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The data of Abramowitz, Abramowitz, Roback, Corney, and McKee , for instance, suggested that female therapists actively avoid treating attractive male clients. In such an anti-libidinal atmosphere, it is little wonder that even such an experienced, well-respected, authoritative therapist as Searles described the courage it required for him to publish his work concerning genital excitement during analytic hours as well as erotic and romantic dreams about patients.

An analogue study by Schover l found male therapists reacting "with anxiety and verbal avoidance of the material" when a female client discussed sexual material. If such feelings are intimidating for experienced therapists, they pose an even greater problem for therapists in training.

Tower described the erotic feelings and impulses that she believed virtually all therapists feel toward their patients, and the fears and conflicts regarding these feelings that lead therapists to withhold discussing the attraction with their own therapists or supervisors. In discussing supervision in training institutions, Lehrman maintained that "such guilt-ridden erotic feelings are a major, if not the major, problem of young male psychotherapists treating attractive female patients.

Given the taboos against acknowledging attraction to a client, the lack of virtually any systematic research in the area is understandable.


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Yet it is dismaying. An understanding of this phenomenon, based upon empirical data, could form a crucial but long-neglected part of our training as psychologists. Indeed, the sexual attraction experienced between those involved in the training programs themselves may be a troublesome and difficult-to-address part of the problem. One out of four recent female graduates had engaged in such sexual relationships. Thirteen percent of the educators engaged in relationships with their students and supervisees.

The extent to which such relationships exert a "modeling effect" for later professional behavior as a therapist awaits more systematic research. For women, sexual contact as students was related to later sexual contact as professionals. The sample of men who had had sexual contact with their educators was too small to test the relationship to later sexual contact as professionals with clients.

The profession of psychology would benefit from a careful examination of the attraction therapists feel for their clients. The study reported in the following sections represents an attempt to gather relevant information. A cover letter, a brief item questionnaire 15 structured questions and 2 open-ended questions , and a return envelope were sent to 1, psychologists men and women randomly selected from the members of Division 42 Psychologists in Independent Practice as listed in the APA Membership Register.

The anonymous questionnaires were numbered in the order received and transferred to a data file for statistical analysis. The questionnaire requested respondents to provide information about their gender, age group, and years of experience in the field. Questionnaires were returned by respondents Of these, or The differential return rate resulted in a male-to-female therapist ratio of about 1.

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In an effort to shed light on the reason for this differential return rate, we sent a brief follow-up letter three months later to female respondents randomly selected from the original survey sample, requesting information about their response to the questionnaire; if they had not returned the questionnaire, we asked why. The responses of the 40 female psychologists who responded only to the follow-up were not very helpful in illuminating the reasons for the discrepancy. The single most common response was too busy. Approximately half For purposes of descriptive convenience, respondents 45 years of age and under are designated as the younger therapists and those 46 and over are designated as the older therapists.

Two hundred and eighty-six respondents men and women were younger therapists; respondents men and women were older therapists. Respondents averaged Younger therapists averaged Only 77 of the respondents reported never being attracted to any client. These were used to evaluate the response categories as a function of sex and age under 45 and over 45 years of age categories.

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Of interest were the 3-way associations among response, age, and sex; the 2-way associations between response and sex and between response and age; and the test for equal frequency of the use of response categories. Table 1 presents the frequencies and percentages of attractions for the sex and age groups of the therapists. Table 2 describes in detail the frequencies and percentages of attraction to male and female clients by male and female therapists.


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A 2 X 2 X 2 between-within-within unweighted means ANOVA was performed on therapist rate of attraction to clients as a function of therapist age category younger and older , sex of therapist, and sex of client. The rating scale was based on frequency of attraction. Respondents indicating that they were never attracted to a client received a 1, respondents who were rarely attracted operationally defined as once or twice in the survey form received a 2, those who were occasionally attracted operationally defined as 3 to 10 times received a 3, and frequently attracted therapists operationally defined as more than 10 times received a 4.

Of the therapists who had considered sexual involvement, 91 had considered it only once or twice. Therapists did not differ significantly according to age. A content analysis was performed on responses to an open-ended question, In instances when you were attracted [to a client] but did not become sexually involved, why did you refrain from the involvement?


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    8. Table 3 lists the major reasons offered in order of frequency mentioned. Patterns were proportionately similar for male and female therapists except for two categories, fear of retaliation by clients and the illegality factor, which were offered only by male therapists as reasons for not acting out sexual feelings toward clients.

    Respondents were asked, "While engaging in sexual activity with someone other than a client, have you ever had sexual fantasies about someone who is or was a client? Such fantasies were reported to have occurred rarely by The vast majority of respondents Sexual intimacies with clients occurred rarely once or twice for 5. Male therapists engaged in sexual intimacies with clients more often than did female therapists 9. Client characteristics that elicited feelings of sexual attraction from therapists were assessed by an open-ended question: "How would you describe the clients to whom you've been attracted?

