Question: Are massage therapists attracted to clients?

If youve ever wondered if it happens (massage therapist-client love connections), the answer is, gulp, yes--its not just a fictional scenario. ... The client may not know much about the therapist, but they certainly love their touch, and the trust that comes along with that, he explains.

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» psychology » » sexual attraction Sexual Attraction to Clients: The Human Therapist and the Sometimes Inhuman Training System Barbara G. Feelings toward clients are generally relegated to vague and conflicting discussions of countertransference, without benefit of systematic research. Survey data from 575 psychotherapists reveal that 87% 95% of men, 76% of women have been sexually attracted to their clients, at least on occasion, and that, although only a minority 9.

About half of the respondents did not receive any guidance or training concerning this issue, and only 9% reported that their training or supervision was adequate. Implications for the development of educational resources to address this subject are discussed. The American Psychological Association holds the copyright.

Sexually intimate behavior between therapists and their clients has emerged as an increasingly serious problem within the profession, as revealed by an examination of the records in three arenas—ethics cases, malpractice suits, and licensing board hearings.

Similarly, during this period, malpractice cases have shown a sharp increase. Asher 1976 reported that the previous insurance carrier had declined to provide further coverage to psychologists because sexual intimacy cases had accounted for 5 of the approximately 45 claims since the start of coverage in 1974.

For instance, as late as 1965, the Colorado Supreme Court, in Colorado State Board of Medical Examiners v. State Board of Examiners of Psychologists 1973however, the Kansas Supreme Court affirmed the right of the board to revoke the license of a psychologist who had tried to persuade two of his patients to engage in sexual intimacies with him.

Board of Medical Examiners 1975a California Appellate Court upheld the right of the board to revoke a psychology license primarily on the basis of sexual intimacies between the psychologist and three patients. For a history of such legal actions, see Pope. There was only one attempt prior to the 1970s to conduct systematic empirical studies of the actual behavior of therapists in this regard.

In 1938, Glover 1955 surveyed members of the British Psychoanalytical Society. There was no report of analyst-patient sexual intimacy. Over two thirds of the sample reported that they took special measures to avoid extraanalytical contact during analysis. Forer, in an unpublished 1968 survey B. Forer, personal communication of the members of the Los Angeles County Psychological Association, found that 17% of the men in private practice indicated that they had engaged in therapist-client sexual Are massage therapists attracted to clients?, whereas no such sexual experiences were reported by women in private practice or by men working in institutional settings.

Kardener, Fuller, and Mensh 1973 surveyed the male members of the Los Angeles County Medical Society. Ten percent of the subsample of psychiatrists reported engaging in erotic contact with clients, with 5% reporting sexual intercourse. Two initial national studies of therapist-client sex, both limiting their sample to psychologists.

Holroyd and Brodsky 1977 found that 7. Pope, Levenson, and Schover found that 7% of their sample of psychologists conducting psychotherapy reported engaging in sexual intimacies with their clients. Please follow this link for a published in peer-reviewed journals. Exceptional caution is warranted in comparing the data from these various surveys. Are massage therapists attracted to clients?

example, the frequently cited percentages of 12. Moreover, when surveys included separate items to assess post-termination sexual involvement, these data are reported in footnotes to this table. Finally, some published articles did not provide sufficiently detailed data for this table e. The study's senior author confirmed through personal communication that the study's findings were that 12.

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Gender percentages about sex with current or former clients did not appear in the article but were provided by an author. Fourteen percent of the male and 8% of the female respondents reported sex with a former client. Six percent of the male and 2% of the female therapists reported engaging in this activity. For a discussion of these national studies and their implications, see.

Despite dated, isolated claims about the benefits—or at least lack of harm—associated with therapist-client sex McCartney, 1966; Romeo, 1978; Shepard, 1971research has shown the harmful phenomena that can be associated with such behavior.

Bouhoutsos, Holroyd, Lerman, Forer, and Greenberg 1983 found that in 90% of the reported cases of therapist-client sexual intimacies, clients were damaged according to their subsequent therapists. The harm ranged from inability to trust and hesitation about seeking further help from health or other professionals, to severe depressions, hospitalizations, and suicide. Pope and Vetter published a national study of 958 patients who had been sexually involved with a therapist.

