Dual Relationships and Sex: Rules for Former Clients and Clients’ Family Members

By Ivan Perkins on April 12, 2018

Dual Relationships and Sex Rules for Former Clients

Betty Haggart lived in Altoona, Pennsylvania. In 1986, she began seeing a psychiatrist, Dr. Doo W. Cho, for weekly psychotherapy. Ms. Haggart saw Dr. Cho over the next four years. On several occasions, Dr. Cho had Ms. Haggart hospitalized for depression.  (Haggart v. Cho, 703 A.2d 522 (Sup. Ct. Penn. 1997).)

There can be little doubt that transference occurred. Ms. Haggart’s visits with Dr. Cho were the highlights of her week. She was in love with Dr. Cho. She described Dr. Cho as “my god” and “my savior.”

In this context, Ms. Haggart was quite amenable when, during an office visit, Dr. Cho guided her hand onto his pants, to show her his erection. She was also fine with Dr. Cho’s approach to therapy, which in her case included hugging, kissing, caressing, and prolonged genital touching. The only time she objected was on a couple of occasions when she was hospitalized, for psychiatric reasons, and Dr. Cho showed up to give her a breast examination. Still, she remained strongly attached. She only stopped seeing Dr. Cho because she could no longer afford his fee.

Only later, when Ms. Haggart began seeing another therapist, did she realize that many of her psychiatric problems—which sometimes required hospitalization—stemmed from Dr. Cho’s hijacking of her transference feelings. Her love for Dr. Cho vanished, and she brought a lawsuit.

Ultimately, though, Dr. Cho prevailed, on the grounds that the statute of limitations had passed. Because Ms. Haggart acknowledged sensing that something was wrong with Dr. Cho’s treatment when he tried to examine her breasts in the hospital, and because this was over two years before she filed suit, the court dismissed the case.

Of course, you should not expect a similar result. Instead, nip this career-ending move in the bud, by just not having sex with your clients.

Also, you should certainly avoid sex with former clients for at least two years, if not indefinitely, as well as with clients’ family members and romantic partners. Remember your basic ethical injunction, to safeguard the well-being of your clients and former clients. If anything you are about to do could be harmful to one of your existing or former clients, well, you should probably not do it.

Ethical codes are becoming stricter on this issue. Generally speaking, sex with former clients—or with their partners or family members—is considered an inappropriate blurring of professional boundaries.

Here are the specific ethical rules on this issue, for each licensure:

  • MFTs. The AAMFT Code of Ethics is the most stringent, as it prohibits any sexual intimacy with current clients, former clients, or known members of the client’s “family system.” There is no two-year waiting period. Therefore, MFTs are prohibited from any such sexual contact by their ethical rules.

 

  • LCSWs. The NASW Code of Ethics has no specific waiting period, but just states that social workers should not have sexual contact with former clients. If the LCSW does have sex with a former client, he or she assumes “the full burden of demonstrating that the former client has not been exploited, coerced, or manipulated, intentionally or unintentionally.”

 

  • LPCCs. The ACA Code of Ethics has a five-year waiting period, and it extends to all former clients, their romantic partners, and their family members. Even after the five years are up, the counselor must “demonstrate forethought,” and document in written form, whether the sexual contact can be viewed as potentially exploitative or harmful to the former client. If there is any potential for exploitation or harm, the LPCC must avoid such contact.

 

  • Psychologists. The APA Ethical Principles contains a two-year waiting period, but then states that such sexual contact should only occur “in the most unusual circumstances.” The psychologist bears the burden of demonstrating that there has been no exploitation.

 

  • Psychiatrists. The American Psychiatric Association’s Principles of Medical Ethics contains a terse statement: “Sexual activity with a current or former client is unethical.” Therefore, psychiatrists, like MFTs, are ethically barred from sexual activity with any former client.

 

As indicated above, sex with someone closely associated with a current or former client—i.e., with a family member, spouse, or partner of that client—is generally barred. Even if such activity is not expressly barred by your professional association, you would shoulder the burden of demonstrating that such contact was in no way exploitative or harmful to the client (so you should probably document the reasons why it is not).

Also, many ethical codes explicitly provide that a therapist may not treat someone with whom they previously had sexual or romantic contact. Sometimes, this ban extends to any partners or immediate family members of that person.

The bottom line: if there is a risk that your sexual activity could compromise your treatment of a current client, or could harm a previous client, such activity is unethical and could expose you to board discipline or civil liability.

For more guidance on this issue (and many others), see our Law & Ethics CE No. 1, Minimizing Legal-Ethical Risk in Psychotherapy.

 

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Continuing Education Law and Ethics

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