Sexual Boundary Violations in Psychotherapy: Facing Indiscretions, Transgressions, and Misconduct

Presenter: Christine A. Courtois, PhD, ABPP

Have you ever said, “I would never do that?” “It would never happen to me” “That only happens to others in the field, not to me.” This is a common perception that most psychotherapists hold that does not account for a wide variety of situational and other circumstances. These will be addressed in this workshop.

The recent #MeToo movement, documenting sexual violations across professional and occupational settings, makes clear that such events are alarmingly common. The psychotherapy setting is no exception. In fact, the nature of therapy and counseling work may contribute to vulnerabilities, given the powerful and intimate emotions engendered. Violations may range from behaviors that are somewhat subtle and uncomfortable to those that are blatant, exploitative, and physically intrusive and range from comments and looks, and increasingly personal disclosures and invasive touching up to and including intercourse and involving rape in some cases. They can be a one-time occurrence or literally last years or decades. In many cases, they involve emotional abuse and coercion (grooming) on the part of the therapist and constitute betrayal trauma.

All major mental health and medical professions prohibit sexual contact between a psychotherapist/practitioner and client/patient as unethical and morally wrong. In most states it is against the law. Despite these prohibitions, sexual boundary violations (SBVs) have not gone away and may even be increasing. Myths including that they are rare, not serious, the result of a patient’s seductive behavior or pathology, and cause little harm will be discussed and challenged. In contrast, SBVs are now recognized as highly damaging with potential for profound and life-changing effects for both members of the dyad and for many third parties (collateral damage). Their occurrence is solely the responsibility of the therapist, regardless of the circumstance.

This presentation will provide an overview of contemporary knowledge on SBVs, based on a recently published book on the topic, co-edited by three psychologists, including the presenter. Special issues to be addressed include a brief historical review, development of ethical prohibitions, prevalence findings, causes and severity, grooming tactics, as effected by racial and cultural contexts and issues of intersectionality, digital forms, aftereffects for victim and therapist, bystander action and inaction, intervention for both parties, and whether rehabilitation and a return to practice are possible. A short video clip by a therapist/survivor will be played to emphasize the consequences. The workshop is intended as a forum for discussion and as a educational effort aimed at understanding and intervention and, most importantly, prevention.

Learning Objectives:

At the end of this workshop, participants will be able to:

1. Identify several reasons why professional boundaries are important in safeguarding both therapist and client.
2. Identify individuals and institutions that might be “collateral damage” when SBVs occur.
3. Describe SBV’s as a form of betrayal trauma that has many negative consequences.
4. Describe ways that therapists can work to prevent SBVs in their own therapies and can work with others when risk is evident.

Christine A. Courtois, PhD, ABPP, a board-certified counseling psychologist, retired from clinical practice in Washington, DC, is now a licensed psychologist, author and consultant/trainer on trauma psychology and treatment in Bethany Beach, Delaware. She is known for her work on adult survivors of developmental trauma in childhood and complex trauma and its treatment. Her co-edited book, Sexual Boundary Violations in Psychotherapy, was recently published; the revised edition, Treating Complex Traumatic Stress Disorders co-edited with Dr. Julian Ford, was published in 2020. In addition to other professional books, she has written a consumer book entitled It’s Not You, It’s What Happened to You. Dr. Courtois served as Chair of the Clinical Practice Guideline for the Treatment of PTSD in Adults for the American Psychological Association (2017) and is past president of APA Division 56 (Trauma Psychology). She co-founded and was Clinical and Training Director of a specialized inpatient and day treatment program, The CENTER: Posttraumatic Disorders Program in Washington, DC. She has received recognition for her work from several state, national, and international professional organizations, including the Cornelia Wilber Award and the Lifetime Achievement Award from the ISSTD.