Sexual feelings of psychotherapists: a cross-sectional study

Background: Psychotherapists who feel sexually attracted towards clients are a common phenomenon. Studies, mainly from the eighties and nineties, show prevalence rates of sexual attraction to clients between 60 to 90%. However, these studies are scarce, not having been continued in the last decades, and seldom include how to handle these feelings. Nevertheless, this is necessary because the population of psychotherapists, ethical perspectives, training and education have changed over time.
Aim: This study determines to what extent 1) psychiatrists experience sexual feelings towards clients in Flanders (Belgium), 2) psychiatrists think that having sexual feelings is discussable in their work-field and 3) psychiatrists state this topic was covered within their education and training.
Method: Based on earlier scientific studies and interviews with experts, a questionnaire was developed and pilot tested among researchers and psychotherapists in training. To improve response rate the “Tailored Design Method” was followed. In the spring of 2017 a call was launched two times in an online newsletter for psychiatrists with a weblink to the online-survey. In the beginning of 2018 a paper questionnaire and a letter of reminder was sent to the postal addresses of the psychiatrists in Flanders. In the spring of 2018 a second mailing and reminder will be send. Addresses were obtained via the National Institute for Health and Disability Insurance (NIHDI).
Results: Preliminary results show a response rate of 23% (n=244). About 70% of the psychiatrists state to have been sexually attracted to clients during their career. More male psychiatrists reported this than female psychiatrists (85% vs. 57%). Respectively 40% vs. 12% fantasized about sexual contact with a client, 36% vs 9% felt sexually aroused during a conversation with a client and 30% vs 14% fantasized about how it would be to have a romantic relationship with a client. In addition, 57% of psychiatrists stated that having sexual feelings are barely or non-discussable in the work-field, and 93% reported that there was little or no attention in their basic psychiatric education about how to handle sexual feelings for a client. Compared to systemic (19%), behaviour (11%) and person-centered therapists (15%), more often psychoanalysts (46%) reported that this topic was covered within their education and training.
Conclusion: A great majority of psychiatrists reported to have been sexually attracted to clients during their career, especially male psychiatrists. A fifth of psychiatrists fantasized about a relationship with a client. However, the topic is hardly discussed in education, training or the work field. It is recommended to pay more attention to this topic in education and training, and to consider sexual feelings in the psychotherapeutic relationship as a non-deviant phenomenon.