The findings suggest that about 90% of patients are harmed by sex with a therapist; 80% are harmed when the sexual involvement begins only after termination of therapy. About 11% required hospitalization; 14% attempted suicide; and 1% committed suicide. About 10% had experienced rape prior to sexual involvement with the therapist, and about a third had experienced incest or other child sex abuse. About 5% of these patients were minors at the time of the sexual involvement with the therapist.

Of those harmed, only 17% recovered fully. For a review of the research on the harmful phenomena that can be associated with sexual involvement between therapists and clients, see Pope. We have begun to explore instances in which a psychologist acts out a sexual attraction to a client and thus violates the prohibition. But, especially in terms of research, we know virtually nothing about the attraction itself.

What seems to cause this attraction? How frequently does it occur among all therapists, not just those who become sexually intimate with their clients? Do therapists feel uncomfortable, guilty, or anxious when they notice such attraction?

Do they tell their clients? Do they consult with their colleagues? Why do therapists refrain from acting out this attraction in cases when they do refrain? In what instances is it useful and beneficial to the therapy? In what instances is it harmful or an impediment? Do therapists believe that their graduate training provided adequate education regarding attraction to clients?

The primary purposes of this article are to raise such questions, to initiate serious discussion and research by providing data, and to examine implications for psychology training. In her review of this literature, Tower 1956 noted that virtually every writer on the subject of countertransference stated unequivocally that no form of erotic reaction to a patient is to be tolerated. Freud believed strongly that this countertransference must never be acted out.

The classical view of countertransference, as first set forth by Freud, became the predominant view. Proponents of the classical view are numerous.

Grossman 1965for example, proposed that the word countertransference be limited to mean only one thing: reaction to transference. All that was said about transference, therefore, also applies to counter-transference, with the addition that it is the transference of the patient which triggers into existence the countertransference of the therapist. Countertransference is a transference reaction of an analyst to a patient, a parallel to transference, a counterpart of transference.

First, the attraction was viewed as countertransference. The work of Winnicott 1949Heimann 1950and Little 1951 formed the impetus for a substantial literature asserting that counter-transference, correctly managed, is a valuable therapeutic resource e. However, the idea that countertransference, despite its positive potential, also constitutes a weakness or error Are massage therapists attracted to clients?

to the goals of therapy remained widespread. Langs 1973 developed the thesis that virtually all mistakes committed by well-trained and experienced therapists are caused directly by countertransference. It is countertransference, rather than transference. Taken as a whole, the literature indicates that the failure to acknowledge and examine countertransference blocks its therapeutic potential and unleashes its destructive effects. Consequently, to the degree that sexual attraction is considered countertransference, it is particularly regrettable when training systems fail to promote the acknowledgment and examination of this phenomenon.

Freeman 1968a female plaintiff had been referred to a psychiatrist for treatment of headaches and diarrhea. According to court records, the symptoms were gone after a couple of months, but the woman agreed to continue treatment in order to get at the underlying causes of her difficulties. She came to feel more and more affectionate toward her therapist. She claimed that when she told him she was in love with him, he said that the feeling was mutual. She later moved to a farm in which the therapist had invested.

On the basis of these and other allegations, the psychiatrist was successfully sued for malpractice. Zipkin properly and as a result she was injured. Freeman started to mishandle the transference phenomenon, with which he was plainly charged in the petition and which is overwhelmingly shown in the evidence, it was inevitable that trouble was ahead. It is pretty clear from the medical evidence that the damage would have been done to Mrs. The case of Zipkin v. Freeman had two interesting implications.

Thus, therapists— even those whose theoretical orientation does not include the transference concept—might be held accountable for the inappropriate handling of a phenomenon that they may Are massage therapists attracted to clients? as an invalid concept or at least one with minimal importance for therapy. The mental health professions, despite the citations mentioned above, seem to shy away from dealing in an honest, open way with the phenomenon of sexual attraction to clients.

Yet, it should be, in our opinion, a central issue in the training of psychotherapists. A stilted, unnatural manner and the suppression of ordinary friendliness and interest are but a few of the detrimental effects of making attraction to clients taboo. In many cases, clients may be punished for their sexual feelings.

