Professional Exploitation Site: AdvocateWeb

This is one of the best sites I've found, regarding professional exploitation, which includes abuse of adults by clergy (from all faiths). It helped me to understand why the dynamics were wrong and why I was vulnerable from the first. I was also able to relate to others and acknowledge it wasn't something I encouraged, but something which was a serious ethical, moral, and legal violation.

The cover up was worse, and the harassment I've experienced since I decided to be vocal about what happened, was the worst part. Hopefully, this will shed light on the problem, for some, and be a comfort for others, that they are not alone. I guess I should add, this article is about sexual exploitation, but there are a lot of articles about other forms of abuse, or exploitation, which are damaging, and the symptoms they cause, even if it does not amount to actual sexual contact but is of a more emotional/romantic nature (such as the next post concerns, where a Catholic man wrote to me about improper conduct between a Benedictine priest and his ex-wife):

http://www.advocateweb.org/hope/historicaloverview.asp#Historical%20Background

Sexual Exploitation
Historical Overview
by Gary Richard Schoener
Gary Schoener is a licensed psychologist and Executive Director of the Walk-In Counseling Center in Minneapolis, MN. He is the senior author of "Psychotherapists' Sexual Involvement with Clients: Intervention and Prevention", co-author of "Assisting Impaired Psychologists", and has written many articles on this topic. Schoener has consulted in more than 3000 cases of sexual misconduct by professionals and was a member of the Task Force on Sexual Impropriety of the American Psychological Association and its Advisory Committee on the Impaired Psychologist. The Walk-In Counseling Center was the recipient of the 1977 Gold Achievement Award in Hospital and Community Psychiatry from the American Psychiatric Association.

This article has been reproduced with permission from the Walk-In Counseling Center. Copyright © 1998 WICC.

Preface
This is text of a presentation by Gary R. Schoener at the opening of the 2nd International Conference on Sexual Exploitation by Professionals, held in Minneapolis, Minnesota in October 1992. These were later edited and rewritten and published in the book "Breach of Trust" (Thousand Oaks Calif.: Sage Press, 1994) which was edited by John C. Gonsiorek.


Introduction
Before examining the history of sexual misconduct by professionals it is important to remind ourselves about how uneasy the relationship is between the helping professions and the law. There is an old joke in which three passengers on a sinking ship--an attorney, a health care professional, and a bishop--find themselves in the same liferaft. Unfortunately, the liferaft is not very seaworthy and begins taking on water, and it becomes clear that it will not make it to an island visible in the distance. The attorney, noting that the raft could handle two, but not three of them, suggests that they draw straws and that the one who gets the short straw has to swim to shore. They do so and the attorney gets the short straw. She is preparing to dive in and swim for the island when suddenly dorsal fins are everywhere--the raft is surrounded by sharks.

The attorney surveys the situation and grimly says, "Better one than three," and dives in and swims frantically. The sharks pull back and form a corridor to the island. The bishop says, "Heaven be praised, it's a miracle." The health care professional says, "Miracle my eye! That's professional courtesy."

This joke can serve as a useful metaphor. Those of us in the helping professions are the crew of the ship. We are the captain, the navigator, and the other crew members. The passengers are our clients and parishioners. It is our job to check the charts before we sail, to make sure where the hidden reefs lie. It is our job to check the weather before sailing so as to avoid, or at least be prepared for storms. It is our job to make sure we have enough life jackets and life rafts, and that they are seaworthy, in case trouble happens. It is our job to make sure that we have procedures for emergencies and that all of the crew understand them. It is when we fail in these duties that the ship goes down, the passengers are endangered, and the sharks come around. The sharks are not the problem...they simply clean up the mess.

This metaphor can be further extended to examine how we may respond when a complaint is made against a professional...that is, a member of the crew. First of all, even if the crew member who is accused of dereliction of duty works in another part of the ship, he/she is one of "us." As such, when a complaint is made we may choose to minimize it or attack the complainant, feeling ourselves attacked as a member of the crew and believing that the crew is a fine crew. Or, we may take the "bad apple" approach, deny any group responsibility, and attack the "bad" crew member as a "bad apple."

