Can you have sex with your sex therapist?

Dear Dr. Milrod:

Do you think that sex therapy is a legitimate field as separate from psychotherapy? I agree that a psychotherapist should not engage in sexual activities with their clients in order to maintain the objectivity that is needed to serve them. What happens to objectivity when you are having sex with the sex therapist, since sex therapy is different from psychotherapy?

Bob, 48

Dear Bob, 48:

Sex therapy is most certainly a legitimate field. If it is sex surrogacy you are thinking of, that is not psychotherapy per se and it is not considered a branch thereof. Sex surrogates assist in the therapeutic process by performing specific exercises with clients referred by psychotherapists or sex therapists as part of a treatment plan. People have all sorts of fantasies about sex surrogates; however, the reality is not particularly prurient or even erotic. Many therapy clients who are prescribed sessions with sex surrogates have serious emotional problems which prevent them from engaging in sex acts at all. Also, sex surrogates are not stereotypically model-like individuals but average-looking professionals who take their jobs very seriously. Of course, the field is not without controversy, in fact your question regarding the legitimacy of sex therapy bears witness to an enduring ambivalence about the entire subject. Some professional organizations do not permit their members to use sex surrogates in therapy, and some states also do not permit it.

You are right in that sex therapy is not specifically psychotherapy. As far as licensure for sex therapists, there is only one state granting it and that is Florida. Needless to say, ethical sex therapists do not have sex with their clients! As to what happens with objectivity when the client is having sex with his or her sex therapist or even psychotherapist? You can well imagine that ANY objectivity flies out the window, particularly on the part of the therapist. It is unethical, illegal in every state for a psychotherapist to have sex with clients. It is also extremely damaging to the client in the long run, because the therapeutic trust and boundaries have been broken. It is also quite natural for a vulnerable client to develop an attraction toward the therapist. In psychoanalytic terms, we call it an erotic transference. Such feelings are best dealt with openly and frankly in the therapy room and worked through so that the client can progress in the therapeutic process.

The Board of Behavioral Sciences and the Board of Psychology in each state look very seriously upon sexual relations with psychotherapy clients. I get some professional magazines sent to me every month and there are listings of “disciplinary actions” taken against psychotherapists. It’s really amazing that despite clear directives, so many therapists get caught having sex with their clients. Mostly male psychotherapists with female clients, but occasionally female therapists with male clients, or lesbian psychotherapists with females as well as gay male therapists with male clients. They get caught mostly because 9 times out of 10, the client is unable to handle the relationship and discloses to someone near and dear, and then gets encouraged to report. The therapist gets hauled in before his/her respective board and depending on the severity of the matter, the professional in question either gets his/her license revoked, or the revocation is “stayed,” meaning probation. S/he also has to pay back all the therapy fees and various other restitution costs. And yes, there can be ensuing criminal lawsuits as well.

I also want to make it clear that ANY kind of dual relationship is unethical and grounds for loss of license. This means that the therapist should not have any other type of relationship beyond the therapeutic one with the client. For instance, a recent client offered me his ski condo in lieu of payment for therapy sessions. Had I accepted, I would have been guilty of dual relations. Of course there are many other rules and laws concerning confidentiality, disclosure, etc. but that’s a topic for another question. Suffice it to say that if you are having sex with your therapist, please seek therapy elsewhere, cease the relationship and report the therapist. It’s not fair to abuse the client’s trust, feelings or money in such an egregious manner, even if the client thinks it feels good for the moment. As I said previously, it usually ends badly and both the clinician and client lose out in the end. Best is to ask your prospective sex therapist for an agreement in writing where this issue is clarified. And if you are seeing a psychotherapist, s/he can and should provide a brochure, pamphlet or weblink where the state boards have detailed descriptions of the law and its consequences regarding sexual relations between therapists and their clients.

Christine Milrod, PhD

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