Fine 1965 described how a therapist, reacting inappropriately to the strong sexual desire of the patient, may harmfully misdiagnose the patient. The data of Abramowitz, Abramowitz, Roback, Corney, and McKee 1976for instance, suggested that female therapists actively avoid treating attractive male clients. In such an anti-libidinal atmosphere, it is little wonder that even such an experienced, well-respected, authoritative therapist as Searles described the courage it required for him to publish his work concerning genital excitement during analytic hours as well as erotic and romantic dreams about patients.

If such feelings are intimidating for experienced therapists, they pose an even greater problem for therapists in training. Tower 1956 described the erotic feelings and impulses that she believed virtually all therapists feel toward their patients, and the fears and conflicts regarding these feelings that lead therapists to withhold discussing the attraction with their own therapists or supervisors.

An understanding of this phenomenon, based upon empirical data, could form a crucial but long-neglected part of our training as psychologists. Indeed, the sexual attraction experienced between those involved in the training programs themselves may be a Are massage therapists attracted to clients? and difficult-to-address part of the problem. Research by Pope, Levenson, and Schover revealed that, nationwide, 10% of the students within psychology graduate training programs engaged in sexual relationships with their teachers and clinical supervisors.

One out of four recent female graduates had engaged in such sexual relationships. Thirteen percent of the educators engaged in relationships with their students and supervisees. Only 2%, however, believed that such relationships could be beneficial to trainees and educators.

For women, sexual contact as students was related to later sexual contact as professionals. That is, 23% of the women who had had sexual contact with their educators also reported later sexual contact with their clients, whereas only 6% of those who had had no sexual contact with their educators had sexual contact as professionals with clients.

The sample of men who had had sexual contact with their educators was too small to test the relationship to later sexual contact as professionals with clients.

The profession of psychology would benefit from a careful examination of the attraction therapists feel for their clients. The study reported Are massage therapists attracted to clients?

the following sections represents an attempt to gather relevant Are massage therapists attracted to clients?. The anonymous questionnaires were numbered in the order received and transferred to a data file for statistical analysis. The questionnaire requested Are massage therapists attracted to clients? to provide information about their gender, age group, and years of experience in the field. Of these, 339 or 57. Sixty-eight percent of the male respondents returned their questionnaires as compared to 49% of the female respondents.

The differential return rate resulted in a male-to-female therapist ratio of about 1. In an effort to shed light on the reason for this differential return rate, we sent a brief follow-up letter three months later to 100 female respondents randomly selected from the original survey sample, requesting information about their response to the questionnaire; if they had not returned the questionnaire, we asked why.

Are massage therapists attracted to clients?

The responses of the 40 female psychologists who responded only to the follow-up were not very helpful in illuminating the reasons for the discrepancy. The single most common response was too busy. For purposes of descriptive convenience, respondents 45 years of age and under are designated as the younger therapists and those 46 and over are designated as the older therapists.

Two hundred and eighty-six respondents 172 men and 114 women were younger therapists; 299 respondents 167 men and 132 women were older therapists. These were used to evaluate the response categories as a function of sex and age under Are massage therapists attracted to clients?

and over 45 years of age categories. Of interest were the 3-way associations among response, age, and sex; the 2-way associations between response and sex and between response and age; and the test for equal frequency of the use of response categories. Table 2 - Therapists' Frequency of Attraction to Clients Never Rarely Occasionally Frequently Clients N % N % N % N % Female clients All men 19 5. The rating scale was based on frequency of attraction.

Respondents indicating that they were never attracted to a client received a 1, respondents who were rarely attracted operationally defined as once or twice in the survey form received a 2, those who were occasionally attracted operationally defined as 3 to 10 times received a 3, and frequently attracted therapists operationally defined as more than 10 times received a 4. Of the 104 therapists who had considered sexual involvement, 91 had considered it only once or twice.

Male therapists had considered sexual involvement with clients Are massage therapists attracted to clients? than had female therapists 27% vs. Therapists did not differ significantly according to age.

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Patterns were proportionately similar for male and female therapists except for two categories, fear of retaliation by clients and the illegality factor, which were offered only by male therapists as reasons for not acting out sexual feelings toward clients.

Such fantasies were reported to have occurred rarely by 19. Male therapists reported having more sexual fantasies about clients than did female therapists 27% vs. Younger therapists were more likely to have had such fantasies about clients than were older therapists 28% vs. The vast majority of respondents 93. Sexual intimacies with clients occurred rarely once or twice for 5.

