Consent requires that a person have all the necessary information to make a decision and the power to choose and have that choice respected by others.
The possibility of authentic consent rests upon equality of power in a relationship. Consent should never be confused with submitting, going along, or acquiescing.
~ Marie M. Fortune SEXUAL VIOLENCE: THE SIN REVISITED
Did I consent to have sex with Dr. T? I guess it depends on whom you ask. If you were to ask him, I’m sure the answer would be yes. If you were to ask any of my other therapists, my lawyer, or any of the folks I know from SNAP, the answer would be a definitive no. If you were to ask me, the answer would be something like: Umm…no… There’s no such thing as consent for sex between a therapist and a patient. I’ve practiced that statement enough now that I sound pretty convincing, even to myself.
Like some victims of professional abuse and exploitation, I was “groomed” for sex over a period of time. The process involved a methodical, systematic wearing away of my boundaries, my morals and values, and my quite appropriate inhibitions and prohibitions.
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One week after my then boyfriend and I decided to split up, Dr. T introduced physical contact into my therapy sessions. He did so with the noblest of intentions (or so it seemed): to provide me with a nurturing connection that could support me in my therapeutic work. After careful consideration, he decided it would be “okay” for us to hug at the end (or beginning) of sessions, and he also suggested that someday he could perhaps hold me while I processed highly emotional issues like loss and abandonment. I was thrilled at the possibility. I felt privileged, special, and very, very lucky. Our first embrace was a momentous occasion that took on an almost mythical quality in my mind.
While he’d always been easy-going, he became even more so during the next few months. He’d crack jokes, tell me funny stories—he was good at making me laugh. I found it easier then to let down my guard, open up more, take things less seriously. Once in a while he’d even call me at home—to check up on me or just say hi. He’d greet me casually, calling me by my last name and saying, “Hey—it’s your buddy!” I loved it when he called. I felt like he really liked me and cared about me. He was no longer just my therapist, he was also becoming my friend.
After about five months of weekly hugs, he began to increase the level of intimacy—a longer hug, a kiss on the cheek, a back rub. Every week it was something new. He approached all of this with nonchalance and calm control. He made all the decisions, judging what was okay, what not, where we could touch, where not, for how long, and how often… There seemed to be no reason for concern. He told me that he loved me and trusted me—he wanted me to be happy and feel good. I deserved that, he said, and he wanted to give that to me.
He decided that it would now be okay for him to try holding me during sessions. He let me pick the position. We’d sit on the floor, me in front and him behind with his arms around me. It felt really good. I felt secure, supported and loved. I found it easy to talk about difficult issues, partly from being held, but also because I felt less self-conscious, since he couldn’t see my face when I talked. After a couple of sessions like this, he took it to the next level and started touching me more, especially around my breasts—at first subtly, almost “accidentally,” then much more intentionally. He seemed to want me to get turned on. He also experimented with different ways of holding me, some of which were highly sexual. Sometimes the things he did felt nice, other times I found myself spacing out or not feeling anything at all. I felt embarrassed and confused about that, but I just couldn’t muster the nerve to say anything about it.
He’d remind me from time to time that he intended our physical contact to be for therapeutic purposes, not just for pleasure. He didn’t want me to take it for granted and sometimes accused me, playfully, of “junking on the hugs.” He thought I should take it all in and allow it to sustain me between visits. Wasn’t it better, he asked, to be aroused than to feel needy and depressed all the time?
During this time he was also introducing more sexualized content into our sessions—he’d ask me about my sexual history, question how I’d feel if he told me that he found me attractive or that I turned him on, ask about any “inappropriate thoughts” I might be having. Sometimes he’d talk about the spiritual benefits of tantric sex. Often, he’d make appreciative—and quite provocative—comments about my body. Truthfully, I felt excited by his flattery and beamed under his attention.
Sometimes I wondered if he knew what he was doing. The hugs were one thing but the more intimate stuff was strange territory; it confused me and I didn’t always know how to respond. But he always found ways to reassure me and diminish my concerns, sometimes teasingly dismissing my discomfort. I began to believe that, if there were any problems with the situation, they were mine—my way of thinking, my more conservative upbringing. He encouraged me to question my beliefs and long-held moral values. Essentially, his philosophy was this: Examine everything, then keep what works and discard the rest. I liked that. I wanted to be different—more confident, less troubled, less weighed down. I wanted to be more like…him.
