Reducing the occupational hazard of sexual boundary violations

August 2023

Sexual boundary violations (SBVs) can be catastrophic for counselors. Some repercussions include loss of career; loss of licensure; loss of family, friends and professional colleagues; expulsion from professional organizations; financial penalties; and civil and criminal lawsuits. Despite knowing these consequences, too many mental health professionals still engage in romantic and sexual relationships with their clients. So why do smart, educated, knowledgeable and compassionate people make such damaging decisions? Data indicate that SBVs are not infrequent isolated incidents. In a 2019 article published in the Journal of Counseling & Development, Tyler Wilkinson, Dannielle Smith and Ramona Wimberly found that 9% of ethical complaints to state licensing boards arose from sexual relationships. Also, the second edition of the Counselor Liability Claim Report published by CNA and HPSO in 2019 determined that engaging in a sexual relationship with a client or a client’s family members accounted for 36.4% of all closed claims between the years 2013 and 2017, with an average associated cost of $113,642. It’s not surprising then that Andrea Celenza, a psychologist and leading expert on the topic, estimates the incidence rate of SBVs is between 7% and 12%. My decades of work with victims, transgressing professionals and college students in psychology programs led to an unwelcome realization: Catastrophic consequences will not prevent SBVs. Instead, reducing SBVs relies on four factors: recognizing myths about SBVs, assessing personal risk, realizing SBVs are a shared occupational hazard and recognizing that SBVs involve a process and are not sudden, unpredictable events.

Three damaging myths

There are three myths that, if left unconsidered, can hinder our work in preventing SBVs:

1. The “bad apple” hypothesis proposes transgressing clinicians are “bad apples” mistakenly allowed into our field; these clinicians are often considered to have sociopathic tendencies and be predatory and highly dangerous. The majority of violations, however, are not the result of predatory clinicians. In Sexual Boundary Violations: Therapeutic, Supervisory, and Academic Contexts, Celenza created a simplified typology consisting of a mere two categories of transgressors: psychopathic predatory transgressors, who engage in sexual activity with numerous clients over the course of their careers and demonstrate little remorse or guilt for their actions, and one-time offenders, a group Celenza describes as “more like you and me than generally accepted or than is comfortable to acknowledge.”
2. Some believe that SBVs are a result of inexperience in the field or age. This belief unfairly places blame on younger clinicians who are new to counseling. There is no evidence to support this claim; in fact, research shows that SBVs are more common among counselors who are midcareer.
3. There is an unshakable certainty that we are personally invulnerable to engaging in an SBV or even having a temptation to do so. We can look in the mirror and confidently say, “I would never do that.” However, this statement ignores empirical research that says that risk is not static and unchanging. Although I might be low risk for a boundary violation today, I may be more vulnerable to it next month or next year. Our level of risk is constantly in flux.

Risk factors

As counselors, we do not enter the field as blank slates but instead have personality traits, some of which protect against boundary violations and others that may increase the risk. Risk factors that may increase the potential for SBVs include:

• Sensation seeking (i.e., people who seek novel and often intense experiences despite the risk)
• Impulsivity
• A propensity for sexual excitement and the inability to inhibit arousal
• A preoccupation with sex
• Being a man (The majority of SBVs are committed by men.)

Of course, these factors alone do not mean someone will experience an SBV or they are unfit to work as a counselor. After all, there are counselors who have histories of depression, anxiety and substance use and who use their personal experiences for client growth. It just means that some of us are hardwired for higher risk of poor sexual decision-making, particularly when dynamic risk factors arise. We encounter dynamic risk factors every day in our practice. Some of the most noted for SBVs are:

• Experiencing a life crisis. Life crises can lead to boundary violations at any level in a person’s career; these crises include relationship problems, serious illness (of oneself or a loved one) or loss through death.
• Undergoing a life transition. Significant life transitions can occur both in and out of the workplace and sometimes simultaneously. These transitions can include workplace promotion, job loss or a sudden change in finances. In a 2003 study published in Professional Psychology: Research and Practice, Douglas Lamb, Salvatore Catanzaro and Annorah Moorman interviewed psychologists who had engaged in SBVs and found that dissatisfaction with their personal life (e.g., being depressed and alienated from family, recently divorced, having a parent who was dying) was a precipitating circumstance preceding these violations.
• Working with a vulnerable client. Most victims of professional SBVs are women presenting with low self-esteem, histories of difficult relationships with men and histories of sexual trauma, including sexual abuse.
• Avoiding the topic. In an article published in Sexual and Relationship Therapy in 2008, S. Michael Plaut said that universities and clinical training programs do not prepare students for the inevitable boundary issues they will encounter in their careers. This lack of training is often compounded by supervisory reluctance to address the topic of erotic attraction because they are also not prepared to address the topic or fear that bringing up the topic will be misinterpreted by a supervisee as a sexual overture. In addition, supervisees often do not disclose issues of sexual attraction in supervision because they fear supervisors will judge them or question their ability to counsel others or they will face disciplinary action.

