Herbert S. Strean - Therapists Who Have Sex With Their Patients: Treatment And Recovery

Therapists Who Have Sex with Their Patients

Treatment and Recovery

Treatment and Recovery

Herbert S. Strean, D.S.W.

Library of Congress Cataloging-in-Publication Data
Strean, Herbert S.

Therapists who have sex with their patients: Treatment and
recovery / Herbert S. Strean.

p. cm.
Includes bibliographical references and index.
ISBN 0-87630-7244
1. Psychotherapist and patientSexual behavior.
2. Psychotherapist and patientSexual behaviorCase studies.
3. Psychotherapists Mental health. 4. Psychotherapists Sexual
behavior. 5. Psychotherapists Counseling of. I. Title.
RC480.8.S755 1993

616.89'023 - dc20 93-17864

CIP

Copyright 1993 by Brunner/Mazel, Inc.

All rights reserved. No part of this book may be
reproduced by any process whatsoever without the
written permission of the copyright owner.

Published by
BRUNNER/MAZEL, INC.
19 Union Square West
New York, New York 10003

Manufactured in the United States of America

10 9 8 7 6 5 4 3 2 1

To my sons
Richard M. Strean, Ph.D.
and
William B. Strean, Ph.D.

with love

Chapter II The Case of Ronald Sterling:
A Macho Psychiatrist Afraid of theWoman With

Chapter III The Case of Roslyn Mason:
A Psychoanalyst Who Administers Expensive Love Therapy

Chapter IV The Case of Bob Williams:
A Sex Addict Who Believes His Women Patients Hunger For Him

Chapter V The Case of Al Green:
A Sadomasochistic Social Worker Who Makes His Female Ex-patients Suffer

Chapter VI Conclusions:
Treatment Principles, Cautionary Notes, and Preventive Measures

For over 25 years, the major part of my professional life has been devoted to teaching, supervising, and treating mental health practitioners. One important dilemma of psychotherapy that virtually all of my professional colleagues continue to discuss with me is how to respond to their patients' sexual fantasies toward them and how to cope with their own sexual feelings toward their patients.

The anxieties, discomforts, and temptations that most of my students, supervisees, and patients share with me are not unique. Ever since the formal inception of psychotherapy, clinicians have had to cope with the sexual stimulation that the therapeutic situation activates in both participants. Although no two therapeutic relationships are identical, because each patient and therapist brings his or her own special dynamics, history, and adaptive mechanisms to the treatment situation, all mental health professionals are obligated to monitor their sexual desires, experience them fully without acting on them, and control them without pressuring themselves or their patients to deny, suppress, or repress sexual feelings and fantasies.

When I was a beginning therapist, I tended to inhibit, deny, and repress erotic feelings toward my patients. I find this to be true with most beginning practitioners in the 1990s. And this was also how one of the first psychotherapists in history dealt with the sexualized transference-countertransference interaction. When Freud's colleague, Dr. Joseph Breuer, noted that his patient, Anna O., lusted after him and wanted him to father her baby, he stopped her treatment and abruptly went off on a second honeymoon and had a baby with his wife.

Dr. Breuer, like many current mental health professionals, did not recognize that his patient's erotic desires were essentially displaced childish fantasies that she harbored toward her own parents. He probably did not realize either that he was turning his patient into an attractive but forbidden mother figure-his mother's first name was Bertha, as was Anna O.'s (a pseudonym for Bertha Pappenheim).

Inasmuch as we therapists are "more human than otherwise" (Sullivan, 1953), there is always the temptation to view the patient's falling in love with us as sexually titillating and nar- cissistically enriching. However, when, like Breuer, we do not recognize that the patient's sexual transference is a replication of his or her neurotic problems and start worrying about having an affair with the patient instead, we are distorting the patient's productions and seeing ourselves unrealistically. Worrying about acting out sexually with a patient usually disguises our wish to do so. It also reveals that we have desires to abdicate our role-set as interpreter, clarifier, and facilitator and want to become the patient's lover instead of his or her therapist.

It has been my consistent observation that when clinicians fail to help their patients talk in detail about their sexual fantasies toward them, they are usually working overtime to renounce their own wishes to have an affair with these patients. The inhibited therapist, who, in my opinion, is often excessively moralistic, is so frightened of the wish to act out sexually with the patient that he or she avers in effect, "Sex does not exist here." This practitioner fails to appreciate the infantile nature of sexuality, does not see how infantile sexuality always plays a dominant role in the individual's neurotic conflicts, and is not aware of how and why the patient and therapist are distorting each other. In effect, this therapist is like a phobic child very afraid of libidinal wishes toward parents and parental figures.

Through my intensive study of this phenomenon-the unconscious meaning of a therapist's renouncing the sexual dimension of psychotherapyI have come to realize that this professional is really a sexually stimulated human being who is hostilely shunning the libidinal component in the therapeutic interaction. The sexual dimension of treatment is avoided by him or her because it is so tempting to act out, but it also appears very forbidden. In reality, the puritanical, moralistic therapist is actively inhibiting what the therapist who has sex with patients is acting out. The differences between the two are not so great!

Although the inhibited clinician and the one who acts out sexually with patients are both trying to cope with much anxiety, both are human beings who are suffering a great deal. We mental health professionals tend to behave much more punitively toward those colleagues who act out sexually with their patients than toward those who squelch their patients' emotional spontaneity. We tend to be much more nonjudg- mental and accepting of those professionals who inhibit their patients' sexuality, who fail to fully appreciate their patients' humanness, and who retard their patients' growth than we are toward those colleagues who have affairs with their patients. Yet, neither the repressed practitioner nor the sexually acting- out practitioner is substantially helping his or her patients! In my opinion, it is an open question as to who is hurting the patient more.

We psychotherapists have a strong tendency to repeat history. Freud, who abstained from having sex with anybody for a good part of his adult life, was very critical of his colleague Carl Jung for having affairs with two of his female patients. Avowing that the psychoanalyst should behave like a surgeon who has no feelings at all toward patients, Freud came close to championing the notion that the clinician should repress sexual interest in the patient. Although he was also very critical of another colleague, Sandor Ferenczi, who hugged his patients, Freud might have been more successful in the treatment of his teenaged patient, Dora, if he had acknowledged his own wishes to hug her.