As things progressed, he tried to get me to take a more active role in our contact. He asked why I didn’t test the limits. Was I afraid of making a mistake? I felt shy and uncertain, and scared by the new feelings I was having for him. I didn’t want to fall in love. I wanted to know that I’d be safe. He assured me that he was there for me, and it would be okay for me to push the envelope or surrender to whatever feelings I might be having. Of course there would be a “net” to catch me if I fell. Besides, what could be wrong with feelings of love? Why not just enjoy them, surrender to them?
The possibility of the two of us having sex was something he’d casually mention from time to time as if it were no big deal. He and his wife had “an arrangement” and I was single, so that was all okay, he said. I couldn’t quite believe he was talking about us having sex. Was he serious? I tried to take it in stride and not think about it too much.
He did want me to understand that, whatever we chose to do, we would never date or have an outside relationship. But as long as I could handle it, why not let ourselves have this gift? And as far as the prohibitions against therapist-patient contact, well, as my therapist, wasn’t he in a better position to judge what was best for me?
Even though he’d never done this before with a patient (or so he said), he had great confidence in his ability to manage the situation and whatever arose. Sure, he was breaking the rules and could lose his license if anyone found out, so we had to be careful. And, if it turned out that I couldn’t handle it emotionally, then we’d have to stop the contact altogether and go back to a more normal therapeutic relationship. But he hoped that he was making the right decision and that I would benefit from this approach he was taking. Of course, the decision was up to me.
That he would go so far for me and take these risks on my behalf made me feel very grateful and very loyal. I wanted to protect him and prove my worthiness, and I happily took on the responsibility of safeguarding our relationship. That included being careful about my own responses. I certainly did not want to disappoint him or appear ungrateful by questioning any of these “gifts” he was offering me—I might lose everything. I had to live up to my part of the bargain. I needed to show him that I could handle whatever we did, no matter what happened.
It took him about two and a half months to get from hugs to sex. Despite everything that had happened up to that point, when it came down to having sex, I hesitated. Things had progressed rapidly the previous couple of weeks—he had finally decided that it would be okay for us to kiss, really kiss—and I was feeling overwhelmed. Kissing him was one thing, but I had this feeling that sex would change everything, and I was terrified. Mostly, I was scared of falling completely in love with him. That felt dangerous, since I knew we could never be together as a couple. I didn’t know if I could handle having those kinds of feelings for him. But there we were, kissing on the floor of his office, and he was saying he really wanted to and asking if he could. I didn’t know what to say. I loved him. I wanted him to be happy, but…this? I tried to avoid a direct response and hoped he’d take the hint. Initially, he did. But then he asked again, promising to do whatever I wanted if I just said yes. To say no, to deny him what he wanted after all he’d done for me—I couldn’t do it.
So I…complied. I acquiesced. I submitted. Repeatedly. On a weekly basis for about the next three years, and on every occasion thereafter.
There were times I didn’t really want to, but it was hard to say no. I’d become “addicted” to him (through traumatic bonding)—both to the contact and to the feeling of validation I got from him when we had sexual contact. And I was worried about losing our special relationship, our friendship. If I refused him, or if he thought I couldn’t handle it, I feared he would end our contact altogether and we would go back to being “just” therapist and patient. That would be a devastating loss and I just didn’t feel strong enough to cope with it. I needed him. I depended on him. Compliance felt…safer.
So there was no saying no.
Periodically, Dr. T would remark on how much power I had in our relationship. This statement invariably confused me, since I felt like I didn’t have any power and couldn’t imagine what he was talking about. Sometimes he’d remark on how much sexual power I had—that he couldn’t resist me and had no discipline around me. He seemed to think I should find this flattering. (I didn’t. I didn’t want his inability to control himself to somehow be my fault.) Other times he would remind me that I could report him and cause him to lose his license. Horrified, I would protest that I would never do that, how could he even think that I would do that… And once again, he would be reassured of my loyalty. Of course I would never betray his trust.
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Dr. T was truly a master of manipulation. He knew my history, my psychological issues, my vulnerabilities, and he understood how to use that information to control me. He created the illusion that I was consenting of my own free will, that I had power and choice and was aware of the risks. I was so deeply under his influence and in such a profound state of denial that it was not until I was well away from him that I started to understand what had really happened. I am still sorting it all out.
On AdvocateWeb there is a brilliant piece of work by Dr. S. Michael Plaut, Ph.D called Informed Consent for Sex Between Health Professional and Patient or Client. Dr. Plaut, a psychologist who specializes in sexual and boundary issues, created his own version of what a statement for informed consent for sex between a health professional and patient might look like. In my opinion, it is both darkly funny and terrifyingly accurate as a document that informs both parties what could happen should they “consent” to have sexual contact. I will hopefully get permission to reproduce the document here on the blog, but until then, you can link to it above or from my Articles and Publications page.