Therapists Vulnerable to Sexual Misconduct Accusations

Sexual Misconduct Accusations

Between October and November 2017, former film producer and entertainment biz executive, Harvey Weinstein achieved infamy as the poster child for sexual misconduct after more than 80 sexual misconduct allegations covering a 30-year period surfaced in a mere 30-odd days.

In the immediate aftermath of the Weinstein allegations, there was some initial victim-blaming backlash toward Weinstein’s female accusers who were perceived by some, if not many, as using Weinstein to advance their own acting careers as much as he used them for his own sexual gratification – contributory negligence vis a vis the proverbial casting couch.

In the truncated period following the watershed Weinstein unraveling, legions of powerful men in politics, media and entertainment have become targets of sexual misconduct allegations launched against them by primarily female peers, colleagues and subordinates.

The second wave of complaints erased any doubt about the unfolding epidemic reflecting nothing more than the casting couch phenomenon endemic to Hollywood glitterazzis and wannabes.

The seeds of sexual misconduct are planted in gardens of power, and the celebrity status arising in its wake, providing wrongdoers with a cloak of invincibility woven from the threads of power, status and influence – powerful men banking on the fact that they could take sexual liberties with impunity because powerful men could never be taken down by subordinate women. Who would believe them anyway?

Some of these men admitted the wrongfulness of their conduct in its entirety, others accepted partial responsibility for something resembling the complainants’ allegations, and others went into full denial mode.

The only thing that is certain is that victims of workplace sexual misconduct have the stage in this theatrical production. They are coming out in record numbers, and their stories are being believed in large measure, particularly in the face of admissions of culpability by the wrongdoers.

Emboldened and empowered, victims are willing to risk outing individuals perceived as having violated their physical and sexual boundaries.

What does this mean for those of us who practice as psychologists? First, not only are we not immune from being potential targets of sexual misconduct allegations, but our work makes us especially vulnerable in some unique but important ways.

The work of psychotherapy and assessment necessarily takes place “behind closed doors,” often in a relational context of a significant and palpable power imbalance; power dynamics that are exaggerated in the face of gender, race, ethnicity, religious, sexual orientation and ability/disability differences – particularly when the client holds one or more less powerful or more disenfranchised statuses.

Being keenly aware of these power imbalances and insuring that you don’t unwittingly capitalize on any of them is good risk management practice.

Second, many clients seek psychological services precisely because they have been victims of sexual misconduct in childhood and/or adulthood. Vulnerabilities from unhealed childhood sexual trauma can result in both increased risk of adult sexual revictimization and in sexual acting out or other provocative or overly sexualized behaviors. And, those behaviors might be directed toward the service provider by the client because it’s a hauntingly familiar albeit dysfunctional dynamic involving recapitulation of the original harm.

Perhaps more than any other field, we are in a uniquely vulnerable position working with vulnerable individuals entrusted to our care in a relationally charged power imbalance. We must ensure that our actions are not perceived as crossing sexual boundaries even in the most nuanced ways, like commenting on a client’s attractiveness or appearance. We must be IMPECCABLE with our boundaries.

While it might be a newsflash to celebrities, politicians, and high-profile media execs that sexual improprieties committed by the powerful against the disempowered are always verboten, as psychologists we have been taught to honor and respect personal and professional boundaries in our work – ethics that are codified in the APA Ethics Code and in state practice statutes.

Research on the prevalence of therapist sexual misconduct against clients is well documented. As a profession, we are not immune from perpetrating acts of sexual misconduct against those we are obligated to care for. Ethics boards regularly announce the names of suspended or otherwise sanctioned psychologists who have committed sexual and other boundary violations.

Touch, even minor seemingly innocuous touch like patting a client’s shoulder or giving a hug may be potentially misinterpreted as an unwanted action the client doesn’t feel empowered to rebuff. Again, the interpretation of touch is context dependent and is substantially influenced by age, culture, race, ethnicity, and gender.

Good therapeutic practice dictates cautious, limited, and mindful use of touch in the context of therapy and always with awareness of whose interests are being served by the touch.

While therapy and assessment clients and their family members are potential victims of sexual assault, best practices include being mindful and aware of any comments, actions or behaviors that might cross physical or sexual boundaries or might make colleagues, students, mentees or staff feel uncomfortable because of their sexualized nature.

