originally Posted by DP_2017

^ I'm sorry it was bad for you... and I agree when it is a CURRENT client, for sure a crime... but this post was about after...and I guess many of us feel it is possible. Rare for it to work, but rare for any good relationship to work. There is always exceptions.

Many people who WANT a relationship after, don't really want/need that resource anymore or have a new one lined up in case. I've never been through it, nor do I know anyone who has but I always try to advocate for real love, even if its rare, it happens... in all types of situations where people meet and get to know each other.... if it's just about sex, that's ok too if like most of us said, the adult is capable of making those decisions, not "vulnerable" and is aware of all the risks etc.

I don’t think “after” necessarily makes a difference. Your ex-therapist knows all about you (and you know they know), you don’t know as much about them (so they start out at third base and you start out trying to get to first), knows what buttons to push, is used to having an adoring client around and could well expect the same in a relationship, plus it would be hard not to fall into the old therapist-client patterns. Right away it is not a relationship between equals. And how will either side ever know it is “real love”? They can’t, because of the nature of the earlier therapeutic relationship.

I’m not saying it would never work, but given human nature the odds are very much against it. It is a recipe for disaster and abuse.