Tuesday, December 11, 2012

Supervision Addressing Counselor-Client Sexual Attraction

Kelli E. Scanlon, The University of North Carolina at Greensboro

What was the purpose of this literature review?
This literature review examined both empirical and conceptual articles concerning the attraction between counselor and client, the use of supervision for managing such feelings, and practitioners’ opinions of the training they received concerning counselor-client attraction.

Major findings or points:
Seminal research on counselor-client attraction indicates that more than 84% of mental health practitioners will experience sexual attraction to a client at some point in their career (Pope et al., 1986).   More recent studies suggest that the number may be higher.  At the same time, counselors-in training consistently report that they feel ill-prepared by their graduate programs to manage sexual dilemmas in real-world settings.  Consequently, helping trainees normalize and navigate attraction within the counseling relationship is a critical component of comprehensive and ethical supervision. 
The most common feeling among counselors who experience counselor-client attraction is discomfort, which may take the form of fear, guilt, shame, anxiety, or caution.   Counselors largely that believe that their clients are not aware of the attraction their counselor may have for them, and it is common for practitioners to terminate counseling without feeling “resolved” about the attraction.  Given trainees’ discomfort with such feelings and experiences, making meaning of the client and/or therapist attractions/responses is an often overlooked —albeit central—step to managing future attraction and fostering trainee self-efficacy.

What does this research mean for counseling practice, settings, and/or training?
Use of clinical supervision to address feelings of counselor-client attraction is critical. By and large, it is incumbent upon the supervisor to raise the issue of sexual attraction with supervisees. Researchers have found that if these issues are not adequately addressed, both the supervisory and counselor-client relationships are likely to suffer.  As such, supervisors would do well to discuss their trainees’ thoughts, beliefs, and concerns about counselor-client sexual attraction before such issues even arise.   Moreover, since peer support is essential in helping to normalize the attraction and reduce the stigma surrounding professional disclosure of sexual attraction, group supervision is one of the best venues for addressing issues of counselor-client attraction.
Fear of being judged by supervisors and concerns about a supervisor’s professional opinion have been shown to be principal barriers to counselors making use of supervision for this need.  Clinician shame is another significant reason why practitioners don’t disclose to their supervisors. Unfortunately, experiencing or perceiving a supervisor’s discomfort with the topic is another deciding factor for supervisees.  Numerous study respondents have suggested that their supervisors either chose not to address sexual attraction to clients or appeared uncomfortable with such conversations.  Since trainees are generally reluctant to raise the issue themselves in supervision, important discussions about sexual dilemmas are often avoided.  Not only do trainees need safe places to discuss experiences of attraction, but supervisors’ disclosure of their own experiences of client attraction tops the list of things that trainees believe would improve their levels of competency and comfort with such experiences. 
Facilitating trainees’ understanding of the differences between sexual attraction (a normal experience) and sexual contact (an ethical violation) is also imperative. Acting upon client attraction happens much less frequently than the experience of feeling attracted, but still more often than it should, suggesting that clinicians-in-training require ongoing clinical supervision in this area.  Both loneliness and overall lack of social support have been shown to be factors that set clinicians at risk for boundary violations and romantic attraction to clients, and should be monitored.  Furthermore, since male therapists are more likely than females to engage in sexual contact with clients, male trainees may require additional supervisory support.
Although research concerning therapist-client attraction in the field of counseling lags behind other clinical disciplines, the literature in this area is growing.  In the meanwhile, counselors can look to research from other helping professions as well as our own Code of Ethics for instruction.  Hamilton and Spruill (1999) offered a comprehensive risk management checklist for use in supervision (Appendix A).  The “Checklist for Trainees and Supervisor” serves as a gauge of appropriate clinical boundaries for trainees and seasoned counselors alike, and provides supervisors with guidelines for comprehensive conversations with their trainees in this area.

supervision, counselor-client relationship, disclosure, training

For Further Reading:

American Counseling Association. (2005). ACA Code of Ethics. Alexandria, VA: American Counseling Association.
Hamilton, J. C., & Spruill, J. (1999). Identifying and reducing risk factors related to trainee-client sexual misconduct. Professional Psychology: Research & Practice, 30, 318-327.
Hartl, T. L., Zeiss, R. A., Marino, C. M., Zeiss, A. M., Regev, L. G., & Leontis, C. (2007). Clients' sexually inappropriate behaviors directed toward clinicians: Conceptualization and management. Professional Psychology: Research & Practice, 38, 674-681.
Ladany, N., & Melincoff, D. S. (1997). Sexual attraction toward clients, use of supervision, and prior training: A qualitative study of predoctoral psychology interns. Journal of Counseling Psychology, 44, 413-424.
Pope, K., Keith-Speigel, P., & Tabachnik, B. (1986).  Sexual attraction to clients: The human therapist and the (sometimes) inhuman training system.  American Psychologist, 41, 147-158.
Rodolfa, E., Hall, T., Holms, V., Davena, A., Komatz, D., Antunez, M., & Hall, A. (1994). The management of sexual feelings in therapy.  Professional Psychology: Research and Practice, 25, 168-172.

