It's the subject of Hollywood movies. Therapist meets patient. Hours of shared intimacies spin away. Eyes lock. Then limbs. Love matches made Hollywood-style - from "Spellbound" to "The Prince of Tides" - without pain, without exploitation.
That's what Hollywood would have you believe. Reality, in fact, is very much different. In many cases, it's devastating.
Sex between therapist and patient - which some estimate happens in at least 10 percent of professional encounters - "is an abuse of a vulnerable person by a person that should know by virtue of their training that this is harmful," said Laura S. Brown, clinical professor of psychology at the University of Washington. "This is not just an affair."
Across the country, courts are seeing more and more sex-related malpractice cases, and licensing boards are investigating an increasing number of allegations.
In this state, the severity of some of the cases has prompted the legislature for the first time to consider a bill that would make it a felony for a therapist to have even consensual sex with a client.
By how much have sex-related complaints increased? Jim Jackson, chief investigator for the state Department of Health, which oversees investigations for all malpractice charges involving mental-health practitioners, says it's difficult to say.
But increase they have.
He attributes it to more reporting - once one victim comes forward, others are more inclined to do the same - rather than more incidents.
The dark secrets of therapeutic relationships out of control have captured the public's attention - and that of insurance companies and professional associations, which have created survivor advocacy groups. Spin-off issues, like a statute of limitations on complaints (currently there is none), will be a topic of impassioned debate for years.
What kinds of cases are being brought before the regulatory boards? Some examples:
-- On Jan. 11 the state Examining Board of Psychology filed a statement of charges against Seattle psychologist Mary Lee Holscher for (among other things) admittedly nursing an adult patient, allegedly masturbating before the patient, and using the client to care for her child and her dog, clean the house, and do yardwork and other tasks.
-- Recently the psychology board suspended for 20 years the license of Gig Harbor psychologist John Finch, 78, an ordained Methodist minister and founder of the school of psychology at Fuller Theological Seminary in Pasadena, Calif. He was charged with engaging in sex and "nude therapy" with clients. There were complaints to the state psychology board about him in 1982, but no statement of charges was filed.
-- On Dec. 24, 1992, the state Examining Board for Psychology issued a statement of charges against Bellevue psychologist Bruce J. Leksa in connection with allegations that he had a sexual relationship with both a mother and a daughter from 1986 to 1990.
Previously, in 1990, the psychology board declared him "unable to practice with reasonable skill and safety because of a mental condition," but allowed him to continue practicing as long as a board-appointed psychologist met with him at least one hour per week over a 10-year period, among other provisions.
-- On Dec. 23, 1992, the board gave a five-year license suspension and a $4,000 fine to Rockport psychologist David Cohen, and required him to undergo continuing education. In a statement of charges filed by the board last May, he admitted to having had a sexual relationship with a self-destructive, suicidal client from 1989 to 1991.
-- On March 12, 1993, the board gave a three-year license suspension to psychologist Paul Gergen, who admitted to having had sexual contact with client Traci Bryan at various times from 1984 to 1989.
Sexual involvement between medical professionals and patients has been considered unethical since the time Hippocrates wrote the oath of conduct. The father of psychoanalysis, Sigmund Freud, also warned therapists about the danger of becoming involved with their patients. Yet some of the early leaders in the field, among them Carl Jung, who had affairs with two patients, and Otto Rank, who had a longtime sexual relationship with author Anais Nin, chose to do otherwise.
Today, the licensing law regulating therapists prohibits them from having any kind of relationship with clients outside of therapy while the therapy is ongoing. It even strongly discourages it after therapy has ended. Therapists are advised not to treat their family members, their students, co-workers or employees, and under no circumstances is sexual contact permissible. The proposed bill would go even further by making it a felony for therapists to have sex with patients.
So why do therapists engage in relationships that ruin careers and damage lives?
The answers are complex.
One theory is that some practitioners aren't well-trained in ethical issues, while others often are ill-equipped to handle the temptation of being the focus of a trusting, sometimes adoring patient. Some can get caught up in an emotionally charged current, unable - and unwilling - to step aside and turn the case over to an unbiased colleague.
