Real bodies: Trust me, I'm a shrink

... or maybe not. DR RAJ PERSAUD on new evidence that reveals how many therapists sleep with their clients reports

The first British study of therapist-patient sexual contact has just been published by Birmingham psychologists Dr Tanya Garrett and John Davis; of the 581 Clinical Psychologists surveyed (a quarter of the total membership of the clinical division of the British Psychological Society), only 3.5 per cent admitted sexual contact with patients, but other data emerged indicating just how big an underestimate this might be.

Almost a quarter of the psychologists reported having treated a patient who had been sexually involved with previous therapists, and nearly two fifths knew of other clinical psychologists who had had sex with patients.

One clinician reported 1000 sexual encounters, another 800, and while almost half of such relationships lasted for less than 3 months, some had continued for more than 5 years. Yet only 13 per cent of the psychologists, who knew of such stories, had taken any action.

While there have been at least ten previous surveys in the US gathering data on the issue, Garrett and Davis' represents a lone study of the British scene. According to the two psychologists, people who have tried to research this uncomfortable issue have been threatened with expulsion from professional organisations.

Garrett and Davis's survey reveals that while male therapists were more liable than females to have sex with patients, men were only 2.5 times more likely to do this than women - a much narrower gender gap than US rates. In America male therapists are 8 times more likely than women to become involved with clients.

Perhaps most intriguing of all was the finding that therapists who had a "humanistic" orientation were almost three times more prone to patient sexual liaisons than other therapists. Humanistic therapy is an attempt to move away from the authoritarian analyst by emphasising the friendliness of the therapist. In particular Humanists reject the overly-theoretical approach and prefer a more `playful' attitude to therapy, perhaps as this survey suggests, rather too playful.

Yet this problem has dogged therapy right back to its roots. In 1906 Carl Gustav Jung, Freud's heir apparent, started treating Sabina Spielrien, a 20-year-old Russian student who fell in love with him, and by 1909 Jung had made her his mistress. Jung wrote to Freud about the affair, but Freud defended Jung and colluded with his denials. He wrote supportively to Jung about affairs with women in therapy: "I have never been taken in so badly, but I have come very close to it". He comforted Jung with the fact that "it will never be possible to avoid little laboratory explosions".

Intriguingly Sabina Spielrein went on to become an analyst and part of Freud's circle in Vienna.

There are many arguments given for why sexual relationships form between therapist and client. Freud believed that patients made sexual advances to avoid confronting their own problems, while others point out that seducing your therapist is about gaining power somehow.

Garrett and Davis found those therapists who had themselves had therapy were even more likely to have sex with patients and that single or divorced therapists were more likely to start a sexual relationship than married ones. Indeed, it would seem that therapists are vulnerable in the same way that their patients are. Loneliness drives both clinician and patient into each other's arms.

These findings appear to be a convincing argument against longer- term therapies where intense relationships are more likely to develop. But what is particularly worrying about Garrett and Davis's results is that their survey was conducted amongst Clinical Psychologists, all registered with the prestigious British Psychological Society. So they would all have at least two degrees, including one postgraduate qualification, often gained against immense competition, plus the vast majority work in the highly regulated NHS.

One shudders to think what must be happening in the unregulated world of private counselling. Here no credentials or affiliation are necessary to hang up a plate, and start practising from the privacy of one's own home.