Bad Men Do What Good Men Dream: A Forensic Psychiatrist Illuminates the Darker Side of Human Behavior

by Robert I. Simon

  The law and legislation concerning sexual misconduct are continually evolving. Sexual abuse and sexual harassment are distinct from each other. Sexual harassment generally happens in the workplace. In sexual harassment, no special relationships or reasons for trust necessarily exist between the harasser and the person who is harassed. Some of the time, it is a matter of an employer taking advantage of an employee, as when the employer provides or withholds job-related benefits based on whether the employee complies or does not comply with sexual requests. Most of the time, sexual harassment occurs between coworkers, creating a hostile work environment.

  Sexual misconduct by professionals, however, differs from coworker abuse because it is an exploitation of professional power and authority that arises from a special relationship that is inherently imbued with trust. Workplace relationships are not built on this implicit sort of trust: an employee does not seek “help” from the employer, only properly remunerated work. Lawyer-client, doctor-patient, priest-penitent, and teacher-student are all power-and-trust relationships. At the core of these relationships is the understanding that the professional will use the power and prestige of his or her position, along with the benefit of years of knowledge, training, and expertise, for the benefit of the person seeking help.

  Abusing the Power and the Glory

  In the past 20 years, more than 500 Catholic priests in North America were reported for molesting children. The Catholic Church in the United States has paid out over $1 billion in settlements to about 2,000 victims, and still more money in legal fees and bills for medical care of the errant priests. Many cases have attracted large-scale public attention.

  Former Roman Catholic priest James Porter was accused of sexually abusing 32 boys and girls in the 1960s while serving as a priest in three Massachusetts parishes. He left the priesthood in 1974, married, and had four children before the charges were brought against him. In 1992 he pleaded guilty to molesting 28 of the Massachusetts children and was sentenced to 18 to 20 years in prison. Civil suits against him, alleging child abuse, were also filed in other states. In a separate court action, Porter was convicted of molesting a 15-year-old babysitter in 1992. In a similar case involving another former priest, 17 men who had accused him of sexually abusing them when they were children agreed to a $13 million settlement offered by several insurance companies.

  There have also been abuses at higher levels of church authority. An archbishop in the Southwest expressed “profound sadness” after female parishioners said that they had had sexual relations with him. The much-beloved Archbishop Robert Sanchez, the first Hispanic Archbishop in the country, resigned in disgrace in 1993 after admitting that he had sex with at least five young women. Another American archbishop resigned in 1990 as head of a southern archdiocese after he was romantically linked to a 27-year-old singer. The highest ranking American Catholic official to be accused of sexual misconduct was Chicago Cardinal Joseph Bernardin, who was the target of a lawsuit that sought $10 million in damages. The Cardinal categorically denied the charges. They were later withdrawn and the suit was dropped.

  Sexual misconduct among clergy exists in other denominations, of course. The sensational sex scandals of superstar televangelists Jim Bakker and Jimmy Swaggart drew national attention. More recently, the prominent minister of a large and venerable Protestant congregation in Washington, D.C., a man whose television program was also viewed worldwide, admitted to having had sexual contact involving “hugging and affectionate kissing,” but not sexual intercourse, with several women in his congregation. After two women filed grievances, the minister was confronted and agreed to undergo counseling and retire. Clergy sexual abuse has occurred also among Jewish, Muslim, and Buddhist congregations—in short, it has occurred wherever it is possible for clergymen, vested in their power and glory, to go over the line that separates pastoral nurturing from sexual intimacy.

  It is by virtue of their knowledge and training that professionals such as clergy hold their power positions. Clergymen are frequently viewed by their parishioners as the charismatic representatives of divine authority, knowledge, and sanctity. Some of the faithful view clergy as interceding on their behalf for reconciliation with God. Frequently, parishioners who feel guilt-ridden, deficient, or needy seek the help of pastoral counselors whom they hold in awe and veneration. These parishioners are vulnerable. Exploitative clergymen who have easy access to such parishioners will take advantage of them. As one sexually exploited victim put it, “They don’t put a gun to your head, they put God to your head.”