Male therapists engaged in sexual intimacies with clients more often than did female therapists 9. Are there any particular salient qualities or similarities among them? Over 80% of the respondents who reported being attracted to clients did offer one or more characteristics. The 997 descriptive items were sorted into 19 content categories presented in order of frequency as. Male and female therapists' responses were fairly balanced proportionately for all of the categories except two. Pope, Patricia Keith-Spiegel, and Barbara G.

Therapist Assessment of and Reactions to Client Attraction Respondents who reported attraction to clients were asked if sexual attraction toward clients had ever been beneficial to the therapy process.

Are massage therapists attracted to clients? was a tendency for male therapists to report more beneficial effects than did female therapists 73% vs. Regarding potential negative effects, respondents were asked if their sexual attraction had ever been harmful or an impediment to the therapy process.

Female therapists were more likely than male therapists to report that their sexual attraction was never harmful 60% vs. Younger and older therapists did not differ significantly in this respect.

A post hoc comparison revealed that the significant sex-by-harm interaction was eliminated if those who believed that the clients were aware of the therapist's attraction were selected out and compared on the negative effect item. Younger therapists tended to feel more discomfort than did older therapists 69% vs. No significant differences emerged between male and female therapists in this regard.

Female therapists were more likely than male therapists to believe that their clients were unaware of the attraction felt toward them 81% vs. For this item, a significant three-way association emerged. Older male therapists were more likely than younger ones to believe that clients were aware of their attraction 40% vs. There were no significant sex or age group differences. Graduate Training and Consultation Seeking We were interested in learning if the respondents' graduate training programs and internships had provided courses or other structured education about sexual attraction to clients.

No significant sex or age differences related to training experience emerged. Younger therapists were more likely than older therapists to seek consultation 64% vs. Male and female therapists did not differ significantly on the rate of seeking consultation. Our data suggest that this widespread phenomenon is one for which graduate training programs and clinical internships leave psychologists almost entirely unprepared.

As discussed in the introduction, inattention to this topic in educational programs may be due partly to the taboo nature of the phenomenon and to the belief that such attraction is dangerous and anti-therapeutic. In our survey, more younger psychologists than older psychologists reported such negative feelings, which suggests that whatever efforts training programs have made in the recent past to address these issues have not been fully successful.

An encouraging finding is that 57% of the psychologists sought consultation or supervision when attracted to a client. This is especially true of younger psychologists and those who felt uncomfortable, guilty, or anxious about the attraction. Although seeking help Are massage therapists attracted to clients? a colleague may in part reflect the view that attraction is a sign that something has gone wrong with the therapy, such consultation and supervision can give psychologists access to guidance, education, and support in handling their feelings.

Most psychologists 71% who were sexually attracted to their clients believed that their clients were unaware of the attraction. Thus the phenomenon seems to be one that generally goes unmentioned in the psychotherapy relationship itself. Moreover, the findings suggest that for a substantial group at least 20% of the respondents, their attraction to clients not only received inadequate coverage or no coverage at all during their graduate training but also went unmentioned to their clients, consultants, or supervisors.

Thus, these psychologists seemingly have refrained from talking about the attraction with anyone else, at least within the context of their professional work. Even though sexual attraction for some psychologists remained unspoken to colleagues and clients, it nevertheless could find expression in the fantasy life and sexual behavior not involving the client of a minority of the profession.

The age and Are massage therapists attracted to clients? differences are consistent with the research regarding sexual fantasizing in general, which shows higher rates for males and for younger adults Pope, 1982. It is important to note, however, that the questionnaire item was limited to sexual fantasies occurring during sexual activity with someone else.

Thus, the rates of more general sexual fantasizing about clients may be much higher. For additional data on sexual fantasizing about therapy clients, see ; ; and. Geller, Cooley, and Hartley 1981-1982 pioneered a research strategy for systematically exploring the ways in which therapy clients mentally represent their therapists through fantasy, mental imagery, Are massage therapists attracted to clients?

conversations, etc. Such a strategy could be adapted to study the ways in which therapists mentally represent the clients to whom Are massage therapists attracted to clients? are sexually attracted. Although 29% of the respondents experiencing sexual attraction to clients engaged in sexual fantasies regarding those clients, a much smaller number engaged in actual sexual intimacies with the clients.