    Are there any particular salient qualities or similarities among them? The descriptive items were sorted into 19 content categories presented in order of frequency as Table 4. Male and female therapists' responses were fairly balanced proportionately for all of the categories except two. The data about psychologists in the previous table come from a national study published as "Sexual attraction to patients: The human therapist and the sometimes inhuman training system" by Kenneth S.

    Tabachnick, American Psychologist , vol. Tabachnick, and Kenneth S. Respondents who reported attraction to clients were asked if sexual attraction toward clients had ever been beneficial to the therapy process. Regarding potential negative effects, respondents were asked if their sexual attraction had ever been harmful or an impediment to the therapy process. Half Younger and older therapists did not differ significantly in this respect. A post hoc comparison revealed that the significant sex-by-harm interaction was eliminated if those who believed that the clients were aware of the therapist's attraction were selected out and compared on the negative effect item.

    To assess therapists' concern about their attraction to clients, respondents were asked, "When you are attracted to a client, does it tend to make you feel uncomfortable, guilty, or anxious? No significant differences emerged between male and female therapists in this regard. Respondents who had been attracted to clients were asked, "In instances when you were attracted to a client, was the client aware of it? For this item, a significant three-way association emerged. Mutuality was assessed by the question, "In instances when you were attracted to a client, was the client also attracted to you?

    There were no significant sex or age group differences. We were interested in learning if the respondents' graduate training programs and internships had provided courses or other structured education about sexual attraction to clients. No significant sex or age differences related to training experience emerged. Male and female therapists did not differ significantly on the rate of seeking consultation. The long-standing absence of systematic research on this topic might give the impression that psychologists—unlike other human beings—are incapable of experiencing sexual attraction to those they serve, or that the phenomenon is at most a strange and regrettable aberration, limited mostly to those relative few who engage in sexual intimacies with their clients.

    This study presents some initial data providing clear evidence that attraction to clients is a prevalent experience among both male and female psychologists. Our data suggest that this widespread phenomenon is one for which graduate training programs and clinical internships leave psychologists almost entirely unprepared. As discussed in the introduction, inattention to this topic in educational programs may be due partly to the taboo nature of the phenomenon and to the belief that such attraction is dangerous and anti-therapeutic.

    It may also be the consequence, in part, of the fact that there is virtually no research-based information about the subject, that there is "nothing to teach. If training programs, by their-behavior and example, suggest that the issue of attraction is to be shunned and that feelings of attraction are to be treated as dangerous and anti-therapeutic, it is not surprising that individual psychologists tend to experience feelings of attraction with wary suspicion and unsettling discomfort.

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    In our survey, more younger psychologists than older psychologists reported such negative feelings, which suggests that whatever efforts training programs have made in the recent past to address these issues have not been fully successful. This is especially true of younger psychologists and those who felt uncomfortable, guilty, or anxious about the attraction. Although seeking help from a colleague may in part reflect the view that attraction is a sign that something has gone wrong with the therapy, such consultation and supervision can give psychologists access to guidance, education, and support in handling their feelings.

    Thus the phenomenon seems to be one that generally goes unmentioned in the psychotherapy relationship itself. Thus, these psychologists seemingly have refrained from talking about the attraction with anyone else, at least within the context of their professional work. Even though sexual attraction for some psychologists remained unspoken to colleagues and clients, it nevertheless could find expression in the fantasy life and sexual behavior not involving the client of a minority of the profession. The age and gender differences are consistent with the research regarding sexual fantasizing in general, which shows higher rates for males and for younger adults Pope, It is important to note, however, that the questionnaire item was limited to sexual fantasies occurring during sexual activity with someone else.

    Thus, the rates of more general sexual fantasizing about clients may be much higher. Geller, Cooley, and Hartley pioneered a research strategy for systematically exploring the ways in which therapy clients mentally represent their therapists through fantasy, mental imagery, imagined conversations, etc. Such a strategy could be adapted to study the ways in which therapists mentally represent the clients to whom they are sexually attracted.

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    The percentages of all respondents 9. The 8 studies table shown above presents summary data from the national studies of sex between psychologists, psychiatrists, or social workers and their clients that have been published in peer-reviewed journals. Pooling the data from the 5, participants in these national studies reveals that overall about 4.

    The gender differences are significant: about 6. For further analyses involving profession, year of publication, etc. Perhaps the courts and regulatory agencies have removed from practice or altered the practices of some psychologists who engaged in extreme and frequent violation of the prohibitions against therapist-client sex.

    The publicity accompanying such cases, as well as the increased attention to imposing explicit sanctions for such violations, may have deterred or restrained many others.