  Advocacy Versus Intimacy

  Persons involved in litigation have often experienced significant psychological trauma before consulting an attorney. Some of them may also be experiencing severe mental distress or may have a psychiatric disorder. The client’s feelings of vulnerability can create considerable dependency on the attorney. The inevitable stress of litigation adds even more traumatic pressure, which also serves to enhance the client’s vulnerability and the lawyer’s power and authority. In these combustible circumstances, this power asymmetry is sometimes exploited by attorneys into sexual involvement with their clients.

  The problem is even more acute when the litigation involves divorce, for matrimonial attorneys have to deal with clients who are often quite distraught over the breakup of a marriage. The stakes in such litigation are high. It may mean the potential loss of one’s children and source of income for a spouse who has stayed at home to raise the children. Such a woman might well view her lawyer as the good, allpowerful parent who can rescue the client from calamity. Whether male or female, the client in such cases is highly dependent on the attorney and often is emotionally needy.

  Even in cases that involve matters other than matrimony, lawyers can sometimes take advantage. In one instance, the attorney grievance commission of a state brought misconduct charges against a prominent attorney for allegedly kissing one client, spanking another, and repeatedly spanking his secretary, sometimes on her bare bottom. The case arose from a complaint by a client who had hired the attorney to bring a personal injury suit against a hunter who had accidentally shot her. When the attorney came to her house to view the scene of the shooting, the woman alleged, he told her she was a bad girl, placed her over his knee, and spanked her repeatedly.

  In another instance, the power-and-authority abuser was a judge who was also the seven-term mayor of his town. He was convicted of violating the civil rights of five women by sexually assaulting them in his courthouse. Two of these felony convictions related to a woman who was trying to retain custody of her child. She testified that the judge had twice forced her to perform oral sex in his chambers. Five misdemeanor convictions involved instances in which four women testified that the judge had fondled them in his chambers.

  In Loco Parentis

  As with attorneys, teachers at all levels have power-authority roles. From earliest childhood, students often view teachers as role models and as parental surrogates. Such personal matters as positive feelings about oneself, good relationships with others, career choices, partner selection, and spiritual aspirations can be profoundly influenced by teachers. A positive encounter with an especially admired teacher can change the course of a student’s life.

  The negative side of this equation more regularly surfaces in college, where professors are similarly esteemed and wield tremendous power, especially in regard to students’ chances for success when they graduate. For many women, success in what is still a man’s world depends on the recognition of their ability by men in power who become their mentors. A top recommendation, a good grade, a phone call from the professor to an important person in business may seem of the essence to a student. The need to obtain these references by the student may be exploited by a professor for sexual purposes. According to several surveys, between 20% and 30% of all female college and graduate students have been sexually approached by their professors. One study reports that 17% of female graduate students in psychology report sexual intimac
y with a professor, whereas 30% turned away unwelcome advances, particularly from female teachers.

  Intense attachment between student and teacher can sometimes become sexualized. There have been a number of instances of female high school teachers becoming involved in sexual relationships with their male students. The most sensational was that of Mary Kay Letheir male students. The most sensational was that of Mary Kay Le year-old. Letourneau was pregnant with the 15-year-old’s child when she was sent to prison. Released for a few days, she was again caught with him and returned to prison, where she birthed a second child. Upon her release from a 7-year jail term, she married the former student, then 22.

  In other such cases, Debra Lafave, a 25-year-old middle-school reading teacher, pleaded guilty to having sex with a student and received a 3-year house arrest. Kimberly Merson, a substitute teacher and cheerleader, admitted in court to “sexual contact” with nine male students ages 15 to 17, and was sentenced to 18 months in jail. And San Bernardino, California teacher Tanya Hadden ran away to Las Vegas with a 15-year-old student from the high school where she taught; she was sentenced to 2 years in prison.

  Helping Others or Helping Ourselves?

  A national survey of fourth-year psychiatric residents found that 4.9% of the 548 respondents reported sexual involvement with their educators. The same survey also reported that 1.2% of the male students and 0.4% of the female students acknowledged sexual contact with their own patients. The abuse of patients by psychotherapists is of great concern to everyone. It is discussed in detail in the following section because it provides a model for understanding professional sexual misconduct in general.