The problem with the "bad apple" approach is that it prevents us from looking at community and institutional problems. Furthermore, to judge from the research data which will be discussed throughout this conference, we've got quite a few thousand "rotten apples" to deal with each year.

As a prelude to the examination of our current knowledge and understanding of sexual misconduct by professionals which will comprise the conference, a brief recapitulation of some history seems in order. Beyond the normal wish to learn from history so as to avoid reliving it, we may now be in a position to understand it in a new light. T.S. Elliot wrote, in "Little Gidding":

We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.

(Gardner, 1987, p.897)

Historical Background
Although there are earlier medical codes and texts, such as the Code of Hammurabi, which was compiled around 2000 B.C., the first concerns about physician-patient sex in a written text are to be found in the Corpus Hippocratum. This was a body of about 70 medical texts compiled by the Library of Alexandria during the 4th and 5th centuries B.C. (Lloyd, 1983).

It is not known how many of these works can actually be attributed to Hippocrates, who lived from 460 to 370 B.C., although it is quite likely that he did not write the most famous item in the Corpus, the Oath which is usually attributed to him (Lloyd, 1983). In both the "Oath" and "The Physician," doctor-patient sexual intimacy is discussed. In "The Physician," the intimacy of the physician-patient relationship is described thus:

The intimacy also between physician and patient is close. Patients in fact put themselves into the hands of their physicians, and at every moment he meets women, maidens and possessions very precious indeed. So towards all these self-control must be used. Such then should the physician be, both in body and in soul. (Trans. by W.H.S. Jones, cited in Reiser, Dyck, & Curran, 1977, p. 5)

The original Greek version of the "Oath," usually referred to as the Hippocratic Oath, states in part:

". . . and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free." (Trans. by W.H.S. Jones, cited in Reiser, Dyck, & Curran, 1977, p. 5)

When the "Oath" was rewritten for Christian physicians some centuries later, this section read as follows:

. . . with purity and holiness I will practice my art . . . . Into whatever house I enter I will go into them for the benefit of the sick and will abstain from every voluntary act of Mischief and Corruption and further from the seduction of females or males, of freemen and slaves. . . . (Braceland, 1969, p. 236)

During the Middle Ages, the treatise "De Cautelis Medicorum," thought to have been written by Arnald of Villanova, read in part:

Let me give you one more warning: Do not look at a maid, a daughter, or a wife with an improper or a covetous eye and do not let yourself be entangled in woman affairs for there are medical operations that excite the helper's mind; otherwise your judgment is affected, you become harmful to the patient and people will expect less from you. And so be pleasant in your speech, diligent and careful in your medical dealings, eager to help. And adhere to this without fallacy. (Braceland, 1969, p. 236)

During the Middle Ages sexual contact between clergy and counselees or parishioners was known but not widely reported. A recent review of child sexual abuse by Roman Catholic priests notes:

Child sexual abuse involving priests is not a new phenomenon within the Catholic Church. Renaissance history reveals evidence of an awareness of this problem within the Church. During that period the Church took a traditional stance that clerics were the responsibility of the Church and, in theory, were not subject to secular law. The prosecutions that took place were tried in ecclesiastical courts under Cannon Law. (Stark, 1989, p. 793)

The issues of professional-patient sex again emerges in the literature near the end of the 18th Century. Concern about physicians taking sexual advantage of their patients through the misuse of mesmerism (hypnosis) was voiced in 1784 by a Commission of Inquiry headed by Benjamin Franklin, which, in a secret report to the French King, Louis XVI, stated:

