SOCI_108_POGREBIN_6

SOCI_108_POGREBIN_6 - .:.-;._J+ ..m..w__.l_g._—n.m:t.yti...

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Unformatted text preview: .:.-;._J+ ..m..w__.l_g._—n.m:t.yti _: 7";“1v... .. V (I m. «aw -.~: : . .u .‘3:;“*‘ ‘ .. f A 44 PSYCHOTHERAPISTS’ ACCOUNTS OF THEIR PROFESSIONAL MISDEEDS MARK R. POGREBIN ERIC D. POOLE AMOS MARTINEZ Intimate sexual relationships between mental health therapists and their clients have been increasingly reported in recent years (Akamatsu. 1987). In a sur- vey of over 1400 psychiatrists, Gartell, Herman, Olarte, Feldstein, and Localio ( 1987) found that 65 percent reported having treated a patient who ad- mitted to sexual involvement with a previous thera- pist. National self-report surveys indicate that approximately 10 percent of psychotherapists admit having had at least one sexual encounter with a client (Gartell, Herman, Olarte, Feldstein, and Lo- calio. 1986; Pope. Keith—Spiegel, and Tabachnick, 1986). It is suggested that these surveys most likely underestimate the extent of actual sexual involve- ment with clients because some offending psycho- therapists either fail to respond to the survey or fail to report their sexual indiscretions (Gartell et a1., 1987). Regardless of the true prevalence rates, many mental health professional assoeiations ex- plicitly condemn sexual relations between a thera- pist and client. Sueh relationships represent a breach of canons of profe5siona1 ethics and are sub- ject to disciplinary action by specific licensing or regulatory bodies. . . . Since 1988 [in Colorado] sexual intimacy be- tween therapists and clients has been explicitly and formally recognized as one of the most serious violations of the professionalwlient relationship, subject to both regulatory or administrative and criminal penalties. Yet, between August 1, 1988, and June 30, 1990, 10 percent (n = 33) of the 324 complaints filed with the State Grievance Board involved allegations of sexual misconduct. Given the implications that these sexual improprieties raise for both the client as victim and the therapist as offender, we wish to examine the written ac- counts submitted to the board by psychotherapists who have had complaints of sexual misconduct filed against them. . . . METHOD To the 33 complaints of sexual misconduct filed from August 1988 through June 1990. 30 written responses from psychotherapists were submitted to the State Grievance Board. Twenty-four thera- pists admitted to sexual involvement with clients; six denied the allegations. In the present study we examine the statements of the 24 therapists who provided accounts for their sexual relations with clients. Twenty«one therapists are men; three are women. The analytical method utilized in reviewing therapists’ accounts was content analysis, which Source: Mark R. Pogrebin. Eric D. Poole. and Amos Martinez, “Accounts of Professional Misdeeds: The Sex ual Exploitation of Clients by Psychmherapists," Deviant Behavior, vol. 13 (1992), pp. 229—252. Reprinted with permission. 284 44 POGREBIN, POOLE, AND MARTINEZ PSYCHOTHERAPISTS’ ACCOUNTS OF THEIR MISDEEDS 285 “translates frequency of occurrence of certain symbols into summary judgments and compar— isons of content of the discourse” (Starosta, 1984, p. 185). Content analytical techniques pro— vide the means to document, classify, and inter— pret the communication of meaning, allowing for inferential judgments from objective identifica- tion of the characteristics of messages (Holsti, 1969). The 24 written responses ranged in length from 2 to 25 pages. Each response was assessed and classified according to the types of expla- nations invoked by therapists in accounting for their acknowledged sexual relations with clients. We employed Scott and Lyman’s (1968) classic formulation of accounts (i.c., excuses and justifications) and Goffman’s (1971) notion of the apology as conceptual guides in organiz- ing the vocabularies of motive used by our group of therapists to explain their untoward behavior. . . . FINDINGS Accounts are “linguistic device[s] employed whenever an action is subjected to valuative in- quiry” (Scott and Lyman, 1968, p. 46). An im- portant function of accounts is to mitigate blameworthiness by representing one's behavior in such a way as to reduce personal accountabil- ity. This involves offering accounts aimed at al- tering the prevailing conception of what the instant activity is, is well as one’s role in the ac- tivity. Excuses, justifications, and apologies all display a common goal: giving a “good account” of oneself. Excuses Appeal of Defeasibility. In an appeal of defeasi- bility, one accounts for one’s behavior by denying any intention to cause the admitted harm or by claiming a failure to foresee the unfortunate con- sequences of one’s act, or both. . . . 