Transcript Slide 1
Psychotherapists’ handling of sexual attraction to clients: A grounded theory Dr Anthony Arcuri1,2 and Dr Doris McIlwain1 1 Department of Psychology, Macquarie University, Sydney, Australia 2 National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, Australia 13th International – 2nd World Conference of the Association of Psychology and Psychiatry for Adults and Children (A.P.P.A.C.) Athens, Hellas, 20 May to 23 May 2008 Background • Decades of absence from psychotherapeutic discourse • In last 20 years, some progressive research: largely descriptive, sporadic, fragmented, primarily US-based • In particular, no theory • RQ: What is the process of psychotherapists’ handling of sexual attraction to clients? Method – Grounded Theory • A method where data is collected via interviews and analysed qualitatively • Generator of theory “where existing theory is inappropriate, too abstracted, or absent entirely” (Henwood & Pidgeon, 2003, p. 134). • Aim is to produce an innovative theory that is ‘grounded’ in data • Achieved via a two-way process between the researcher’s conceptualisations and the raw data The participants • • • • • Eleven psychologists who practice psychotherapy Six men, five women Mid-twenties to mid-sixties One to 40 years’ experience Varying theoretical orientations – Learning theory-based (CBT, DBT, ACT) – Psychodynamic – Narrative – Systemic family therapy – Humanistic • Interviewed about hypothetical experiences of sexual attraction to clients The theory Sexual attraction develops Appraisal of context manageability Decision-making ethics, consequences Actions Consequences Resolution; End therapy Development of sexual attraction to clients • Client – physical, personality, behaviour, similar in age to psychotherapist • Psychotherapist – Usual attraction to above qualities mild experience – Unmet needs: intimacy, sexual fulfilment, excitement, validation of self-image; occasioned by relationship break-up, loneliness more intense experience – Age: decrease of libido with age hinted at • Context of therapeutic relationship – intimate, emotionally intense Handling the sexual attraction – the psychotherapist’s characteristics • Combined personal and professional identities – values, morals, ethics, boundaries, beliefs • Maturational characteristics – psychotherapy experience, age, life experiences • Psychotherapy training history • Theoretical orientation • Relationship status • Gender Appraisal of the sexual attraction • Intensity – low to high • Interference with psychotherapy – minimal to great • Mutuality of the sexual attraction • The client’s characteristics – presenting problems, emotional stability, age • Timing – point during therapy at which it emerged • Reasons – self-origin, client/therapy-origin Perceived manageability • Self-efficacy and self-control • Less manageable contexts: – Highly intense, greatly interfering sexual attraction – Mutual sexual attraction – Especially vulnerable clients – Previous unsuccessful attempts at handling the sexual attraction Decision-making – Psychic and behavioural management • Acknowledgement and awareness • Repression and ignorance – perhaps more common among those less experienced • Allowing sexual thoughts – conflicting beliefs • Active strategies – self-analysis, self-talk, selfcontrol/willpower, mindfulness • Passive strategies – compartmentalise, disregard, shut off the sexual attraction • Behavioural strategies Therapeutic use of the sexual attraction • When sexual attraction appraised as relevant to therapy • Use it to understand client’s needs and relational style; assist treatment planning • Mixed opinions regarding self-disclosure – Unethical across all contexts – Unethical only if: client emotionally unstable, immature; sexual attraction due mainly to therapist’s issues; disclosure raw, direct Self-disclosure of the sexual attraction • Might self-disclose if: – Confident – Received guidance about doing so – Sexual attraction appraised as having emerged via the process of the therapeutic relationship – Perceived as having therapeutic benefit • Direct disclosure – one participant • Indirect disclosure – concepts of transference, countertransference, intimacy, closeness, non-sexualised Guidance seeking • All believed important for difficult-to-manage sexual attraction • Despite this, many potential barriers: – Anxiety, shame, embarrassment, awkwardness – Same-sex attraction – Available source of guidance unsupportive, insensitive, incompetent, responsible for therapist’s future (trainee) – Past negative experiences of seeking guidance – Perceived as indicator of weakness, maladjustment – Trainee: “underdeveloped self-esteem” – Experienced therapist: maintaining reputation as “in control” Guidance seeking • Conditions conducive to seeking guidance: – Source of guidance: trustworthy, open-minded, competent; psychodynamic; initiates discussions about sexual issues; self-discloses own experiences – Psychotherapist commonly self-discloses to, has positive relationship with, source of guidance – Psychotherapist desires understanding – Sexual attraction interfering with psychotherapy, difficult to manage Privileging the sexual attraction • Some disclosed examples: – Special care of physical appearance – Discussing sexual attraction evocatively with others – Sexual fantasy • Some hypothetical examples discussed: – Special treatment of clients – Extended sessions – Manipulation to meet own needs – Socialising with the client – Sexual relationship/contact Discontinuation of psychotherapy • Where sexual attraction deemed unmanageable • Access to adequate referral networks • Decision in consultation with colleagues, client • How to tell client why referring them? – Genuine reason? – White lie? Implications • Raise awareness of sexual attraction issues among psychotherapists and the profession • Coverage of sexual attraction issues in psychotherapy training and ethics guidelines • Education: normalising; discussed in and outside of ethics classes; modelling of appropriate behaviour, disclosure; based on sound theory and evidence • Scholars of different theoretical orientations need to articulate their positions on sexual attraction issues • Supervisors: set conditions conducive to guidance seeking Limitations • Self-reported, mostly hypothetical data • Researcher influence on collection and interpretation of data – Gender – Pre-existing beliefs Future directions • Many questions remain unanswered • Exploration of actual experiences • Clarification of the role of gender in the process (via quantitative research) • Further examination of the role of intensity • Clients’ experiences • Momentum For further information or discussion, contact: Anthony Arcuri [email protected]