When therapists have the hots for their clients

The fictional Dr Weston
(played by Gabriel Byrne)
 experiences lust for a client

Clients go to psychotherapy seeking a mind massage, but all too often things turn physical. Cases of inappropriate sexual contact in psychotherapy average around 10 per cent prevalence, and a 2006 survey of hundreds of psychotherapists found that nearly 90 per cent reported having been sexually attracted to a client on at least one occasion. It's an issue dramatised artfully in the HBO series In Treatment, which follows the life and work of psychotherapist Dr Paul Weston.

A new paper by clinical psychologist Carol Martin and colleagues discusses how therapists deal with these awkward feelings. The researchers interviewed 13 psychotherapists (7 men), including 2 clinical psychologists and 2 psychoanalysts, in-depth about times they'd been attracted to a client but had stopped themselves acting on those urges.

The results can be broken down into three categories: the therapists' general views about being attracted to clients; the effective coping processes that therapists went through on realising they were attracted to a client; and harmful ways of coping.

The therapists were generally of the view that sexual attraction to clients was normal and not necessarily harmful. However, views differed on exactly where the boundaries should lie. For example, some therapists condoned fantasising about clients whereas others did not.

Effective ways of coping involved the following processes, though not always in order: noting the attraction, which was often accompanied by feelings of anxiety or unease; facing up to the feelings, which often involved managing shame and embarrassment; reflecting on the attraction, including the relevance of the therapist's own past; processing the feelings, including considering the implications of the situation; and finally formulating a way forward that would be to the client's benefit.

Harmful ways of coping included: clumsily reinforcing therapeutic boundaries, which often left the client feeling rejected and to premature ending of therapy; taking a moralising or omnipotent stance, including implying that the client had inappropriate feelings; feeling needy ("... it seems inevitable that being single ... you imagine those 'what if' questions, if we'd met elsewhere ...", said one male, middle-aged therapist); over-identifying with the client (one therapist talked of feelings of "yearning and anguish" after therapy ended; another spoke of being overwhelmed by a client's pain and extending therapy sessions to cope); and finally responding with over-protective anxiety, including offering support that they didn't usually offer, including allowing meetings between sessions, touch, hugging and sharing of personal information.

Martin and her team said that none of what they'd heard in the interviews constituted a boundary violation so severe that they had to blow the whistle on any of their participants (participants were warned that this would happen where appropriate). However, the researchers said the results showed that "even among experienced, accredited practitioners, sexuality and sexual feelings commonly intrude into the therapeutic encounter and required management for client benefit."

Every therapist may be vulnerable to practising in ways that they later regret, the researchers concluded, especially at times of personal stress or difficulty. "The framework and typology of common problematic reactions developed through this study has potential value in training and supervision for sensitising practitioners to the issues early on, and in maximising therapeutic benefit," they said.

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Martin, C., Godfrey, M., Meekums, B., and Madill, A. (2011). Managing boundaries under pressure: A qualitative study of therapists’ experiences of sexual attraction in therapy. Counselling and Psychotherapy Research, 11 (4), 248-256 DOI: 10.1080/14733145.2010.519045

Post written by Christian Jarrett for the BPS Research Digest.

Already struggling to keep New Year resolutions? Here's the first detailed study of daily temptation and resistance

There it is, posing. A small, perfectly formed chocolate. The diminutive trouble-maker causes you angst. You adore chocolate, but you're battling to lose weight. Immediate longing clashes against a longer-term goal. Just how often are we torn in this way? And how often are we able to resist?

To find out, Wilhelm Hofmann and his colleagues equipped 205 participants (66 per cent female, average age 25; mostly students, but also the general public) in Würzburg, Germany with Blackberry smartphones. For seven days, the participants were beeped seven times a day and asked to report whether they were experiencing a desire now or in the preceding 30 minutes. The participants noted what their desire(s) was, how keenly it was felt, whether it caused internal conflict, whether they attempted to resist it, their success, as well as who they were with and where they were. Data was also collected on the participants' personalities.