. . . the danger exists. . . since the physician can, if he will, take advantage of his patient. . . . Even if we ascribe to him superhuman virtue, since he is exposed to emotions which awaken such desires, the imperious law of nature will affect his patient, and he is responsible, not merely for his own wrong-doing, but for that he may have excited in another. (Franklin, de Bory, Lavoisier, Bailly, Majault, Sallin, d'Arcet, Guillotin, & Le Roy, 1965, p. 6)

Perry (1979) notes that at ". . . the time the report was written. . . medical doctors enjoyed a bad reputation in the eyes of a significant segment of the lay public." (p. 188) It would be well for all of us in the helping professions, who today enjoy considerable public respect, that such has not always been the case...and, if we don't police ourselves more effectively it can easily cease to be the case.

A book widely thought to be America's first psychological novel, The Scarlet Letter by Nathaniel Hawthorne, was published in 1850. It described the shame of a young woman who was required to wear the scarlet letter "A" (for adulteress) after having been made pregnant by a clergyman, Arthur Dimmesdale, who escaped public disgrace, but not emotional consequences. In a meeting with Hester in the forest, Rev. Dimmesdale tells Hester, when asked if he's found any peace in the preceding seven years,that he has found "None! Nothing but despair." (Hawthorne,1991) When Hester inquires as to whether the good works he has done in the church among those who revere him has brought comfort, Dimmesdale replies:

As concerns the good which I may appear to do, I have no faith in it. It must needs be a delusion. What can a ruined soul, like mine, effect towards the redemption of other souls?--or a polluted soul, towards their purification? And as for the people's reverence, would that it were turned to scorn and hatred! Canst thou deem it, Hester, a consolation, that I must stand up in my pulpit, and meet so many eyes turned upward to my face, as if the light of heaven were beaming from it!--and then look inward, and discern the black reality of what they idolize? I have laughed, in bitterness and agony of heart, at the contrast between what I seem and what I am! And Satan laughs at it!
(Hawthorne, 1991, p.134)

Henry Ward Beecher (1813-1887), son of famous clergyman Lyman Beecher and brother of the author of Uncle Tom's Cabin, Harriet Beecher Stowe, was "one of the premier preachers in the late nineteenth century," according to the Dictionary of Christianity in America (Reid, Linder, Shelley, Stout, 1990). A short summary of his career is presented thus:

Under his preaching (1847-1887) Plymouth church became one of the first large middle class suburban churches in America. As editor of two well-read journals, the Independent (1861-1863) and the Christian Union (1870-1881) Beecher's influence reached well beyond the confines of his own church's membership. Yale University invited him to deliver the prestigious Lyman Beecher Lectures for three years straight (1872-1874) (Reid, Linder, Shelley, & Stout, 1990, p.123).

Though omitted from many summaries of church history, at the height of his distinguished career and pastoral influence, Beecher undertook pastoral counseling of Elizabeth Tilton, the wife of a friend, who was grieving the death of her infant. Beecher reportedly convinced her to engage in an intimate relationship with him, cautioning her not to tell anyone about it (Morey, Oct. 5, 1988). In 1872 journalist Victoria Woodhull published the story of the relationship and was jailed, but subsequently released (Fortune, 1989, p.120). Theodore Tilton sued Beecher. A congregational investigating committee, ignoring "almost irrefutable evidence," not only exonerated Beecher but expressed towards him "sympathy more tender and trust more unbounded" than before (Morey, Oct.5, 1988, p.868). Elizabeth Tilton was excommunicated in 1878. Beecher's career was not significantly affected (Waller,1982).

Romance novels of the late 19th and 20th century often portrayed ministers as boyish and innocent men, pursued by women who sought to seduce them, but whose clutches they managed to escape (Morey, 1988). For example, Corra Harris' A Circuit Rider's Wife, published in 1910 (and serialized in the Saturday Evening Post the same year), includes the following narration by Mary, wife of a Methodist minister:

...when we hear of a minister who has disgraced himself with some female member of his flock, my sympathies are all with the preacher. I know exactly what has happened. Some sad-faced lady who has been "awakened" from a silent, cold, backslidden state by his sermons goes to see him in his church study.(They who build studies for their preachers in the back part of the church surround him with four walls of moral destruction and invite it for him. The place for a minister's study is in his own home, with his wife passing in and out, if he has female spiritual invalids calling on him.)

