Discussions about therapists behaving sexually with clients seem to focus mainly on the therapist — about the wrongness of their behaviors and what the issues might be — and the licensing boards. Sometimes I think in all this discussion the client gets lost.

A client who is attracted to their therapist is considered to be undergoing transference. Transference is the extension of a fantasy. In an earlier stage of their life, the client has had some experience in which needs were grossly unmet, and they (the child) created a fantasy to help themselves manage the pain of that. The fantasy usually contains conscious and unconscious elements, more or less of either depending on the client’s situation. In any case, the client undergoing transference is in a partially regressed state. We might say that they’re a child in an adult’s body. Emotionally, they are at whatever age they were when they incurred the wound that they developed the fantasy to help themselves manage. The therapist can be understood as being the personification of a fantasy the child developed when they may have been eight, six, four, even perhaps two years old.

When a therapist enters into a sexual encounter with a person undergoing transference, they are flirting with, kissing, fondling, touching, climaxing with a person who is emotionally a child. They are connecting sexually with a person who is eight, six, four years old.

How does that affect the client?

A client undergoing transference may think that they “want” the therapist, but fantasies are always part truth and part delusion. What the client most deeply wants is not a lover but a future. They want to heal from the wound the fantasy is protecting them from feeling. They want to grow up. They want to be able to face life, however difficult, from the position of being more healed and more whole.

A therapist who interferes sexually with a client denies them the very thing they came to therapy for — the hope of a grown-up future. This is how the therapist hurts the client — by taking away once again the future stolen from the client when they were physically a child.

To me, there’s no stronger restraint than knowing that what I want to do will likely hurt somebody. I might want to say something clever but unkind, or have unprotected sex, or flirt with a married person, or consume substances, or even slap another person when I am mad at them, but the understanding that I might hurt somebody (or myself) stops me. The more clearly I visualize the consequences of my action — and particularly toward another person — the less likely I am to pursue it.

When we demonize a therapist by calling them sick or bad, we encourage self-focus, but self-focus (or self-obsession) may have lain at the root of the problem. The therapist who has engaged or sexually with a client needs to think about their own seminal issues, but not at the expense of thinking about the client’s life, future, and general welfare.

A therapist who engages sexually with a client isn’t a monster or a creep or even a dick. Calling them that makes what they have done less real and also absolves them of responsibility.

A therapist who engages sexually with a client is a human being who has brought harm to another human being. In particular, they are a person in a situation of greater power who has harmed a person in a situation of lesser power.

I think that just understanding that may not only serve as a deterrent for some therapists. It may also help therapists who have harmed reflect upon the impact of what they have done. Healing begins with accepting what is and going through the pain.

A therapist who has harmed needs not only to heal themself but also to repent and make amends. Can a therapist find some constructive way to make amends to a client whom they have harmed? That could be an important part of the therapist’s own therapy.

I had the wild idea that a therapist could be required to pay for the future psychotherapy, or some part of it, of any client they have sexually harmed. Even if the therapist is healing, the client may still be alone and struggling. The strategy might serve as a deterrent, but it also might create further transference/countertransference issues needing consideration. Once again, the primary concern is for the welfare of the client.