1n the follow- ing account, the therapist claims ignorance of professional rules of conduct governing relations with clients: I did not know that seeing clients socially outside of therapy violated hospital policy. . . [11f I real- ized it was strictly forbidden, I would have acted dtflerently. . . In the following example, a therapist admits that she simply misinterpreted her own feelings and did not consciously intend to become sexually involved with her client: It was after a short period of time that [first expe— rienced any sexual feelings toward her. I did ex- cuse the feelings I had as something which I never would act on. Unfortunately, I did not understand what was happening at the time. Similarly. another therapist seeks to diminish culpability by attributing his sexual indiscretion to a misreading of his client’s emotional needs: I experienced her expressions ofafiection as caring gestures of our spiritual bond, not lust. And I had no reason to suspect otherwise from her, since I had been so clear about my aversion to romantic involvement. We had sexual intercourse only once after termination. I am not promiscuous, neither sexually abusive nor seductive. . . . Scapegoating. Scapegoating involves an attempt to blame others for one’s untoward behavior. Scapegoating is available as a form of excuse in the professional—client relationship because of the contextual opportunity for the therapist to shift personal responsibility to the client. The therapist contends that his or her actions were the product of the negative attributes or will of the client, for example, deceit, seduction, or manipulation. The therapist in the following example recognizes the wrongfulness of his behavior but deflects re- sponsibility by holding the client culpable for her actions: I am not denying that this sexual activity took place, nor am [trying to excuse orjustifv it. It was wrong. However, the woman who complained about me is a psychologist. She was counseling me as well, on some vocational issues. So if anyone 286 PART ELEVEN PRJVILEGED DEVIANCE had cause for complaint under the regulations, it seems it would be me. Another example of an account where the therapist attempts to “blame the victim” for the improper sexual activity reveals the focus on his diminished personal control of the relationship: That I became involved in a sexual relationship with her is true. While my actions were reprehene sible. both morally and professionally. I did not mislead or seduce her or intend to take advantage ofher Myfault, instead, wasfailing to adequately safeguard myself from her seductiveness, covert and overt. Here we have a therapist recognizing the impro— priety of his actions yet denying personal respon— sibility because of the client’s overpowering charms. The message is that the therapist may be held accountable for an inadequate “self-defense” which left him vulnerable to the client’s seductive nature, but that he should not be culpable for the deviant sexual behavior since it was really he who was taken in and thus “victimized.” The thera- pists account for his predicament presumes a “reasonable person” theory of behavior; that is, given the same set of circumstances, any rcason- able person would be expected to succumb to this persuasive client. Justifications Sad Tale. The sad tale presents an array of dismal experiences or conditions that are regarded—both collectively and cumulatively—as an explanation and justification for the actor’s present untoward be- havior. The therapists who presented sad tales in— variably focused on their own history of family problems and personal tribulations that brought them to their present state of sexual affairs with clients: Ironically, her termination from therapy came at one of the darkest periods of my life. My father had died thatyear I had met himfor thefirst time when I was in my twenties. He was an alcoholic. Over the years we had worked hard on our relationship. At the time ofhis dying, we were at peace with one another. Yet. I still had my grief At the time I had entered into individual therapy to focus on issues pertaining to my father’s alcoholism and co- dependency issues. I then asked my wife to join me for marriage counseling. We were having substan< tial problems surrounding my powerlessness in our relationship. Therapy failed to address the balance ofpower I was in the worst depression [had ever experienced in my entire life when we began our sexual involvement. Therapists who employ sad tales admit to having sexual relations with their clients, admit that their actions were improper, and admit that ordinarily what they did would be an instance of the general category of the prohibited behavior, They claim, however, that their behavior is a spe— cial case because the power of circumstance voids the defining deviant quality of their actions. This type of account is similar to Lofland’s (1969, p. 88) “special justification,” where the actor Views his current act as representative of some category of deviance but does not believe it to be entirely blameworthy because of extenu— ating circumstances. One therapist outlines the particular contextual factors that help explain his misbehavior: The following situations are not represented as an excuse for my actions. There is no excusefor them. They are simply some of what [feel are circum- stances that formed the contextfor what I believe is an incident that will never be repeated. (1 ) Life losses: My mother-in-law who lived with us died. My oldest son and, the next fall, my daughter had left homefor college. (2) Overscheduling: I dealt with these losses and other concerns in my life by massive over- scheduling. Other therapists offer similar sad tales of tragic events that are seen to diminish their capacity, either physically or mentally, to cope with pre sent circumstances. Two cases illustrate this ace counting strategy: In the summer of 1988, my wife and I separated with her taking our children to live out-ofstate. This was a difficult loss for me. A divorce followed. 