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Psychotherapists’ handling of sexual attraction to clients: A grounded theory Dr Anthony Arcuri 1,2 and Dr Doris McIlwain 1 1 Department of Psychology,

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Presentation on theme: "Psychotherapists’ handling of sexual attraction to clients: A grounded theory Dr Anthony Arcuri 1,2 and Dr Doris McIlwain 1 1 Department of Psychology,"— Presentation transcript:

1 Psychotherapists’ handling of sexual attraction to clients: A grounded theory Dr Anthony Arcuri 1,2 and Dr Doris McIlwain 1 1 Department of Psychology, Macquarie University, Sydney, Australia 2 National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, Australia 13 th International – 2 nd 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

2 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?

3 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

4 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

5 Sexual attraction develops Appraisal of context  manageability Decision-making  ethics, consequences Actions Consequences The theory Resolution; End therapy

6 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

7 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

8 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

9 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

10 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, self- control/willpower, mindfulness Passive strategies – compartmentalise, disregard, shut off the sexual attraction Behavioural strategies

11 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

12 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

13 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”

14 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

15 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

16 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?

17 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

18 Limitations Self-reported, mostly hypothetical data Researcher influence on collection and interpretation of data –Gender –Pre-existing beliefs

19 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

20 For further information or discussion, contact: Anthony Arcuri


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