Title:
Supervision
Addressing Counselor-Client Sexual Attraction
Author:
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.
Labels:
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?
Accountability
•
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?
Other
•
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.