This lady is perfectly innocent in that she has not considered her moral responsibility to the preacher she is about to victimize. She is very modest, really and truly modest. He is a little on his guard till he discovers this. First, she tells him that she is unhappy at home...

...He sees her reduced to tears over her would-be transgressions, and before he considers what he is about he has kissed the "dear child." That is the way it happens nine times out of ten, a good man damned and lost by some frail angel of the church. (Harris, 1988, pp. 81-83)

Mary nipped one such potential relationship--that between a parishioner and her minister husband William--in the bud by privately confronting the woman, after having watched with chagrin that:

...William was always cheered and invigorated by her visits. He would come out of his study for tea after her departure, rubbing his hands and praising the beautiful, spiritual clearness of her mind, which he considered very remarkable in a woman. (Harris, 1988, pp. 83-84)

Mary proposes a solution to this problem:

Someone who understands real moral values ought to make a new set of civil laws that would apply to the worst class of criminals in society--not the poor, hungry, simple-minded rogues, the primitive murderers, but the real rotters of honor and destroyers of salvation. Then we should have a very different class of people in the penitentiaries, and not the least numerous among them would be the women who make a religion of sneaking up on the blind male side of good men without a thought of the consequences. (Harris, 1988, p. 85)

So, we know what the problem is...it is women. In case one is tempted to relegate this account of the 1880's published in 1910 to the past it should be noted that it was reissued as The Circuit Rider's Wife (Harris, 1988) in 1988 and had a second printing in 1990. Furthermore, The Bishop's Mantle, written by Agnes Turnbull in 1948, contained similar sentiments, describing the struggles of Hilary Laurens, a young minister, who was barely able to escape the clever plotting of predatory women in his congregation:

In spite of himself he thought of the ministers, from Beecher down, who had had trouble with women. Every city clergyman had to recognize this menace. A few to his own knowledge through the years, in spite of their utter innocence, had yet escaped by a hair's breadth. A few here and there had not even escaped. There were always the neurotic women who flocked not only to the psychiatrists but also in almost equal numbers to ministers, pouring out their heart confessions and their fancied ills; there were those pitiable ones in whose minds religion and sex had become confused and intermingled; there were those who quite starkly fell in love with a clergyman and wanted love from him in return. Yes, a man of God had to be constantly on his guard in connection with this problem of women [emphasis mine] (Turnbull, 1948, p.235).

Erotic feelings between therapist and client also are found in the earliest reported cases of psychotherapy--the "talking cure." Anna O. was treated using hypnosis by Joseph Breuer in 1880; subsequently, the case became one of Freud's most widely discussed models of psychotherapeutic treatment. Ernest Jones (1953), Freud's first biographer, reported, on the basis of Freud's account of the case:

...that Breuer had developed what we should nowadays call a strong counter-transference to his interesting patient....his wife became bored at listening to no other topic,...jealous....unhappy and morose. It was a long time before Breuer...divined the meaning of her state of mind. It provoked a violent reaction in him, perhaps compounded of love and guilt, and he...[brought] the treatment to an end....that evening he was fetched back to find [Anna O.] in the throes of an hysterical childbirth...the logical termination of a phantom pregnancy...he managed to calm her down...and then fled the house in a cold sweat. The next day he and his wife left for Venice to spend a second honeymoon... (pp. 224-25)

Although this experience deterred Breuer from further experiments with hypnosis to treat hysterical symptoms, Freud went on to experiment with the "talking cure" and, eventually, to develop psychoanalysis. In his classic Introductory Lectures in Psychoanalysis, published in 1917, Freud noted the romantic and erotic feelings his female patients exhibited toward him, labeling it transference. In writing on this topic, Freud (1958) clearly indicated that the therapist should not take advantage of the patient's "longing for love" and should abstain from sexual involvement. Freud also noted that the therapist had to struggle with his own countertransference love feelings.