For still others the reason for involvement is darker, twisted among the therapist's mental illness, where the patient is slowly groomed for the role of victim, his or her confessions used for the therapist's benefit.
"We live in a society where we are all trained to see vulnerability as a sexually attractive asset, particularly in women, who constitute 95 percent of the victims of sexual abuse," the UW's Brown said. "Therapists get the same socialization most of us do, but by good training and supervision they never act this out.
"All relationships are kind of a dance. We are all used to the dance steps of normal intimacy. A lot of the dance steps in therapy are kind of similar. A lot of times people get real confused. There is emotional intensity, what feels like closeness. In reality it's one person doing 90 percent of the sharing, talking about very personal intimate details. There are strong feelings each way."
To some, Bryan's involvement with psychologist Gergen, from July 1984 to November 1985 and from April 1988 to December 1989, may sound like the familiar prelude to an affair.
Suffering from post-traumatic stress disorder following a rape, Bryan, now 32, sought psychological help from the husband of a friend.
According to court documents, one evening when Bryan was particularly panicked about being alone, the friend invited her to her home and introduced her to her husband, a Puyallup psychologist and licensed massage therapist in private practice.
An advocate of "reparenting," Gergen's therapeutic concept of acting in a parental role to the patient, Gergen pulled Bryan onto his lap and held, rocked and stroked her. Bryan stayed several nights at the Gergen family home, sleeping on the couch. Official therapy began a week later.
Therapy included Gergen giving Bryan massages requiring her to be disrobed from the waist up. He frequently hugged and held her, occasionally tickled and complimented her, and included her in his family's activities - from birthday parties to family dinners - calling it part of the "reparenting" process. He said she came to be regarded as a surrogate family member.
Eventually, Bryan and Gergen formed a mutual attraction for each other that spiraled into disaster.
Each has a slightly different version of what happened from then on.
Gergen admits to having kissed Bryan once and touched her breasts on three occasions. He says Bryan begged him to have intercourse with her, but he refused.
Bryan said that at first Gergen acted the role of the loving parent. She said he told her repeatedly that he loved her, that he could provide the "missing link" in her "behavioral memory" by acting like a father to her, which included telling her how precious she was and how much he loved her. She acknowledged she eagerly responded and fell in love with him.
Later, she said, he initiated sexual contact, kissing her, wrestling with her, grabbing her breasts on several occasions, her buttocks and her vaginal area.
In the end, the court agreed with Bryan and said that Gergen fell below the standard of care for psychologists by:
-- Accepting his wife's friend as a client in the first place;
-- Mishandling the transference process (a normal occurrence where the client becomes attracted to the therapist), making overt sexual contact with her, causing her feelings to be intensified.
The court said he should have known he could not control his feelings toward her and should have consulted with or referred her to another therapist.
Bryan was awarded a partial summary judgment. His insurance company paid her the maximum: $125,000.
In addition to suspending his license for three years, the psychology board required him to pay back more than $19,000 to the Crime Victims Compensation fund, which financed Bryan's therapy, and to pay a $4,000 fine.
Should he decide to practice as a licensed psychologist again he would have to have therapy, continuing education, and have his practice monitored by another psychologist for at least three years.
For Bryan, the sentence was not severe enough.
"Even the best-crafted settlements in these cases can never make the plaintiff whole," prosecutor Jerald Anderson told the board.
How did the therapeutic relationship race so out of control?
In a letter to the examining board, Gergen said that his purpose in having "physical contact (with Bryan) . . . was to communicate to her that she was worthy of unconditional positive regard in the hopes that if she could trust me . . . she would be able to establish a healthy relationship with another man."
He is not alone in that kind of argument.
According to an American Psychiatric Association survey, 19 percent of practitioners who become involved with patients do so believing they are enhancing the patient's self-esteem or offering an emotionally beneficial experience to the patient. Sixty-five percent of the offenders stated that they had been in love with the patient and 92 percent believed that the patients were in love with them. In 47 percent, the sexual contact was mutually initiated.
Regardless of who initiated the sex, the boards that determine the fate of a therapist's professional standing (and can permanently or temporarily suspend licenses), and the courts that hear the malpractice cases, say the therapist is totally responsible.