"To our knowledge," the researchers said, "this study is the first one that has used experience sampling methods to map the course of desire and self-control in everyday life."

Here are some of the basic findings. The participants were experiencing a desire on about half the times they were beeped. Most often (28 per cent) this was hunger. Other common urges were related to: sleep (10 per cent), thirst (9 per cent), media use (8 per cent), social contact (7 per cent), sex (5 per cent), and coffee (3 per cent). About half of these desires were described as causing internal conflict, and an attempt was made to actively resist about 40 per cent of them. Desires that caused conflict were more likely to prompt an attempt at active self-constraint. Such resistance was often effective. In the absence of resistance, 70 per cent of desires were consummated; with resistance this fell to 17 per cent.

"Inner conflict is a frequent feature of daily life," the researchers said. "The findings suggest that self-regulation is needed many times in a typical day, because conflicts are frequent."

Strong desires and weak desires were just as likely to provoke an attempt at self-restaint, but as you'd expect, it was strong desires that were least likely to be constrained. However, even desires rated by participants as "irresistible" were often successfully controlled.

Broadly speaking, personality traits were related to participants' experience of desire and conflict, whereas environmental factors, such as the company of others, had a bearing on whether those desires were enacted and/or resisted.

For example, people who scored highly on a measure of trait self-control had just as many desires, but they were less likely to report experiencing internal conflict; their desires were generally weaker; and they attempted to resist them less often. These findings are revealing. It's not that people with high self-control have saintly willpower, it seems. Rather, they seem to avoid putting themselves in situations in which they are exposed to problematic temptations. "The result is not a desire-free life," the researchers said. "Au contraire, the result appears to be that they mainly have desires that they can satisfy."

Other relevant personality factors included perfectionism (associated with strong desires, high conflict and frequent resistance) and narcissism, which was associated with less conflict - these people felt they were entitled to their desires.

As for environmental factors: being highly inebriated weakened resistance to desires; desires were felt more strongly; and they also led to more internal conflict. The presence of other people, meanwhile, increased people's ability to resist conflict-inducing desires - perhaps because of the fear of disapproval, or maybe other people's help was sought to fight temptation. Company also led to fewer desires being consummated, even ones that weren't resisted. But there was an exception to this - if other people were engaging in the desired behaviour, then this had the effect of weakening resistance and made it more likely that the desire would be fulfilled. Finally, when at work, desire provoked inner conflict more than it did in any other context.

"Our findings suggest that desire is a common, recurrent theme in the daily lives of modern citizens," Hofmann and his team concluded. " ... everyday life may be an ongoing drama in which inner factors set the stage for motivation and conflict, while external factors contribute to how well people manage to resist and enact their current wants and longings."

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Hofmann, W., Baumeister, R., Förster, G., and Vohs, K. (2011). Everyday temptations: An experience sampling study of desire, conflict, and self-control. Journal of Personality and Social Psychology DOI: 10.1037/a0026545

Post written by Christian Jarrett for the BPS Research Digest.

Do Northerners really feel the cold less?

In Britain, we all know the stereotype of hardy Northerners: out on the town on a Winter's night, arms and legs bare, seemingly oblivious to the cold. But do people up North really feel the cold less? According to a report in yesterday's Times newspaper by Paul Simons, an ongoing survey is aiming to find out. Initial results from this research by the Met Office and Open Air Laboratories suggests that people feel the cold just as much regardless of which region they live in. Moreover, contrary to the myth, there's some evidence that Northerners are more likely to change their clothing than Southerners, be that for warmth or to be cooler. Another emerging finding is a rural/urban divide, with rural folk being more likely to don coats in colder weather. "Whether this is due to an urban climate is difficult to say," Simons writes, "but towns and cities can generate their own microclimates which affect temperature."

Link to the research on people's response to the cold (there's still time to take part)
Link to Times article "Weather Eye: northerners vs southerners" (subscription required)