It’s pretty common knowledge that therapists should not have sex with their clients (Kitchener & Anderson, 2011). The APA Ethics Code (APA, 2010) is unequivocal on this; Standard 10.05 states, "Psychologists do not engage in sexual intimacies with current therapy clients/patients.” The harm done to clients has been well-documented (e.g., Pope, 1990). The APA Code also recognizes that sex with relatives, guardians, or significant others of clients is also unethical (APA, 2010, Standard 10.06). Picture a situation in which a therapist is seeing a child; the Code forbids the therapist from initiating a romantic or sexual relationship with the child’s parent. By the way, Standard 10.06 goes on to say that "psychologists do not terminate therapy to circumvent this standard.”
This leads us to the issue of therapists initiating (or agreeing to) sexual activity with former clients, which is a little more controversial and often misunderstood. The APA Code, Standard 10.08(a), states: "Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy.” This is the first part of the 2-year rule. One purpose of the prohibition against post-therapy sexual activity is that the effectiveness of therapy can be compromised if clients are either hopeful or concerned that the therapeutic relationship might turn into a romance the day (or month, or year) after therapy is over.
Some people hold the view that once a client, always a client. They would argue that the prohibition against sex with former clients should be absolute and life-long. However, a lifetime ban on sexual intimacies with all former clients might be too stringent. Picture this: A therapist and client meet once for an initial consultation about therapy and quickly agree that the therapist does not do the kind of therapy the client needs. They do not see each other again for 25 years. They run into each other at a public lecture and decide to go for coffee. Would you see this potential romance as unethical? (See Yalom, 1996, for an interesting fictional exploration of this and other ethical issues.)
When I present this type of case to students they typically say it’s OK to pursue a romance after (a) a 25-year hiatus and (b) a one-session professional relationship. They also agree that it would not be OK to ask a former client out (or to accept an invitation) two days after terminating a 10-year therapy! Somewhere in the middle is a point at which post-termination relationships cross the line between ethical and unethical. The 2-year rule is APA’s way of acknowledging that life holds few absolutes; many continua need to be considered. Thus, the Ethics Code includes an absolute prohibition against sex with former clients for a period of two years following termination. The next part of the 2-year rule provides an opportunity for some judgments to be made by therapists. APA Standard 10.08(b) starts:
Psychologists do not engage in sexual intimacies with former clients/patients even after a 2-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/ patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including ….
Many people, especially graduate students I’ve talked to, are under the misconception that, as one student put it, "all of a sudden after two years it’s OK to have sex with a former client.” As you can read in Standard 10.08(b), therapists are not that free—they need to assure that the relationship will not be exploitative. Here are the seven factors the Code says therapists should consider:
- How much time has elapsed since the end of therapy
- The type of therapy, how long it lasted, and how intense it was
- How the termination was handled
- The "personal history” of the client
- The client’s current functioning
- The risk of harm of the contemplated relationship
- "Any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a post-termination sexual or romantic relationship with the client/patient.”
This is worse than asking the parents of your fiancé for their child’s hand in marriage. The likelihood that these conditions are met is pretty small, don’t you think? The bottom line: Sexual intimacies with former clients are strongly discouraged by the APA Ethics Code at any point in time. At the same time, as in most ethical decisions, the code cannot take away all judgments.
To close, I leave you with a question for you to ponder: The APA Code is silent about the issue of relationships between professors and former students. What do you think the standard should be about professors engaging in postgraduation relationships with undergraduate or graduate students?
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from HERE
Kitchener, K. S. & Anderson, S. K. (2011). Foundations of ethical practice, research, and teaching in psychology and counseling (2nd ed.). New York, NY: Routledge.
Pope, K. S. (1990). Therapist-patient sexual involvement: A review of the research. Clinical Psychology Review, 10, 477–490.
Yalom, I. D. (1996). Lying on the couch. New York, NY: BasicBooks.