transference which can operate to compromise the client's ability to weigh the risks and the benefits of sexual involvement.
Added to prohibitions against sexual involvement on the grounds of the impaired ability of the client to choose, is the fact that there is (or can be) a coercive element. The therapist is the patient's hope for release from turmoil. Thus, the patient is vulnerable to interpreting the therapist's sexual advances as a statement saying, "Have sex with me or else I, one of your few hopes for release from inner pain, will reject you." This same point has been made by several authors (e.g. Coleman, 1988; Gonsiorek & Brown, 1989; Herman, Gartrell, Olarte, Feldstein & Localio, 1987). Specifically, they have noted that there is a "power imbalance" in the therapeutic relationship (which is to the therapist's advantage) and which can covertly subvert the patient's freedom to choose through its coercive components.
There is also a fraudulent aspect to therapist-client sexual involvement because for a therapist to convey to a client that he can be both her doctor/healer and sexual partner (as well as receiver of fiduciary gain) is a fundamental deception. It is a deception not only because of the many conflict of interests that can arise to obstruct adequate fulfillment of each of these roles, but also because existing data clearly shows that most clients involved in sexual relationships with their therapists suffer harm as a result (Pope & Bouhoutsos, 1986).
The foregoing ethical dimensions of sexual/relational involvement between therapist and client explain existing prohibitions against such involvement. However, it nonetheless needs to be recognized that not every sexual relationship in therapy will be characterized by the factors discussed. In other words, some patients may make unimpaired decisions in the absence of coercion with a clear understanding of the likely consequences, and without subsequent il...