How Clients Can Be Injured

Beginning with Masters and Johnson (1966,1970,1975), investigators have examined how therapist-client sexual involvement affects clients (Bouhoutsos, Holroyd, Lerman, Forer, & Greenberg, 1983; Brown, 1988; Butler & Zelen, 1977; Feldman-Summers & Jones, 1984; Herman, Gartrell, Olarte, Feldstein, & Localio, 1987; Pope & Vetter, 1991; Sonne, Meyer, Borys, & Marshall, 1985; Vinson, 1987). Approaches to learning about effects have included studies of clients who have returned to therapy with a subsequent therapist as well as those who undertook no further therapy after their sexual involvement with a therapist.

The consequences for clients who have been sexually involved with a psychotherapist have been compared to those for matched groups of therapy clients who have not been sexually involved with a therapist and of patients who have been sexually involved with a (non-therapist) physician. Subsequent treating therapists (of those clients who undertook a subsequent therapy), independent clinicians, and the clients themselves have evaluated the effects. Standardized psychological assessment instruments have supplemented clinical interview and behavioral observation. These diverse approaches to systematic study have supplemented individual patients' firsthand accounts (Bates & Brodsky, 1989; Freeman & Roy, 1976; Noel & Water-son, 1992; Plaisil, 1985; Walker & Young, 1986).

The consequences for the clients seem to cluster into ten very general categories: (1) ambivalence, (2) guilt, (3) emptiness and isolation, (4) sexual confusion, (5) impaired ability to trust, (6) confused roles and boundaries, (7) emotional liability, (8) suppressed rage, (9) increased suicidal risk, and (10) cognitive dysfunction, frequently in the areas of concentration and memory and often involving flashbacks, intrusive thoughts, unbidden images, and nightmares (Pope, 1988b, 1994,2001).

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