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Sexual Exploitation, Not Consent

It was a shocking statement on January 28 in Annapolis during the HB 33 hearing when the lobbyist for the Maryland Board of Examiners of Psychologists declared that Lynette’s Law, a bill that would protect people from sexual exploitative mental health professionals, was about criminalizing consensual relationships. What’s shocking is the continued disregard by the state boards for their own code of ethics and professional literature which makes it quite clear that sex between a mental health professional and a patient is never consensual.

The publication "Professional Therapy Never Includes Sex".
State of California Department of Consumer Affairs

Immediately springing to the forefront is literature published by the Maryland Department of Health and Mental Hygiene, Broken Boundaries, which describes a sexually exploitative relationship as, “Sexual contact occurs between a helping professional and client in a relationship that, on the surface, may appear to be mutually consensual, but the patient's role make it impossible for her or him to give meaningful consent.”

What is that patient’s role and why is it impossible for her or him to give meaningful consent? Broken Boundaries explains that, too: “By its nature, the relationship between helping professionals and their clients is unequal. Trusting that professionals have their best interests at heart, clients become vulnerable in the health care setting. ... Because they depend on professionals' trustworthiness, knowledge, and authority, clients tend to not question a professional's judgment or behavior. This places the professional in a position of power and can make the client susceptible to exploitation.”

The State of California, where sexual exploitation by a mental health professional is a felony, produced a publication titled Professional Therapy Never Includes Sex which emphasizes, “Therapists are trusted and respected, and it is common for patients to admire and feel attracted to them. However, a therapist who accepts or encourages these normal feelings in a sexual way — or tells a patient that sexual involvement is part of therapy — is using the trusting therapy relationship to take advantage of the patient. And once sexual involvement begins, therapy for the patient ends.”

California adheres to the Code of Conduct set forth by the American Psychological Association and maintains this policy for two years after the therapeutic relationship has ended. In fact, according to the APA Standard 10.8, if a psychologist wishes to engage in “sexual intimacies” with a former client after those two years it has to be considered an unusual circumstance and they bear the burden of proving there has been no exploitation. It’s a solid policy, but why, the lobbyist seemingly neglected to ask herself, must they do this? It’s for all the reasons above and the severe harm produced.

Kenneth S. Pope, Phd., ABPP, author of Ethics in Psychotherapy and Counseling and considered one of the foremost experts on therapy sex abuse, provides the following statistics of a national study: “The findings suggest that about 90% of patients are harmed by sex with a therapist; 80% are harmed when the sexual involvement begins only after termination of therapy. About 11% required hospitalization; 14% attempted suicide; and 1% committed suicide.” The most common effects of victims that have been involved with therapist-patient sex include ambivalence between escaping the abusive therapist and protecting him or her, cognitive dysfunction, intense emotional eruptions, emptiness and isolation, impaired ability to trust, guilt, increased suicidal risk, role reversal and boundary confusion, sexual confusion (including believing their only worth is to provide sexual gratification to others), and suppressed anger which may lead to self-loathing, self-punishment, and self-destructive behaviors. An issue of consent wasn’t raised since it doesn’t exist in this dynamic, and the depths of these effects underscore how harmful and exploitative client sex with a therapist can be.

The founder of Lynette’s Law, Heather Sinclair, further describes this flagrant imbalance of power, “If people want to know how much power mental health professionals have they should put it in context. Mental health professionals have the power to decide whether you can own a firearm, whether you're involuntarily hospitalized, whether you're compliant with probation, evaluating and determining whether you get custody and/or visitation of your children, whether you can become a foster parent or an adoptive parent, hold a security clearance, and many times they're expert witnesses in criminal trials. That's an awful lot of unregulated power that they hold.”

Exploitative therapists know they hold this power and they groom their unsuspecting clients into believing it is a consensual situation when it can never be. They’ll tell their patients that what they’re feeling is normal and they may start suggesting sitting on the couch together to ease boundary tensions and slowly work in flirtatious remarks. The article “Don't Call It Consent: Being Groomed For Sex” on describes one case of escalated grooming starting with the therapist becoming “a friend” with weekly hugs to a kiss on the cheek and back rubs to holding during sessions to fondling all for “therapeutic reasons.” The patient continued to open herself up to her therapist in their sessions, fully trusting this manipulator, but the conversations grew more sexualized in nature. Finally, with the patient thinking she was in love, sex became “part of therapy.”

California reminds us, however, that, “It doesn’t matter if you, the patient, started or wanted the sexual involvement with the therapist. Therapists are responsible for keeping sexual intimacy out of the therapy relationship and are trained to know how to handle a patient’s sexual attractions and desires.” The Maryland DHMH booklet echoes that by stating: “The professional has a responsibility to control the boundaries of the relationship and to ensure that sexual activity does not occur.”

Again, the client's role makes it impossible for her or him to give meaningful consent. It’s psychological manipulation, and we know what sex without consent is. Lynette’s Law continues to work hard to protect mental health patients from this kind of sexual exploitation.

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