Preventing sexual abuse of patients/ clients
Opinion: Good intentions don't always produce good results
March 30, 2019
by Beth Mares RP
Did you hear the one about the town's dentist and the town's physiotherapist who went out on a date? Next day they reported each other to each other's colleges as required by law, and both automatically lost their licences, as required by law. You see, they had used each other's professional services within the past year, so by law they were automatically guilty of sexually abusing each other.
Legislation mandating automatic loss of licence in such a case was passed under the Wynne government, but has yet to be proclaimed. I hope that the present health minister will rethink it. However the College of Registered Psychotherapists of Ontario has proposed to go one better, and ask for legislation to the effect that for registered psychotherapists, the time period is five years instead of one.
Concerns about the psychotherapists' College's proposal
Automatic loss of licence is already mandated by law for sexual contact during the first year after termination of therapy. The proposed change would extend this period to five years after termination. So far as I can determine, the College's definition of sexual contact is broad enough to include such things as a therapist responding in kind to a playfully flirtatious or ribald remark or gesture by a "client", in this case, former client, even someone who only did one session.
So far as I am aware, the College has presented no evidence or reason to think that this change would reduce the incidence of sexual abuse by therapists. The only advantage would appear to be that the College is relieved of the task of determining whether in a particular case the therapist has in fact abused the client; the College already has the power to revoke the license of a therapist deemed to have taken advantage of a former client, even if it happens fifty years after therapy ended.
One of problems here is that different meanings of "psychotherapy" are conflated and confused. We use the same word for psychotherapy as defined in the controlled act of psychotherapy that we use for any session with a professional licensed to perform the controlled act. They are not the same thing.
While a supportive stance and common purpose (therapeutic alliance) are needed in all that we do, some of our work is essentially the same as might be done by a coach, friend, or workshop instructor. In my experience with short term therapy, including short term dynamic therapy, emotional dependency is usually absent or minimal and fleeting. Some typical examples would be CBT (when that is sufficient and deeper work is not required), hypnotherapy for chronic pain, assertiveness training, help with parenting, psychoeducation, or providing grounding and support while someone thinks through a difficult decision.
The proposed change would limit the choices of anyone who has ever done a session with a psychotherapist.
If we say that we are pursuing a zero tolerance policy toward sexual abuse of clients and protecting their autonomy, the College's stated aims, I expect most current and former therapy clients will be in favour. But if they are informed that the actual proposal is to further limit their options for socializing and choosing a life partner they might well see this as reducing their autonomy. This measure would be especially onerous in small communities, where the pool of potential companions is much smaller, and it could deter people from seeking counselling. In addition to people who live in small centres, this would apply to members of ethnic, religious, sexual or linguistic minorities who prefer to seek counselling with one of their own.
We must also take very seriously the damage that the revocation of a therapist's licence would do to her clients. Even if they are doing short term therapy they may have to start all over again with a new therapist. If they are engaged in long term therapy and emotionally dependent on the therapist, not only have they lost their time and money, but they will be re-traumatized; the feeling of safety that they were working to build will be turned on its head as they experience at a gut level that their world is indeed unpredictable and unsafe. We might also consider that a small centre could lose its only therapist.
Rather than indiscriminately handing out penalties, the best way to forestall sexual abuse of clients would be to develop thoughtful, humane and evidence-based guidelines. This would promote buy-in from both therapists and the general public.
The College's statement about the change they are proposing:
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