Despite Freud's warnings of the potentially erotic atmosphere of the psychoanalytic relationship, some of his followers experimented with physical contact with clients. When Freud learned that Ferenczi, one of his followers, had engaged in kissing and other physical contact with clients, he wrote a challenging letter on December 13, 1931, warning Ferenczi about this practice (Grosskurth, 1991, p.206).

Wilhelm Reich (1945, pp. 126-7) believed that the therapist should allow the client's overt sexual feelings to develop until they are "concentrated, without ambivalence, in the transference." Although he never advocated sexual relationships between therapist and client, at times "[he] physically manipulated... [some clients] to 'appropriate' responses" (Marmor, 1970, p. 12). Reich (1945, p. 133) cited two measures of whether sensual genital striving was freed from repression: "Phantasies of incest without guilt feeling" and "genital excitation during analysis...." While explaining Reich's theories and behavior as, in part, symptoms of paranoid schizophrenia, Marmor (1970, p. 12) accused Reich's students and followers of using "the prestige of this unfortunate psychoanalytic pioneer to act out their own countertransference needs."

In recent years it has come to light that psychoanalyst Carl Jung had a romantic affair with Sabina Spielrein, whom he treated from 1905 to 1909. She had been 19 years old when she began her analysis. Subsequently she became a physician and in 1912 joined the Vienna Psychoanalytic Society (Carotenuto, 1984). Gay (1988, p. 396), in his biography of Freud, described Spielrein as:

"one of the most extraordinary among the younger analysts," who " had gone to Zurich to study medicine and in desperate mental distress, went into psychoanalytic treatment with Jung." "She fell in love with her analyst, and Jung, taking advantage of her dependency, made her his mistress. After painful struggle in which Freud played a minor but not admirable part, she freed herself from her involvement and became an analyst."

Her relationship with Jung was discussed in letters between Freud, Jung, and herself and later was reprinted in a book by Aldo Carotenuto, first published in Italy in 1980, and then appeared in English translation (Carotenuto, 1982) as A Secret Symmetry: Spielrein Between Jung and Freud. The book generated reviews such as Bettelheim's (1983) "Scandal in the Family." In terms of physical contact the romantic involvement may have gone no further than kissing and talk of love, but Spielrein has been referred to as Jung's "mistress," implying greater sexual involvement. The rumors it generated and the subsequent interchanges between Freud, Jung, Spielrein, and others are discussed by Masson (1988, pp. 170-77) Grosskurth (1991) and others.

In a letter to Freud dated 4 June 1909, Jung mentions the relationship and indicates that Spielrein was "systematically planning [his] seduction" (McGuire, 1988, p.228). Freud's response, dated 7 June 1909, was supportive and noted that while Freud himself had "never been taken in quite so badly," he had "...come very close to it a number of times and had a narrow escape" (McGuire, 1988, p.230). Freud focused all blame on Spielrein:

The way these women manage to charm us with every conceivable psychic perfection until they have attained their purpose is one of nature's greatest spectacles (McGuire, 1988, p.231).

On 21 June 1909 Jung wrote to Freud that he had met with Spielrein and discovered that she had not been the source of the rumors about their relationship and indicates remorse about "the sins" he had committed:

When the situation had become so tense that the continued preservation of the relationship could be rounded out only by sexual acts, I defended myself in a manner that cannot be justified morally. Caught in my delusion that I was the victim of the sexual wiles of my patient, I wrote to her mother that I was not the gratifier of her daughter's sexual desires but merely her doctor, and that she should free me from her. In view of the fact that the patient had shortly before been my friend and enjoyed my full confidence, my action was a piece of knavery which I very reluctantly confess to you as my father (McGuire, 1988, p.236).

