Sex in therapy

No, no, no! Sex is NEVER part of therapy.

The guiding principle for all therapists is to Do no harm. Having sex with a client does harm. You have to be able to trust your therapist completely. If he or she is benefiting from your relationship, other than earning a fee for the session, the relationship is not about you. It is about the therapist.

Because of the power dynamics and privacy of the client-therapist relationship, therapists can and have exploited clients sexually. While this behavior sounds unimaginable, it’s not forced sex that is the problem. Erotic transference–yes, it has a name–happens often in the therapeutic relationship. Some clients develop sexual feelings toward her or his therapist. This is a normal response to intimacy. But let me be clear, it is the client who has these feelings and talks about them in therapy. Not the therapist. The therapist’s role is to assist the client in working through her or his erotic transference. It is the therapist’s duty to protect the client from exploitation. When the therapist cannot do so, ethics and laws do.

Sex in TV therapy

Do you remember the HBO series (2008-2010) In Treatment? Beautifully written, captivating acting, compelling dialog, convincing story, it had just enough drama to keep you coming back for more each week. Some of the episodes looked a lot like ethical therapy, but some did not. In the first season, the writers and director portrayed Laura, the young attractive client, as a seductress who the therapist Paul Weston could not resist. This unfair, and even harmful, image implies that clients may not be safe in therapy, and that a client cannot talk about erotic transference with her or his therapist. In addition to Paul’s expressing his attraction to Laura and “coming on” to her, Paul’s supervisor, Gina, encouraged his pursuit of Laura!

  • If a therapist suggests that sex is okay or part of therapy, or if you ever feel physically unsafe or uncomfortable with a therapist, leave immediately.
  • If you feel attracted to your therapist, talk about it. IF YOU WANT TO.
  • If your therapist encourages you to talk about sex and you don’t want to, say so. If the therapist insists, find another therapist.
  • The therapist must always maintain the professional boundary and allow you to work through your feelings.
  • If your therapist does not respect the professional boundary in any way, find another therapist.

Again, sex is NEVER part of the therapy process.

What is sex?

According to the California Department of Consumer Affairs:

  • “Sexual contact” means the touching of an intimate part of another person, including sexual intercourse.
  • “Touching” means physical contact with another person either through the person’s clothes or directly with the person’s skin.
  • “Intimate part” means the sexual organ, anus, groin or buttocks of any person and the breast of a female.

Your talking about erotic transference, is not sex. The therapist’s innuendos, jokes, comments that feel invasive, touching in a sexual way, unwelcome hugs initiated by the therapist, kissing are. All of these threaten the client’s sense of safety. You might be thinking, “But I was the one who started talking about sex” or “I want to have sex with my therapist.” Sorry. There are no buts. If your attraction to your therapist gets in the way of the work you’re doing, it might be time to find another therapist.

Sex with a client does so much emotional damage, a therapist who crosses the sex boundary with a client and is reported will lose his or her license, serve jail time, and pay a fine. It’s not your responsibility to control your therapist’s sexual urges.

Be an informed client, read Therapy Never Includes Sex.

How do you know if your therapist is maintaining boundaries

A client-therapist relationship that’s headed for boundary crossing has “red flags”. If you answer no to any of the following questions, get a second opinion about your feelings.

  • Do you feel safe?
  • Does the therapist hear, understand, and respect you?
  • Can you talk to your therapist about anything with complete confidence that the therapist is interested in your well-being?
  • Can you express your feelings?
  • Do you feel satisfied with the therapist’s answers to your questions?
  • Does the therapist encourage you to talk about topics you are not ready or willing to talk about?
  • Would you like to continue working with this person?
Secrets, shame, and confidentiality

The most difficult feeling for most people to talk about is shame. If your shame has something to do with sex, you might not want to talk about it. The deeper the shame, the more you’ll keep the shameful topic(s) secret. Denial, secrets, and lies accompany the shame.

When you talk about shaming topics, you have to trust that your therapist will support you and maintain the professional boundary. That won’t happen if your therapist cannot control his or her feelings.

Sex in therapy – laws

In California, you are protected by the following laws.

  • Any act of sexual contact, sexual abuse, sexual exploitation, sexual misconduct or sexual relations by a therapist with a patient is unprofessional, illegal, as well as unethical as set forth in Business and Professions Code sections 726, 729, 2960(o), 4982(k), 4992.3(l), 4989.54(n), and 4999.90(k).

See the Department of Consumer Affairs web site for more information.

Sex in therapy – ethics

You are also protected by two marriage and family therapists’ associations and their professional codes of ethics.

The California Association of Marriage and Family Therapy (CAMFT):

Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient’s spouse or partner, or a patient’s immediate family member, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical.– CAMFT code of ethics

The American Association of Marriage and Family Therapy (AAMFT):

1.4 Sexual Intimacy with Current Clients and Others: Sexual intimacy with current clients or with known members of the client’s family system is prohibited.

1.5 Sexual Intimacy with Former Clients and Others: Sexual intimacy with former clients or with known members of the client’s family system is prohibited. –AAMFT code of ethics

Sex with a client is unethical. It is also illegal. You can read the entire codes of ethics published by the CAMFT  and the AAMFT at the end of this post. If you believe your therapist has acted unethically, you can phone either association for advice about what to do.

Summing it up

I hope that answers some of your questions about sex in therapy.

Want to learn more about finding the right therapist for you? Ben Butina has published an online guide on PsychCentral, How to Find a Good Therapist. It begins with a two-word sentence: THERAPY WORKS!!

CAMFT_Ethics  AAMFT_Ethics