The percentages of all respondents 9. The shown above presents summary data Are massage therapists attracted to clients? the national studies of sex between psychologists, psychiatrists, or social workers and their clients that have Are massage therapists attracted to clients? published in peer-reviewed journals.

Pooling the data from the 5,148 participants in these national studies reveals that overall about 4. The gender differences are significant: about 6. For further analyses involving profession, year of publication, etc. However, in the current study, of those who engaged in sexual intimacies with their clients, 86% did so once or twice, 10% did so between 3 and 10 times, and only one psychologist female reported a frequency of over 10 times.

Perhaps the courts and regulatory agencies have removed from practice or altered the practices of some psychologists who engaged in extreme and frequent violation of the prohibitions against therapist-client sex.

The publicity accompanying such cases, as well as the increased attention to imposing explicit sanctions for such violations, may have deterred or restrained many others. The current research provides some preliminary information about the clients to whom therapists are sexually attracted. When asked to describe the personal attributes of the clients who elicited the sexual attraction, male and female psychologists did not differ, for the most part, Are massage therapists attracted to clients?

their responses. However, males, far more than females, mentioned physical characteristics. This difference seems an obvious reflection of the sex role stereotypes characteristic of the general culture. Most respondents believed that sexual attraction to clients had been, at least in some cases, useful or beneficial to the therapy.

Men seemed to view sexual attraction to clients as not only more beneficial but also more harmful than did women. Respondents' reports concerning whether clients were aware of the therapists' attraction were significantly related to the belief that attraction was harmful.

Although the association does not constitute causation, it is still tempting to speculate that Are massage therapists attracted to clients? therapists' responses reflected a belief that what clients do not know will not hurt them. Why do therapists refrain from acting out their attraction to clients? It was gratifying to note that the major reasons seemed to express professional values, a regard for the client's welfare, or personal values compatible with professional standards.

Fears of negative consequences and self-serving reasons were mentioned, though less frequently. Therapist Gender and Sexual Attraction That sexual attraction to clients is a common experience among female as well as male psychologists is a finding worth emphasizing in several respects.

First, the relevant countertransference literature as well as the therapist-client sexual intimacy literature often uses the pronoun he when referring to the therapist and the pronoun she when referring to the client in instances in which there are no specific antecedents.

This usage is understandable most therapists are men; most clients are women but nonetheless is misleading. It implies incorrectly that the only therapists who experience sexual attraction to clients are men and that the only clients to whom therapists are attracted are women. It may serve to place an even greater taboo upon the sexual attraction a female psychologist may experience toward her clients and may thus cause or amplify the anxiety, discomfort, or guilt that accompanies this attraction.

Second, the early widely publicized malpractice suits concerning therapist-client sexual intimacy involved male therapists and, as a consequence, the discussions of this issue focused almost exclusively on male therapists.

Third, the findings of the current study suggest that therapist gender, as a variable, may be systematically associated with the various aspects of attraction to clients. For example, whereas the percentage of therapists attracted exclusively to their own sex was 0. Further research is needed to examine the validity, meaning, and implications of such findings. For the research and associated literature to be truly illuminating and useful, it must be acknowledged that the sexual exploitation of clients and the distinctly different phenomenon of sexual attraction to clients are not limited to male therapists.

Furthermore, it should be noted that attraction to clients, though a common experience, is apparently not universal: Five percent of the men and 24% of the women in this study reported no sexual attraction to their clients. Training Implications The data suggest that personal ethics and a regard for client welfare are more compelling than fear of negative consequences as reasons for refraining from sexual intimacies with clients.

Therefore, efforts to rely predominantly on a system of imposing external sanctions for such behavior may be much less effective in preventing violations than an approach focused on formal training, both in graduate institutions and in continuing education programs.

To be successful, a training approach must first of all acknowledge the value of honest, serious discussions about therapists' attraction to clients. Therapists and therapists in training must be acknowledged as fully human, as capable of feeling sexual attraction to those to whom they provide professional services. The taboo must be lifted. Education regarding this topic can be an appropriate part of almost all clinical and professional Are massage therapists attracted to clients?

and training. Similarly, the topic should be reflected in textbooks and other teaching materials and techniques see, e. Third, the material presented should include information based on systematic research. The virtual absence of research on the topic of therapists' attraction to their clients lends more force and urgency to the standard and obligatory call for further research.

