Introduction

It should be made clear at the outset that the phrase ‘sexual abuse’ is used in this chapter in its broadest sense, to include anything sexual within a therapeutic relationship, from flirtatious behaviour (Box 2.1) to rape. Experts in the field now emphasise that sexual abuse should not be considered in a simplistic linear manner, particularly in terms of its effect on the patient (Gabbard & Lester, 1995). As a result, there is growing recognition that any form of sexualised or exploitative behaviour within the consulting room can have profound and devastating consequences.

Self-authored accounts of exploitative experiences of psychotherapy began in 1976 with Julie Roy's book Betrayal (Freeman & Roy, 1976) followed by Ellen Plasil's (1985) Therapist and Carolyn Bates’ and Annette Brodsky's (1988) Sex in the Therapy Hour. Such accounts have proliferated during the past three decades, such that there is now an extensive patient-authored literature on all forms of sexual exploitation in psychotherapy. In research terms, this literature is an important naturally occurring data source, as these accounts were initiated and produced by patients without thirdparty influence. This literature can therefore be considered to be a genuine reflection of the patient's perspective on professional exploitation. This is in contrast to research performed using questionnaires and interviews, which impose a structure or pre-selected categories on the data.