44 POGREBW. POOLE, AND MARTINEZ PSYCHOTHERAPISTS‘ ACCOUNTS OF THEIR MISDEEDS 287 Soon after I had a bout with phlebitis which hospi- talized mefor ten days. My daughter, who livedfar away with my former wife, was diagnosed with leukemia; and my mother had just died. Additional stress was caused by my ex-wife and present wife '5' embittered interactions. . . . Sad tales depict individuals acting abnormally in abnormal situations. In short, their instant dc- viance is neither typical nor characteristic of the type of person they really are, that is, how they would act under normal conditions. They are vic- tims of circumstance, for if it were not for these dismal life events, their sexual improprieties would never have occurred. Denial of Injury. Denial of injury is premised on a moral assessment of consequences; that is, the individual claims that his or her actions should be judged as wrong on the basis of the harm resulting from those acts. Again, the actor acknowledges that in general the behavior in which he or she has engaged is inappropriate but asserts that in this particular instance no real harm was done. This type of account was preva— lent among the therapists who had engaged in sexual relations with clients following the termi- nation of therapy. A good therapy termination establishes person—to- person equality between participants. Blanket con- demnations of postvtherapy relationships also are founded on a belief that such relationships invari- ably cause harm to the former patient. I defy any- one to meet Gerry. interview her, and then maintain that any harm was done to her by me. . . . Apology . . . Two consequences of an accused wrongdoer’s action are guilt and shame. If wrongful behavior is based on internal standards, the transgressor feels guilty; if the behavior is judged on external normative comparisons, the person eXperiences shame. Shame results from being viewed as one who has behaved in a discrediting manner. In the following three cases, each therapist expresses his remorse and laments his moral failure: [find myself in the shameful position that I never would have thought possible for me as I violated my own standards of personal and professional conduct. Ifeel very badly for what I have done. ashamed and unprofessional. I feel unworthy of working in the noble profession of counselling. I entered into therapy and from thefirst session disclosed what I had done. I talked about my shame and the devastation I had created for my family and others. Schlenker and Darby ( 1981) observe that the apology incorporates not only an expression of re- gret but also a claim of redemption. An apology permits a transgressor the opportunity to admit guilt while simultaneously seeking forgiveness in order that the offending behavior not be thought of as a representation of what the actor is really like. One therapist expresses concern for his actions and proposes a way to avoid such conduct in the future: I continue to feel worry and guilt about the damage that I caused. I have taken steps I felt necessary which has been to decide not to work with any client who could be very emotionally demanding, such as occurs with people who are borderline or dependent in their functioning. This account seems to imply that one’s remorse and affirmative effort to prevent future transgres- sions are sufficient remedies in themselves, pre- empting the need for others to impose additional sanctions. . . 1 DISCUSSION The consequences of deviant activity are prob- lematic, often depending on a “definition of the situation” When a particular definition of a spe- cific situation emerges, even though its dominance may be only temporary, individuals must adjust their behavior and views to it. Alternative defini- tions of problematic situations routinely arise and u :*«»—.——-:-,—t 288 PART ELEVEN PRlVILEGED DEVIANCE are usually subject to negotiation Thus, it is in- cumbent upon the acclised therapist to have his or her situation defined in ways most favorable to maintaining or advancing his or her own interests. When “transformations of identity” are at stake, such efforts become especially consequential (Strau5s, 1962). The imputation of a deviant iden- tity implies ramifications that can vitally affect the individual’s personal and professional life. As noted earlier, the negotiation of accounts is a ne- gotiation of identities. The account serves as an impression-management technique, or a “front,” that minimizes the threat to identity (Goffman, 1959). If the therapist can provide an acceptable account for his or her sexual impropriety— whether an excuse, justification, or apology—he or she increases the likelihood of restoring a cher- ished identity brought into question by the deviant behavior. There is a close link between successfully conveying desired images to others and being able to incorporate them in one’s own self-conceptions. When individuals offer accounts for their prob— lematic actions, they are trying to ease their situa- tion in two ways: by convincing others and by convincing themselves. An important function of accounts is to make one’s transgressions not only intelligible to others but intelligible to oneself. Therapists sought to dispel the view that their de- viation was a defining characteristic of who they really were; or, to put it another way, they at- tempted to negate the centrality or primacy of a deviant role imputation. The goal was to maintain or restore their own sense of personal and profes— sional worth notwithstanding their sexual de— viancy. In a way, laying claim to a favorable