Chapter 7 Summary
Sexual exploitation of clients by therapists is a blatantly unethical practice, as is sexual contact with students, employees, supervisees, research participants, and others for whom the
professional has responsibility. Sexual contact with former clients is always prohibited for at least two years after the termination of therapy. The limit is five years in the ACA Code. Even after
this period sexual contact is permitted only in the most unusual circumstances and only in some professions. The codes do not directly address the issue of sexual contact after teaching or
supervision responsibilities have ended, but in these cases professionals must demonstrate that the supervisory responsibilities have truly ceased. Moreover, they must be able to show that the
sexual contact is nonexploitive.
Sexual misconduct by mental health professionals has been widely studied, and the results show clear evidence of sexual exploitation by professionals. Up to 12% of therapists have admitted sexual
contact with current and former clients, and some have acknowledged multiple contacts. Since this research relies on the willingness of professionals and clients to disclose such events in therapy,
the reliability of that figure is probably not high. In any case, surveys of mental health professionals have found that approximately half of those sampled have seen at least one client who
reports an experience of sexual exploitation by a former therapist. A similar percentage of faculty and supervisors have admitted the same misconduct. The only demographic variables associated with
this violation are gender and, to a lesser degree, age. Older male therapists and faculty are more likely to engage in this behavior than younger or female therapists. Victims, on the other hand,
are more likely to be female and younger than the therapist. Children as well as adults have become victims of sexual exploitation by therapists. Research has shown that sexual misconduct inflicts
serious and long-lasting psychological damage on victims. In fact, that damage has been compared to the effects of rape or incest.
Sexual misconduct needs to be distinguished from experiences of sexual arousal. A great majority of counselors and therapists report having been sexually attracted to a client on occasion. The
experience of attraction is not unethical in itself as long as it is handled responsibly. The counselor has the duty to monitor his or her behavior so that the attraction does not distract the
client from the therapeutic focus of the session and does not prevent the counselor from providing competent service. Consultation and supervision are also advised when an attraction occurs.
Given this context, it is not surprising that the use of nonerotic touch as a therapeutic approach is controversial. Some call it taboo, and others view it as an appropriate if used wisely. All
professionals regard nonerotic touch as inappropriate if it serves the professional’s needs over the clients’ or is insensitive to cultural, social, or gender considerations.

Essay Question 1
Sexual contact with former clients is one of the most controversial issues in the field. Describe the position of the APA and ACA codes on this topic and at least three reasons some scholars
disagree strongly with this position.

Chapter 8 Summary

Effective, beneficial counseling and psychotherapy depend on the therapist’s ability to provide objectivity and single-minded commitment to the client’s welfare. It also depends on the client’s
ability to trust the professional. Implicit in that trust is confidence in the professional’s selfless interest in the client and a sense of emotional closeness to the professional. When a
practitioner has an additional personal or professional relationship with a client, objectivity, selfless commitment to the client, and client trust are all endangered to some degree. In other
words, when a practitioner is both friend and researcher or therapist and teacher, the professional is putting him- or herself in a conflict-of-interest situation. Both parties in the professional
relationship may be hampered in reaching their therapeutic goals by the existence and demands of the other relationship. Having more than one relationship with a person with whom there is or has
been a professional relationship is called a multiple relationship or nonprofessional interaction. The terms, boundary crossing and boundary violation, are also used, the former to designate
multiple relationships at low risk for harm to clients, and the latter to identify high risk relationships.
The ethical difficulties of multiple relationships are most apparent in therapeutic relationships, but they are often inappropriate in other forms of professional contact as well. Nonsexual
multiple relationships with clients seem to occur more frequently than sexual relationships, according to researchers. The professions’ ethics codes do not universally endorse multiple
relationships, but their provisions have become less restrictive in recent years and thereby place a greater burden on the professional to use good ethical judgment. The criterion on which they
base this judgment is the professional’s duty to promote the client’s welfare without undue risk of harm. Multiple connections with clients can impair objectivity, interfere with therapeutic
progress, and affect the client’s emotional connection to the clinician. They also can intensify the power difference between professional and client, and can result in exploitation of clients.
Multiple relationships have these effects partly because the obligations and expectations from different roles are often inherently incompatible. The more divergent the obligations of two roles,
the more likely the multiple relationship will be unethical.
Because not all multiple relationships can be avoided, especially in rural and small community settings, professionals need to examine carefully whether to start a particular multiple relationship.
Clients’ access to alternative competent care ought to be considered, along with cultural variables and the potential for an individual to benefit from services despite the multiple connection.
Generally, though, the attitude of the mental health professional should be to prevent risk (Sonne, 1994). High-risk relationships should not be initiated even if they have the potential to do
good. If the relationship cannot be avoided, the professional should discuss the implications and risks of the situation with the client, and then carefully document both that discussion and the
subsequent progress of counseling. The professional should seek expert supervision and develop an alternative plan in the event of unforeseen complications. If practitioners find themselves
frequently engaging in multiple relationships, they need to examine their motivation and become more creative in finding alternative access to care for the clients involved. Counselors following
the ACA Code must be especially vigilant to ensure that the potential benefit of a non-professional interaction with a client or former client is truly merited.
Bartering—trading goods or services instead of money for counseling—is also a practice discouraged by the ethics codes, but not forbidden. A professional who is entertaining a bartering
relationship with a mental health client should read the professions’ codes carefully and should consult his or her state laws and regulations. Some states forbid the practice, and some
professional liability insurers exclude claims resulting from a bartering arrangement.

Essay Question 2

What decision rules should a counselor use prior to accepting barter from a client? Give an example of a circumstance under which you believe accepting barter to be ethical and one in which it
would be unethical.

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