Jung had written to Sabina Spielrein's mother, indicating that he had moved from doctor to friend "the more easily" because he had not charged a fee, and then made a proposition that he would come to regret--that if she wished him "to adhere strictly to [his] role as doctor," she should pay him "a fee as suitable recompense for [his] trouble" (Donn, 1990, p.93).

In his letter of 30 June 1909 Freud reports that he has written to Sabina Spielrein's mother, as Jung asked him to, and that "the matter has ended in a manner satisfactory to all. He asks Jung to not fault himself for drawing Freud into the situation, asserting that "it was not your doing but hers" (McGuire, 1988, p.238). Again we can see what the problem is--it is seductive women. As for the harmful impact of such behavior on the client, Bettelheim wrote:

Whatever may be one's judgment of Jung's behavior toward Spielrein...one must not disregard its most important consequence: he cured her...

In retrospect we ought to ask ourselves: what convincing evidence do we have that the same result would have been achieved if Jung had behaved toward her in the way we must expect a conscientious therapist to behave toward his patient? However questionable Jung's behavior was from a moral point of view--however unorthodox, even disreputable, it may have been--somehow it met the prime obligation of the therapist toward his patient: to cure her. True, Spielrein paid a very high price in unhappiness, confusion, and disillusion for the particular way in which she got cured, but then this is often true for mental patients who are as sick as she was. (Carotenuto, 1984, p. 38)

A disturbing footnote was added to this seemingly incongruous defense of Jung after Bettelheim's suicide when former patients, trainees, and staff from his famed Orthogenic School came forward with stories of emotional and psychological abuse by Bettelheim (Angres, Oct. 1990; Schoener, Sept. 1991; Schoener, March 1992).

In 1913 Ernest Jones, one of Freud's inner circle, had become the subject of a complaint by a former patient to the President of the University of Toronto where he was a faculty member. This patient, who alleged sexual advances by Jones, had come forward with the help and support of her general practitioner. Jones claimed that the general practitioner, a woman, had a lesbian relationship with the complainant, but the credibility of his defense was undermined by his admission that he had paid money to the patient in an attempt to buy her silence (Grosskurth, 1991, p.56).

F. Scott Fitzgerald's novel Tender is the Night, published in 1933, dealt with a psychiatrist, Dr. Diver, who became romantically involved with a woman who was a patient. In one scene she asks Dr. Diver if he found her attractive:

He was in for it now, possessed by a vast irrationality. She was so near that he felt his breathing change but again his training came to his aid in a boy's laugh and a trite remark. (Fitzgerald, 1933, p.174)

During the next fifty years a number of novels and movies would include plots involving sexual and/or romantic involvement between professional and client. Most involved male professionals and female clients.

Despite the fact that the ranks of physicians and clergy were overwhelming male, such transgressions were not limited to male professionals, even in the early days. Karen Horney, one of the leading figures in psychoanalysis, was quoted as saying:

As a rule it is better not to have social relationships with a patient, but I am not terribly rigid about it. Generally, I have none or a restricted relationship. (Wolff, 1956, p. 87)

However, in her biography of Horney, A Mind of Her Own, Susan Quinn notes that in her later years Horney had a romantic relationship with a young man who was in treatment with her, something Quinn (1988, p. 378) attributed to "old impulsive ways [which] survived into middle age." Quinn claims that this relationship, begun during the second half of the 1940s, lasted until the end of Horney's life in 1952.