The current study of therapists' attraction to clients, along with the initial research concerning therapist-client sexual intimacy and student-teacher sexual intimacy, represents an initial attempt to gather basic data in previously unexplored areas.

Fourth, the phenomenon of therapist-client sexual intimacy must be clearly differentiated from the experience of sexual attraction to clients. The latter seems to suffer from guilt by associationand the general failure to discuss the experience openly does little Are massage therapists attracted to clients?

clarify the situation. Fifth, educational programs must provide a safe environment in which therapists in training can acknowledge, explore, and discuss feelings of sexual attraction. If students find or suspect that their teachers are critical and rejecting of such feelings and that such feelings are treated as the sign of an impaired or erring therapist, then effective education is unlikely.

Students may fear that their disclosures of sexual attraction will lead to their educators asking intrusive questions about their personal lives, making insensitively flip or humorous comments, failing to maintain appropriate confidentiality i. Students need to feel that discussion of their sexual feelings will not be taken as seductive or provocative or as inviting or legitimizing a sexualized relationship with their educators. As discussed in the introduction, sexual intimacies between teachers or supervisors and their students, most often in the context of a working relationship, Are massage therapists attracted to clients?

not uncommon. Educators must display the same frankness, honesty, and integrity regarding sexual attraction that they expect their students to emulate. Psychologists need to acknowledge that they may feel sexual attraction to their students as well as to their clients. They need to establish with clarity and maintain with consistency unambiguous ethical and professional standards regarding appropriate and inappropriate handling of these feelings. Sex-role related countertransference in psychotherapy.

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Sexual contact between patient and therapist. Medical Aspects of Human Sexuality, 5, 34-56. Comparing romantic and therapeutic relationships. Erotic feelings in the psychotherapeutic relationship. Further recommendations in the technique of psycho-analysis: Observations on transference-love. Original work published 1915 Geller, J. Images of the psychotherapist: A theoretical and methodological perspective.

Imagination, Cognition, and Personality: Consciousness in Theory, Research, Clinical Practice, 3, 123-146. New York: International Universities Press. The technique and practice of psychoanalysis Vol. New York: International Universities Press. Transference, countertransference, and being in love. International Journal of Psychoanalysis, 31, 81-84. Erotic contact as an instance of sex-biased therapy. Psychologists' attitudes and practices regarding erotic and nonerotic physical contact with patients.

Ethical issues in sex therapy and research pp. A survey of physicians' attitudes and practices regarding erotic and nonerotic contact with patients. American Journal of Psychiatry, 130, 1077-1081. Women and therapy: A survey on intemship programs. Psychology of Women Quarterly, 1, 125-137. Borderline conditions and pathological narcissism. Sexual awareness training for counselors. Teaching of Psychology, 2, 33-36.

Thetechnique of 'psychoanalytic psychotherapy Vol. Countertransference and the process of cure. American Journal of Psychotherapy, 14, 545-549. Behavior therapy and cognitive therapy. Countertransference and the patient's response to it. Journal of Sex Research, 2, 227-237. State Board of Examiners of Psychologists, 510 P2d 614 S. Implications of fantasy and imagination for mental health Theory, research, and Are massage therapists attracted to clients? Order No. Professional Psychology: Research and Practice, 24, 374-377.

Psychological Perspectives on Human Sexuality pp. New York: John Wiley and Sons. American Psychologist, 34, 682-689 Pope, K S.

Professional Psychology, 11, 157-162 Pope, K. Professional Psychology: Research Are massage therapists attracted to clients? Practice, 24, 142—152. Professional Psychology: Research and Practice, 25, 247-258. Martin Shepard answers his accusers.

Therapeutic communication New York: Norton. Archives of Sexual Behavior, 10, 477-492. Oedipal love in the countertransference. In Collected papers on schizophrenia and related subjects pp. New York: International Universities Press. Original work published 1959 Shepard, M. The love treatment Sexual intimacy between patients and psychotherapists. The use of imagery and fantasy techniques in psychotherapy.

Sex between therapists and clients: A review and analysis. Psychoanalysis Evolution and development New York: Hermitage House. Journal of the American Psychoanalytic Association, 4, 224-255.

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Women therapists not immune to sexual involvement suits. Principles of psychotherapy New York: Wiley. Therapist disclosure: The use of self in psycho therapy. International Journal of Psychoanalysis, 30, 69-75.

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