Decades of studies also show that organizational factors (e.g., work culture, leadership style, peer interactions) can increase or decrease the likelihood employees will comply with workplace rules and regulations. These factors can tax an employee’s ability to cope, which can then lead to poor decision-making. For example, a stressful work environment could compromise an employee’s ability to make good decisions. Organizational factors can also decrease the chances employees will engage in help-seeking behaviors, which means they will be less likely to report sexual misconduct or concerns.

An occupational hazard

Richard Honig and James Barron, in a 2013 article published in the Journal of the American Psychoanalytic Association, argued that SBVs are an “occupational hazard” for mental health professionals and discussed six reasons for this:

1. Clients often start therapy when other relationships in their lives are dissatisfying or dysfunctional. Mental health professionals enter a client’s life when the client is more susceptible to being attracted to someone who genuinely cares about them.
2. Mental health practitioners experience highs and lows in their own romantic lives.
3. Although unconditional positive regard is a crucial ingredient for treatment, paradoxically it also increases risk for attraction.
4. Therapy aims for ever-increasing levels of intimacy. Even cognitive therapy, an approach not traditionally thought of as entailing profound intimacy, requires clients to move past examining overt behaviors to exploring automatic thoughts and implicit core beliefs. Therapy is a progressively intimate experience.
5. Limited self-disclosure by practitioners causes some clients to idolize them; they do not see the deficits, flaws and unflattering aspects of a counselor’s personality that are readily apparent to their romantic partners, friends and children.
6. Treatment is conducted without witnesses. This leads not only to a lack of surveillance as to what is happening behind closed doors in sessions but also to emotional deprivation in existing relationships. Because of confidentiality laws, professionals are unable to share major portions of their lives with loved ones, and in turn, clients often share their most intimate thoughts and feelings with their therapist and withhold this information from others in their lives. This secrecy often prevents people from recognizing when a therapeutic relationship is devolving into boundary violations.

Boundary violations as a process

Research clearly informs us of the need to examine the process leading to a violation. SBVs do not simply happen but instead culminate in an insidious chain of internal and external occurrences. The following is a brief overview of the parts involved in this process:

1. A triggering event: The initial arousal often occurs after a triggering event such as physical or emotional attraction, interaction style or a shared connection.
2. Fantasy: Clinicians may experience both voluntary and involuntary sexual or romantic fantasies of a particular client; this can include masturbation to the fantasies.
3. The choice: After recognizing arousal and attraction to a client, mental health professionals either stop progression toward an SBV or engage in faulty and distorted self-talk that leads to a violation. Distorted thinking (e.g., “My client would never tell anyone about this; it will remain between us”) allows them to minimize their doubts and fear of the consequences and overlook that SBVs are unethical and harmful to clients.
4. Nonsexual boundary crossings: Nonsexual boundary crossings consistently precede a sexual relationship between a client and mental health professional. According to the literature, two of the most common boundary crossings that happen before an SBV are increased self-disclosure by the professional and social contact with a client outside therapy (e.g., texting, emailing and calling a client to discuss social and nonclinical matters; meeting for drinks or a meal; socializing together).
5. SBVs: At this phase, a singular sexual behavior occurs, or a romantic or sexual relationship begins.
6. Post-violation considerations: After the violation occurs, the clinician must deal with the ramifications of their actions. During this phase, counselors may not disclose the relationship to anyone, may act like nothing has changed or may use distorted thinking (often justification and rationalization) to manage the crisis. They also have to consider the long-term ramifications of their boundary violation, especially if it develops into a romantic relationship.

When counselors understand this underlying process that often leads to SBVs, they can take control of the situation and make better decisions moving forward. A counselor can map where they are in the process and implement a series of corrective measures to change course.

Conclusion

Although SBVs seem to be a common occurrence in mental health professions, clinicians can take steps to prevent these boundary violations from happening. The first crucial step is acknowledging that SBVs are truly an occupational hazard; they are not typically the result of predatory clinicians and poor hiring decisions. Instead, they are an inevitable and unavoidable risk arising when two human beings, each with their own fragilities, meet and discuss profound and often intimate matters in privacy. Thus, we must normalize sexual and romantic attraction in clinical practice; interacting with clients can lead to attraction just as easily as it can lead to anger or frustration or reactivate one of our own traumas. The attraction is not wrong, but acting on it is. We must also recognize and continually evaluate our personal and idiosyncratic risk for acting on potential attraction. No clinician is risk free. Finally, we can educate ourselves about the process that often leads to SBVs. This behavior is not an abrupt occurrence; it is the result of an interconnected chain of events. With proper supervision or consultation with a colleague, counselors can disclose their feelings of sexual or romantic attraction early in the process and learn to navigate through it rather than act on it. We are all at risk for SBVs, so let’s start talking about them in a well-informed and productive manner.  

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Michael Shelton is a recognized national expert on male sexual disorders, substance use and LGBT issues. He is the author of seven books, including Sexual Attraction in Therapy: Managing Feelings of Desire in Clinical Practice and Fundamentals of LGBT Substance Use Disorders: Multiple Identities, Multiple Challenges. He is a faculty member in the psychology program at Thomas Jefferson University. He is also a content expert on human sexuality with Psychology Today. Counseling Today reviews unsolicited articles written by American Counseling Association members. Learn more about our writing guidelines and submission process at ct.counseling.org/author-guidelines.

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