Appendix A: Risk Management - A Checklist for Trainees and Supervisors

Therapist Response to Clients

       Do you find it difficult to set limits on the demands your client makes of you?
       Do you accept phone calls from your client at home or your office when the client needs you to (a) help with a “crisis,” (b) deal with minor problems, or (c) alleviate his or her loneliness or meet his or her need to talk to someone who “understands”?
       Do you make statements such as “This is not my usual practice; I ordinarily don't do this, but, in your case … ” or “Under the circumstances, it seems OK to … ”?
       Do you find yourself wanting to rescue your client from some situation or behavior that is detrimental to him or her?
       Do you find yourself talking about your client to others?
       Does your client occupy your thoughts outside office hours?
       Do you hope you will “run into” your client at the grocery store, social settings, and so forth?
       Is it becoming progressively easier and more satisfying to share intimate details of your own life with your client?
       Do you find opportunities to talk about nontherapy issues with your client?
       Do you take care to dress or look more attractive than usual for a particular client?
       Do you find yourself wondering what the client thinks about you?
       Do you make excuses to talk with your client by phone?
       Do you accept friends of your client as therapy clients, and then find yourself spending a lot of the session talking about the original client to the current client rather than focusing on the current client's problems?
       Do you find yourself looking forward to seeing a particular client (or type of client) and feeling disappointed if he or she cancels the session?

Therapist Needs

       Does your primary satisfaction come from your work with therapy clients?
       Do you have more clients than required or more than your fellow practicum students?
       Are you lonely and feeling as if your needs are not being met by anyone?
       Do you have a circle of friends with whom you engage in pleasurable social activities?
       Do you have a circle of friends to whom you can turn for support?
       Do you have one or more close friends in whom you could confide about fears, anxieties, and self-doubts?
       What are the important stressors in your life, and what steps are you taking to resolve or to cope with them?

Session Characteristics

       Do you regularly extend the session for one client but not for others?
       Do you regularly start the session early, end it late, or both for one client?
       Do you schedule a particular client at times that afford the opportunity to linger, or to walk out of the clinic together, and so forth?
       Do you schedule the client after regular office hours because your schedule or the client's schedule does not permit regular office hours?


       Do you find yourself forgetting to document phone calls from your client?
       Do you find yourself getting defensive about particular clients or certain issues (e.g., you bristle when a supervisor suggests that there is no progress being made and a referral is in order)?
       Are you reluctant to talk about transference or boundary issues, particularly feelings related to sexual attraction by or to the client?
       Do you find it difficult to tell your treatment team or supervisor some details related to your client?
       Is there anything that you “try not to talk about” concerning a particular client?
       Do you find yourself putting off seeking supervision or consultation about a particular client or issue?
       Does the tape always run out or mess up at a “sensitive” point in the session? Does the therapy session regularly extend beyond the length of the tape?
       If you make phone calls, extend sessions, and so forth, how much of this information is recorded in the client's file? Do you find yourself unwilling, or “forgetting,” to document information with regard to a particular client?


       Have the secretaries or other people commented about your behavior toward a client?
       Have you offered to do such things as give the client a ride home, give tutoring in a difficult class, or arrange a meeting outside the therapy hour or place?
       Are you concerned about the client's feelings toward you, or your feelings toward the client?

Checklist for Supervisors

       Have I discussed how to establish a professional therapist–client relationship with my practicum students?
       Have I reviewed the issue of sexual attraction to clients and shared my own experiences with my practicum students? If I am unwilling to share my own feelings, what have I done about this?
       Have I created an atmosphere of openness and willingness to discuss the fears, uncertainties, and so forth of my practicum students?
       Do my practicum students know about boundary violations and the reasons for establishing boundaries?
       Have I discussed the checklist for students with them?

Hamilton, J. C., & Spruill, J. (1999). Identifying and reducing risk factors related to trainee-client sexual misconduct. Professional Psychology: Research & Practice, 30, 318-327.

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