During the 1960's the human potential movement blurred some of the distinctions between traditional psychotherapy and new methods such as encounter groups. The taboo against touch in psychoanalysis was questioned, with for example, one female analyst arguing:

...it seems absurd that any qualified psychoanalyst should be so carried away by contact with a patient, however attractive, that he (or she) could not refrain from complete gratification...(Mintz, 1969, p.371)

Despite experimentation with nudity in sensitivity groups (see for example Maslow, 1965, p. 160 or Bindrum, 1972), only one author argued for sexual contact with clients. J.L. McCartney, a psychoanalyst, claimed to have experienced "overt transference" with 30% of his female patients, including undressing, genital touch, or sexual intercourse with 10% (McCartney, 1966). Although no clients complained, McCartney was widely attacked within the profession and was expelled from membership in the American Psychiatric Association.

The next decade opened with the publication of Masters and Johnson's classic Human Sexual Inadequacy in 1970, inaugurating the development of the new field of sex therapy. Ironically, these authors reported that a sizeable number of their clients had reported sexual contact with a previous therapist and labeled such conduct "rape" in a widely reported address to the American Psychiatric Association convention in 1975 (Masters & Johnson, 1975). However, media accounts of "sex therapy" and the use of sexual contact in research and "sexual surrogates" in therapy left many consumers less clear about what might constitute acceptable in therapy.

Martin Shepard's (1971) book The Love Treatment, based on interviews with eleven clients who reported sexual relationships with their therapists. fueled major controversy when popular articles such as "Should you sleep with your therapist? The raging controversy in American psychiatry" in Vogue (Weber, Jan. 1972). Shepard's (1972) second book, A Psychiatrist's Head, which described an orgy during a group therapy session, resulted in the revocation of Shepard's medical license, despite the absence of client complaints (Simon, 1988).

A feminist counter-offensive began with the publication of Phyllis Chesler's Women and Madness in 1972. One of its chapters discussed sex between male therapists and female clients based on interviews with ten women who reported such an experience. This was followed by two widely discussed Ph.D. dissertations involving case studies of women who reported sex with their therapists (Belote, 1974; D'Addario, 1977).

The 1970's also saw the advent of the self-report survey of professional groups with the publication of Kardener, Fuller, & Mensh's (1973) study of a sample of 1,000

physicians in Los Angeles County. Their finding that 10% of psychiatrists and other physicians acknowledged erotic contact with clients, and that 5% acknowledged sexual intercourse, established the seriousness of the scope of the problem and presaged the ensuing professional debate not to mention a large number of self-report surveys (Schoener et. al., 1989, pp.25-45).

From March 10 to 19 the case of Roy v. Hartogs was tried in New York City. It was widely reported in newspapers around the U.S. and Canada. Julie Roy, the plaintiff, charged Dr. Renatus Hartogs, a psychiatrist with good credentials and the author of a column for Cosmopolitan magazine, had sexually exploited her. Ms. Roy won the suit and the next year co-authored a book, Betrayal, which was later made into a made-for-TV movie of the same title (Freeman & Roy, 1976). While not the first such case, its broad publicity led to many other clients coming forward and presaged the local and national coverage of other cases in by news media.

A major discussion of therapist-client sex occurred in May of 1976 at the annual convention of the American Psychiatric Association. The next year a national survey of psychologists was published whose findings mirrored those of Kardener, Fuller, & Mensh (Holroyd & Brodsky, 1977), and in 1978 a California Psychological Association Task Force undertook a large scale survey of psychologists concerning their knowledge of cases (Bouhoutsos et.al., 1983).

The remainder of the 1970's through the present have been characterized by many theoretical articles and discussions at professional conferences, continuing research (largely involving surveys), and repeated efforts to refine the language of professional codes of ethics (so as to have more specific prohibitions against sex with clients). Complaints to ethics committees and licensure boards and malpractice actions related to sexual misconduct by therapists steadily increased during the 1970's and 1980's. There is no evidence that all of this study and discussion, or even the refinements in the ethics codes, changed professional behavior.

