The American Psychiatric Association’s Ethics Committee held its annual confidential meetings this month in Washington as a former patient renewed her accusations of rape and drug abuse against a past president of the group.
Sex abuse by therapists prompts ethical debate
By David McCracken
September 27, 1992
Last year the APA’s Appeals Board voted to suspend Jules H. Masserman, a Chicago psychiatrist who had been honored the world over, from the APA and the Illinois Psychiatric Society for five years. That action came after six women filed separate lawsuits over seven years, charging Masserman with sexual misconduct and promoting addiction to barbiturates, among other charges.
Four suits have been settled out of court by Masserman’s insurers, including one filed in 1984 by Barbara Noel of Chicago and settled for $200,000. One was dismissed as being outside the statute of limitations, and one is pending.
Noel, a former patient, is co-author with Kathryn Watterson of “You Must Be Dreaming” (Poseidon Press, $21), which sets forth Masserman’s alleged misdeeds. In it, Noel says an additional 13 women signed a complaint against Masserman with the Illinois Department of Registration and Education in 1986, which launched an investigation into allegations of misconduct. Masserman again settled out of court, signing a consent order but denying all charges and giving up his license to prescribe drugs or practice medicine or any form of psychotherapy.
Masserman, a past president of the American Psychiatric Association, is a member of its Board of Trustees, professor emeritus at Northwestern University, author of 16 books and hundreds of articles on psychiatry and is now accused by Noel of being a rapist and drug-pusher.
The issue of therapist-patient sexual relations has received increasing attention in the news media and from therapeutic professionals in recent years, after the publication in the mid-1980s of studies that documented significant percentages of such interaction, a violation of ethics for psychiatrists and psychologists.
The Gartrell study, of which Dr. Nanette Gartrell was the principal author, found in a nationwide survey of U.S. psychiatrists that 7.1 percent of male and 3.1 percent of female respondents had had sexual contact with their patients. Surveys of psychologists uncovered similar percentages, usually somewhat less than one in 10.
Hannah Lerman, a clinical psychologist in Los Angeles, says, “The bulk of the data says that it’s somewhere between 7 and 15 percent, with a higher percentage of men (therapists) engaging in it. But the return rate of the questionnaires is very low compared to similar kinds of surveys.”
Regardless of the percentage of sexual abuse, doctors say the effect on patients is almost unanimously devastating.
“When sexual intercourse begins, therapy ends,” notes a 1983 study on the consequences of patient-therapist sexual involvement published in the journal Professional Psychology.
The emotional intensity of the therapeutic context is what makes such interaction so dangerous. Dr. Glen Gabbard, editor of “Sexual Exploitation in Professional Relationships” (American Psychiatric Press, 1989), likens it to incest in his book: “Victims of this form of professional incest have placed their trust in a person whom (sic) they assume will place their interest above his or her own by the very nature of the professional relationship. When this trust is betrayed, the impact is often as damaging as familial incest.”
Gabbard also noted that victims of incest and sexual abuse exhibit similar symptoms.
Jacqueline Bouhoutsos, a Los Angeles clinical psychologist, says that overall, sexual abuse comes down to the individual therapist.
“In analysis,” she says, “you’re so close to the therapist all the time – sometimes for years, usually every day – and you get into really intimate information.”
It’s a view echoed by Dr. Jeremy Lazarus, chairman of the APA’s Ethics Committee.
“Psychoanalysis does lend a certain closeness over time to two people, and it may stimulate feelings within the patient and therapist, more so than in other kinds of treatment,” he says. “It’s a psychiatrist’s job to be aware of that and to use it in the treatment.”
The American Psychiatric Association and the American Psychological Association have responded to the problem with several measures, among them developing pamphlets for patients on how to recognize sexual abuse by therapists, and increasing instructional efforts for students and professionals.
Such efforts have not gone far enough for some state legislators, as complaints to state licensing boards and local professional associations have increased. Over the last three years, eight states, including and Illinois, have criminalized therapist-patient sexual relations.
In fact, it was Barbara Noel’s frustration with the limited response of the American Psychiatric Association and the Illinois Psychiatric Society that led her to write her book.
The Illinois Psychiatric Society voted to publicize Masserman’s suspension in 1991, but that was not enough for Noel, now on tour promoting the book and discussing the issue.
“I want to warn other women,” she says. She also hopes other professional organizations of which he is a member will drop him, ultimately discouraging other therapists from behaving as Noel says he did.
Said Noel: “Some of the calls I got in the on-air programs recently in Washington and New York were from men who had been students of psychotherapy or therapists themselves and claimed that we just didn’t understand how tempting it was for men. And I said, ‘Well, so what? You’re committing incest, so stop it.”‘
A statement from Masserman appears as an afterward in Noel’s book. “Please note that there were no criminal charges filed at any time, let alone rape. The only action filed was to obtain money, to secure money,” his statement reads. “I deny all the allegations. I never did anything unethical to any patient.”
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