Organizational climate is a significant predictor of sexual harassment. Strive to create a safe space for employees, colleagues, and clients. Prudence would suggest sexual harassment education and the development of sexual harassment policies and practices if you work in an organizational or other institutional setting. If not, develop your own policy and guidelines for a sexual harassment free workplace. There are HR consultants and risk management resources available online to assist in that process if you work as a solo practitioner and don’t have organizational resources available.

To be meaningful in practice, sexual harassment prevention policies need to identify an individual to whom sexual misconduct allegations can be reported – ideally someone in a neutral position, not someone perceived to be aligned with the power hierarchy in an organization.

A process for investigating and responding to any sexual misconduct complaints needs to be in place. In the event that someone in the workplace is found to have engaged in sexual misconduct, corrective actions must follow or the policies and other practices are moot.

Being mindful, aware, and having impeccable boundaries, along with developing effective polices, practices and education are keys to successful risk management.

Therapy Tidbits – March/April 2018Course excerpt from Therapy Tidbits – March/April 2018 – a 1-hour online continuing education (CE) course comprised of select articles from the March/April 2018 issue of The National Psychologist, a private, independent bi-monthly newspaper intended to keep psychologists (and other mental health professionals) informed about practice issues. Click here to learn more.

This online CE course is sponsored by:

Professional Development Resources is a nonprofit educational corporation 501(c)(3) organized in 1992. We are approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC); the Association of Social Work Boards (ASWB); the American Occupational Therapy Association (AOTA); the American Speech-Language-Hearing Association (ASHA); the Commission on Dietetic Registration (CDR); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy, Psychology & School Psychology, Dietetics & Nutrition, Speech-Language Pathology and Audiology, and Occupational Therapy Practice; the Ohio Counselor, Social Worker & MFT Board and Board of Speech-Language Pathology and Audiology; the South Carolina Board of Professional Counselors & MFTs; the Texas Board of Examiners of Marriage & Family Therapists and State Board of Social Worker Examiners; and are CE Broker compliant (all courses are reported within a few days of completion).

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Physicians in Hot Water for Online Missteps

By John Gever, Senior Editor, MedPage Today

Most state medical boards have received — and acted on — complaints about physicians’ online behavior, a survey showed.

Physicians in Hot Water for Online MisstepsOf 48 state medical boards responding to the survey, all but four indicated that they had received reports of “online professionalism violations” at some point, such as prescribing drugs over the Internet without seeing the patients or misrepresenting credentials, according to S. Ryan Greysen, MD, of the University of California San Francisco, and colleagues.

Most of the complaints led to disciplinary proceedings or consent orders, Greysen and colleagues reported in a research letter published in the March 21 Journal of the American Medical Association.

The letter did not indicate the total number of violations or their outcomes, but many of the boards indicated that they had received more than three reports of potential violations in some of the eight specific categories covered in the survey.

“Inappropriate patient communication online” — a category that included sexual misconduct — had been reported to nearly all the 48 responding boards, as were misrepresentations of credentials and use of the Internet for inappropriate practice, such as online prescribing to unseen patients.

Somewhat less common, but still reported by at least half of the boards, were complaints about the following online behaviors:

  • Violation of patient confidentiality
  • Failure to reveal conflicts of interest
  • Derogatory comments about patients
  • Depictions of intoxication
  • Discriminatory language or practice

The survey was sent to 68 executive directors of state medical and osteopathic boards, with a response rate of 71%.

One-quarter of respondents indicated that their boards had taken no action on one or more reported violations. More than 70% of respondents said they had pursued some type of disciplinary procedure including formal hearing, consent order, or informal warning.

Suspension, restriction, or revocation of licenses had occurred at 56% of boards. Other sanctions included letters of reprimand, fines, and mandatory education or community service.

Violation reports came from different types of sources — patients or their families, other physicians, other types of professionals, or board staff during the course of other investigations.

Online misbehavior by physicians is probably still rare, Greysen and colleagues wrote, but “this is likely to change as the use of social media continues to grow.”

The researchers also noted that the violations in many cases were serious, and their public nature “may reflect poorly on physicians’ values.”

Greysen and colleagues suggested that regulators and physicians should specifically address online practices through “consensus-driven, broadly disseminated principles.”