Sexual Boundary Violations in Psychotherapy

Regardless of what model of psychotherapy is used, all therapists are vulnerable to boundary transgressions. This book explains why this is this case, and how to avoid such violations.

Professional attitudes toward sexual boundary violations (SBVs) have evolved over the years, resulting in ethical and legal guidance to prevent such violations. Despite this guidance, SBVs still occur in treatment, and institutions and colleagues often deny or rationalize them. Therapists need a deeper understanding of how SBVs occur in order to avoid them.

This book examines the events leading up to SBVs as well as what happens to clients and therapists once they are discovered. The book also considers the broader effects of such behavior on colleagues, institutions, families, and others. Numerous case illustrations are included to illustrate how therapeutic relationships are compromised, sometimes in subtle and gradual ways. Authors emphasize the importance of therapist education and consultation with mentors and peers to maintain a professional frame for the therapeutic relationship.

Foreword
Kenneth S. Pope

1. Sexual Boundary Violations in the Psychotherapy Setting: An Overview
   Arlene (Lu) Steinberg, Judith Alpert, and Christine A. Courtois

I. Ethical and Legal Issues

2. The APA Ethics Code and Legal Statutes Regarding Sexual Boundary Violations: History and Current Status
   Linda Campbell, Linda Knauss, and Lauren Meaux
3. Boundaries and Ethics of Professional Conduct
   Stephen B. Levineand Christine A. Courtois

II. Perspectives From Different Theoretical Orientations

4. Erotic Transferences and Countertransferences in Sexual Boundary Violations: An Interview with Andrea Celenza
   Interviewers: Arlene (Lu) Steinberg and Judie Alpert
   Interviewed: Andrea Celenza
5. Psychoanalytic Perspectives on the Problem of Erotic Idealization
   Elizabeth Goren and Sue Grand
6. A Cognitive Behavioral Approach to Understanding Sexual Boundary Violations
   Amy Wenzel
7. Going Beyond the Contact Boundary: A Gestalt Therapy Perspective
   Monique N. Rodriguez
8. The Art of Helpful Sex Talk in Therapy: A Psychoanalytic Sex Therapist Speaks
   Elizabeth Goren
9. Sexual Misconduct in the Feminist Therapy Realm
   Laura S. Brown and Christine A. Courtois

III. Unique Settings and Populations

10. Sexual Boundary Violations in Pastoral Counseling
    Christine A. Courtois and Arlene (Lu) Steinberg
11. Sexual Boundary Violations in the Digital Age: New Frontiers and Emerging Challenges
    Frederic G. Reamer
12. Considering Racial and Cultural Context in Sexual Boundary Violations
    Pratyusha Tummala-Narra
13. Sexual Boundary Violations Outside of Cisgender/Heterosexual Dyads
    Elizabeth Clark and Kori Bennett

IV. Dynamics and Effects

14. Mind F*CK: The Grooming Process in “Professional Incest”
    Christine A. Courtois and Judie Alpert
15. Grooming and the Dynamics of Abuse as Experienced and Viewed through the Eyes of Victims and Peer Advocates: Cases from TELL
    Janet Wohlberg
16. Three Victim/Survivors Speak: Stories of Confusion, Shame, Anguish and Resilience
    Christine A. Courtois, Judith Alpert, and Goldie Eder
17. When Colleagues Betray: The Harm of Sexual Boundary Violations in Psychotherapy Extends Beyond the Victim
    Jennifer M. Gomez, Laura K. Noll, Alexis A. Adams-Clark, and Christine A. Courtois

V. Responding to Sexual Boundary Violations in Psychotherapy

18. Treating Clients Who Have Been Sexually Abused by a Therapist
    Tyson Bailey and Laura Brown
19. Supervision with Therapists Who Have Engaged in Sexual Misconduct
    Gary R. Schoener
20. The Treatment of Therapists Who Sexually Offend
    Philip Hemphill, Christine A. Courtois, Mark Gold, Alexis Polles, and Drew Edwards

Epilogue: Prevention and Intervention
Judith Alpert, Arlene (Lu) Steinberg, and Christine A. Courtois

Arlene (Lu) Steinberg, PsyD, is an adjunct associate professor at Ferkauf Graduate School of Psychology, where she supervises clinical psychology graduate students and teaches psychological counseling to rabbinic students, and is a practicing psychoanalyst in New York City. She is author of several articles and chapters on trauma. She recently co-edited the special issue of Psychoanalytic Psychology (2017) on sexual boundary violations with Dr. Alpert.

She is past Treasurer of Division 39 (Psychoanalysis) of the American Psychological Association (APA). She is currently serving a 3-year term as Division 39 representative on the APA Council of Representatives.

Judith L. Alpert, PhD, is professor of applied psychology at New York University and Faculty and Clinical Consultant at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis. She has edited six books and numerous journal articles on trauma and women’s issues. She co-edited the special issue of Psychoanalytic Psychology (2017) on sexual boundary violations with Dr. Steinberg and practices psychotherapy in New York City.

She was the first president and a founding member of Division 56 (Trauma Psychology) of the American Psychological Association (APA). Dr. Alpert is the recipient of the Award for Scholarship from Division 39 (Psychoanalysis) of APA.

Christine A. Courtois, PhD, ABPP, a board-certified counseling psychologist retired from clinical practice in Washington, DC, has been an adjunct professor of psychology and social work at several universities and is now an independent consultant/trainer/author on topics of trauma psychology and treatment. She has authored, co-authored, and co-edited a dozen professional books on the dynamics and treatment of child sexual abuse, complex trauma, and PTSD.

Dr. Courtois is past president of Division 56 (Trauma Psychology) of the American Psychological Association and founding Associate Editor of the division’s journal, Psychological Trauma. She has received numerous professional awards from several organizations.

This outstanding new book is a must-read for mental health professionals. It is the most comprehensive resource to date on the subject of boundary violations and the damage they inflict on patients. The authors and editors are to be congratulated for their remarkable volume—it deserves a place on the shelves of all practitioners.
—Glen O. Gabbard, MD, Author of Boundaries and Boundary Violations in Psychoanalysis

It is unusual in the professional literature to find a book that is both very broad in its scope, yet filled with analytic detail addressing questions raised by the material. Clinical, legal, ethical, and treatment considerations are all covered. Several sections—for example, discussing clergy sexual misconduct, grooming, racial and sexual identity issues—have not been so well and thoroughly discussed in other sources. This text should be an excellent starting point for entry into this charged area.
—Thomas G. Gutheil, MD, Professor of Psychiatry, Harvard Medical School, Boston, MA

Psychologists take pleasure in thinking of themselves as healers. Sexual boundary violations do occur, though, and the integrity of our field demands that we confront this painful reality. Covering a wide variety of topics in a thorough and probing way, editors Steinberg, Alpert, and Courtois deserve our thanks for assembling a volume that educates us and pushes us to reflect deeply and to remain alert and vigilant about preventing such violations.
—Elliot Jurist, PhD, Professor, Psychology and Philosophy, The City College of New York, New York, NY