image in spite of aberrant behavior means voiding the ap- parent moral reality, that is, the deviance—laden de— finition of the situation that has been called to the attention of significant others (Grievance Board) by a victim-accuser (former client). Goffman (1959, p. 251) maintains that indi— viduals are not concerned with the issue of moral— ity of their behavior as much as they are with the amoral issue of presenting a moral self; Our activity, then. is largely concerned with moral matters, but as performers we do not have a moral concern with them. As performers we are mer- chants of morality. The presentation of a moral self following de— viance may be interpreted as an attempt by the individual to reaffirm his commitment to consen- sual values and goals in order to win the accep- tance of others (Tedeschi and Riorden, 1981). The demonstration of shared standards of conduct may also be seen as consistent with the wish to redeem oneself in the eyes of others and to pre- serve self-respect, The desire for self-validating approval becomes more important when cir- cumstances threaten an individual‘s identity. In these instances an actor will often make self- presentations for purposes of eliciting desired responses that will restore the perception of self by others that he or she desires. If discredited actors can offer a normal presentation of self in an abnormal situation, they may be successful in having their instant deviant behavior per- ceived by others as atypical, thus neutralizing a deviant characterization. Individuals seek a “common ground” in ac— counts of their deviant behavior, explaining their actions in conventional terms that are acceptable to a particular audience. These accounts should not be viewed as mere rationalizations. They may genuinely be believed in. . . . Finally, it should be noted that, as retrospec— tive interpretations, accounts may have little to do with the motives that existed at the time the de- viance occurred. In this case accounting for one’s deviant behavior requires one to dissimulate, that is, to pretend to be what one is not or not to be what one is. As Goffman (1959) asserts, social behavior involves a great deal of deliberate decep- tion in that impressions of selves must be con— stantly created and managed for various others. Thus, it is not logically necessary that one agree with others’ moral judgments in order to employ accounts. Even where no guilt or shame is con— sciously felt, one may offer accounts in the hope of lessening what could he, nonetheless, attribu- 44 POGREBIN. POOLE, AND MARTlNEZ PSYCHOTHERAPISTS’ ACCOUNTS OF THEIR MISDEEDS 289 tions of a deviant identity. When used convinc- ingly, accounts blur the distinctions between “ap- pearance and reality, truth and falsity, triviality and importance, accident and essence, coincidence and cause” (Garfinkel, 1956, p. 420). Accounts em- REFERENCES body a mixture of fact and fantasy. As shown in the accounts provided by therapists, what is most problematic is determining the mixture best suited for a particular situational context. Akarnatsu, J. T. 1987. “Intimate Relationships with For- mer Clients: National Survey of Attitudes and Behavior among Practitioners.” Professional Psy~ chology: Research and Practice 18:454—458. Garfinkel, H. 1956. “Conditions of Successful Degra- dation Ceremonies.” American Journal of Social- ogy 61:420—424. Gartell, N., J. Herman, S. Olarte, M. Feldstein, and R. Localio. 1986. “Psychiatrist—Patient Sexual Con— tact: Results of a National Survey. 1: Prevalence.” American Journal of Psychiatry 143:1126— l 131. Gaitell, N., J. Herman, S. Olarte, M. Feldstein, and R. Localio. 1987. “Reporting Practices of Psychiae trists Who Knew of Sexual Misconduct by Col~ leagues.” American Journal of Orthopsychiatry 572287495. Goffman, E. 1959. The Presentation of Self in Everyday Life. Garden City, NY: Doubleday. Goffman, E. 1971. Relations in Public: Microstudies of the Public Order New York: Basic Books. Holsti. O. R. 1969. Content Analysisfor the Social Sci? ences and Humanities. Reading, MA: Addison— Wesley. REVIEW QUESTIONS Lofland, J. 1969. Deviance and Identity. Englewood Cliffs, NJ : Prentice—Hall. Pope, K. S., P. Keith—Spiegel, and B. G. Tabachnick. 1986. “Sexual Altraction to Clients: The Human Therapist and the (Sometimes) lnhuman Training System." American Psychologist 41: 147—158. Schlenker, B. R., and B. W. Darby. 1981. “The Use of Apologies in Social Predicaments.” Social Psy- chology Quarterly 44:271—278. Scott, M. B., and S. M. Lyman. 1968. “Accounts.” American Sociological Review 33:46—62. Starosta, W. J. 1984. “Qualitative Content Analysis: A Burkean Perspective,” pp. 185—194 in Methods for Intercultural Communication Research, edited by W. Gudykunst and Y. Y. Kim. Beverly Hills, CA: Sage. Strauss, A. 1962. ‘Transformations of Identity,” pp. 63—85 in Human Behavior and Social Processes: An Inter— actional Approach, edited by A. M. Rose. Boston: Houghton Mifflin. Tedeschi, J. T., and C. Riorden. 1981. “Impression Man- agement and Prosoeial Behavior Following Trans- g'ression,” pp. 223—244 in Impression Management Theory and Social Psychological Research, edited by J. T. Tedeschi. New York: Academic Press. 1. What are the differences between “excuses” and “justifications”? Give an exam- ple, not mentioned in the article, of each. 2. What are some methodological problems with the data used in this article? ...
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