Counseling education and supervision;

Therapy can be confusing: two people converse in a private room, one in distress, the other described as a helpful expert. At least one of the two is likely to express thoughts and feelings usually kept secret. In other circumstances, the exchange of such intimacies may herald a more physical relationship. For therapists, however, the professional relationship explicitly precludes such contact. The BACP Ethical Framework for Good Practice in Counselling and Psychotherapy,1 for example, requires that practitioners must not abuse their client’s trust in order to gain sexual, emotional, financial, or any other kind of personal advantage. Sexual relations with clients are prohibited, along with sexualised behaviour.

While psychotherapists and counsellors generally acknowledge that sexual attraction is a common and often ordinary human response to another, they also recognise that acting on such feelings in therapy will quickly become problematic. The early psychoanalytic community had to confront and respond to such instances as Jung’s relationship with Sabina Spielrein.2 Rosie Alexander’s3 description of the times she sat on her therapist’s knee and felt his erection, elicits a mixture of emotions in the reader, not least shock, and the narrative is saturated with a sense of betrayal.

There have been several types of research investigating boundary breaches and sexual boundary violations.4 In spite of these, however, there is little certainty about how common sexual boundary violations are, as the sources of information about them (confession, client reporting, complaints to organisations, and knowledge of colleagues’ conduct) are all vulnerable to error. Further studies have attempted to identify characteristics of transgressing therapists and the factors that contribute to such events (see Moggi et al5 for an example), and to understand the effects on clients who have experienced therapist-client sex.6 If sexual feelings are ubiquitous and sexual attraction a real possibility in the context of the therapy relationship, how are these managed in therapy? Complaints about sexual boundary violations form a small proportion of complaints about therapists and health professionals.4, 7, 8 Is it the prospect of opprobrium from colleagues or the threat of sanctions from regulatory agencies that contains the relationship within professional boundaries? Do reported violations represent only a small proportion of actual sexual boundary violations? .......

Aim: To identify therapists’ views on sexual boundaries and the strategies they employ to manage them in therapeutic practice. Method: In-depth qualitative interviews were conducted with a sample of 13 accredited, experienced practitioners of psychotherapy or counselling. A grounded theory approach, informed by principles from Free Association Narrative methodology, was employed, in which team members used debriefing sessions for extending depth of understanding of the interviews. Findings: There is consensus about boundaries at the extremes, but variability about fantasy, flirtation and touch. A core process was generated from accounts of successful management of sexual attraction. We identified four problematic ways of reacting to boundary pressure, each with potential to harm clients and therapy. Discussion: A participant-observer stance was conceptualised as essential for managing threats to boundaries, consistent with the empathic stance. Minor boundary crossings were viewed by interviewees as both potential precursors of more serious transgressions, and as opportunities for understanding the client's difficulties. Implications for practice: These span training, accrediting organisations, supervision and therapy practice.