Frustrated consumers who had been sexually exploited and concerned professionals began seeking remedies through media attention and changes in public policy. In 1984 Wisconsin criminalized therapist-client sex and the Minnesota legislature created a Task Force on Sexual Exploitation by Counselors and Psychotherapists. In 1985 Minnesota criminalized therapist-client sex, including sexual contact by clergy who were providing counseling for emotional problems. To date nine states have criminalized, and several have special civil statutes covering suits against therapists for sexual misconduct (Jorgenson, Randles, & Strasburger, 1991).

In October of 1984 the indictment of Father Gilbert Gauthe Jr. for sexual abuse of children in Lafayette, Louisiana, sent shock waves around North America. The criminal case was followed by a $12 million lawsuit against the church, both of which received wide publicity. In May 1985 a secret report was made to the Conference of Catholic Bishops at their annual meeting, held that year at St. John's University in Collegeville, Minn. The report warned that the church had to deal more effectively with priests who sexually molested children (Berry, 1992).

Numerous other lawsuits followed, many of them involving alleged sexual abuse of children by clergy. However, interdenominational task forces in several states examined sexual misconduct by clergy with both child and adult counselees/parishioners. The Washington Council of Churches issued a report on Sexual Contact by Pastors and Pastoral Counselors in Professional Relationships in 1984 and the Minnesota Interfaith Committee on Sexual Exploitation by Clergy published Sexual Exploitation by Clergy: Reflections and Guidelines for Religious Leaders in 1989.

In 1989 two cases of alleged sexual misconduct by priests with young people received considerable publicity throughout North America--Father Bruce Ritter, the founder of Covenant House Charity in New York (Sennott, 1992) and the Mount Cashel Orphanage case in Newfoundland (Harris, 1990). That same year Rev. Marie Fortune's book Is Nothing Sacred? challenging the religious community to deal more effectively with sexual misconduct in the church, was published. Dr. Peter Rutter's Sex in the Forbidden Zone, also published in 1989, generated considerable discussion and media coverage in North America and brought about in incredible response from many victims/survivors of sexual misconduct by professionals. Hundreds of people, for example, have contacted our center about misconduct by therapists and clergy as a result of reading this book.

By the end of the 1980's and beginning of the 1990's a number of church denominations had developed or were working on policies and guidelines for handling complaints of sexual misconduct by clergy.

Sexual misconduct by non-psychiatric physicians and other health care professionals, by contrast, has received considerably less attention until recently. Burgess and Hartman's (1986) Sexual Exploitation of Patients by Health Professionals received little attention by contrast to the books about sexual misconduct by therapists and clergy. The case of Dr. John Story, a family practitioner who was criminally convicted of sexual misconduct with female patients in 1988, was the subject of a major book DOC: The Rape of the Town of Lovell (Olsen, 1989) and has been featured on a number of TV shows. There has also been media coverage of local cases in a number of cities, although nothing in the United States has had the impact and visibility of the debate raging in Canada over the past two years in response to The Preliminary Report and The Final Report of the Special Task Force on Sexual Abuse of Patients of the College of Physicians and Surgeons of Ontario (both in 1991). Other provincial colleges have undertaken similar studies and are examining the need for change as not only physicians, but other regulated health professions examine the problem of sexual misconduct within their own professions. It is my belief that complaints involving physicians in specialties other than psychiatry as well as complaints involving other health care professions will increase throughout the 1990's.

Conclusion
What have we learned from this brief recapitulation of the history and evolution of our concern about sexual misconduct by various professional groups? It seems that a certain critical level of visibility is necessary before either the profession itself or the community attempts to intervene in a major fashion to prevent or remedy sexual misconduct with clients. What is also apparent from a review of the history of this issue is that sexual misconduct by professionals is a very old problem, and one which has evaded solution for many centuries. Our history also tells us that ethics codes, discussion, and research alone have failed to significantly change the situation. We have tried "Plan A"--self-regulation in concert with codes of ethics--and it has not solved the problem. Twenty four centuries is probably long enough to try any one solution--now it is time for some new initiatives. Hopefully this brief historical overview has provided sufficient background so that we can now focus our efforts on solutions.

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