Precursors to Therapist Sexual Misconduct Preliminary Findings

This article presents preliminary findings on the characteristics of and predisposing factors in therapists engaging in sexual intimacies with patients. Data were derived from comprehensive evaluations, consultations, supervisions, or analytically oriented treatments. Particularly salient were frequent misunderstandings of, rationalizations about, or defensive transformations of love and hate in the countertransference. Common findings involved (a) long-standing and unresolved problems with self-esteem, (b) sexualization of pregenital needs, (c) restricted awareness of fantasy, (d) covert and sanctioned boundary transgressions by a parental figure, (e) unresolved anger toward authority figures, (f) intolerance of negative transference, and (g) defensive transformation of countertransference hate into countertransference love. Coexistence of multiple levels of reality within the psychotherapeutic dyad is discussed as an area in which misunderstandings and rationalizations frequently occurred.