Am J Psychiatry 1991; 148:1466-1473
Copyright © 1991 by American Psychiatric Association
Psychotherapist-patient sexual contact after termination of treatment: an analysis and a proposal
PS Appelbaum and L Jorgenson
Department of Psychiatry, University of Massachusetts Medical School, Worcester.
Controversy over the legitimate extent, if any, of sexual contact between
psychotherapists and former patients remains intense. In this paper the
authors review current approaches to controlling posttermination sexual
contact, offer a conceptual framework within which the problematic aspects
of therapist-patient sex both during and after treatment can be understood,
and develop a set of recommendations for policies that balance the goals of
protecting former patients and avoiding unnecessary interventions into
consensual relationships. Review of ethical, legal, and administrative
controls on posttermination sex revealed considerable heterogeneity of
approaches, which appeared to be based on confusion concerning the
rationale for restriction. An analysis of the problems with
therapist-patient sexual contact suggests four areas of concern: impaired
decision making, coercion, fraud, and exploitation of a fiduciary
relationship. The nature and magnitude of these problems differ in pre- and
posttermination sexual relationships. The authors conclude that clarity of
restrictions on posttreatment sex is important, but an absolute ban is not
essential to protecting former patients. Rather, a 1-year waiting period
after termination, during which even social contact would be precluded,
should minimize problems and allow former patients and therapists to enter
into intimate relationships. The authors discuss the advantages and
disadvantages of this approach over other approaches.