  The common thread that runs through the sexual misconduct in the helping professions is that professional relationships produce certain role expectations in the people being served. The therapist, professor, lawyer, or clergyman are all fiduciaries to the people they serve. A fiduciary is a person who acts for another in a capacity that involves confidence or trust. That fiduciary role does not include the establishment of an intimate sexual relationship, such as we understand those relationships to exist in a context of love. Love relationships differ from fiduciary ones in the following way: in love relationships, the presumptions exist that two relatively equal individuals are joining together, that they are doing so by freely given consent, and that they do so for the purpose of meeting their mutual needs.

  A key factor in a fiduciary relationship gone awry is vulnerability. People who do not possess the power or resources to choose or to act for themselves are deemed vulnerable. Age, gender, education, cultural background, race, role, current life situation, and a number of other individual psychological factors all affect a person’s vulnerability. The judge who allegedly forced the woman seeking to retain custody of her child to perform oral sex exploited many of these factors. The relationship between the judge and this woman cannot be considered a love relationship because, among other things, it lacked her freely given consent. When sexual activity is induced through fear, coercion, or manipulation that is imposed through a position of power or authority, the meaningful consent that is so necessary for an emotionally satisfying sexual relationship is absent.

  Female vulnerability and sexual coercion are woven into the fabric of our society. Efforts to understand sexual exploitation solely by means of individual psychological analysis of the particular victim or perpetrator often may overlook important societal-cultural factors. Such an analysis fails to recognize that sexual coercion is embedded throughout the structure and processes of most human culture. It would be a naïve error to conclude, however, that female professionals do not sexually exploit persons who seek their help. Nevertheless, female exploiters among professionals are in a distinct minority. Why male professionals are the perpetrators in the majority of the sexual exploitation cases is an extremely complex question. The answer involves cultural factors; for instance, men are acculturated to test boundaries, whereas women have been taught to accept boundary testing. There are also biological factors, for instance, the role of testosterone in producing sexual aggression. The evolutionary fact that men were hunter-predators may make some contribution to the male psyche. But cultural factors alone do not provide a satisfactory answer—the fact is that most male professionals do not sexually exploit their clients. This means that individual psychological factors play key roles for male professionals who do cross the boundary between maintaining their fiduciary role and sexual intimacy.

  Therapist-Patient Sex

  No accurate figures are available concerning the actual percentages of mental health professionals who commit acts of sexual misconduct. Most of the surveys that have attempted to ascertain the incidence of therapist-patient sex fall short on two counts: 1) the acts committed may be too narrowly defined, and 2) the survey methods are notoriously unreliable. Only about 15% to 25% of the therapists surveyed bother to respond. Also, the truth of what they have said on the survey cannot be verified independently. It can safely be assumed that most of the offenders do not respond to the survey, so that the real incidence must be higher than the reported incidence. That said, it must be pointed out that the reported figures are high enough to be of concern. A nationwide survey of 1,442 psychiatrists revealed 7.1% of male and 3.1% of female respondents acknowledged sexual contact with their own patients. Eighty-eight percent of these sexual contacts occurred between male psychiatrists and female patients, 7.6% between male psychiatrists and male patients, 3.5% between female psychiatrists and male patients, and 1.4% between female psychiatrists and female patients.

  There has also been therapist sexual contact with child patients. In one study of 958 patients who were sexually exploited, 5% were minors. In another study exclusively of minors, the average age of sexually exploited children was 12 for male patients and 14 for female patients. Generally, psychiatrists, psychologists, and social workers have equal rates of sexual involvement with their patients.

  Let me say it plainly: sex between a therapist and a patient always is unprofessional, is unethical, and constitutes malpractice. Psychiatrists, as physicians, pledge to first do no harm to their patients when they take the Hippocratic oath. Sex with a patient is never an acceptable form of treatment. Patients who come for psychiatric or psychological treatment are experiencing mental and emotional suffering that is painful and can be debilitating. Their decision-making capacities and judgment are usually impaired to some degree. Although the patient may not be incompetent to make major life decisions, he or she may have vulnerabilities and psychological blind spots that can be exploited. Moreover, the patient seeks out the therapist as a critically important source of help and hope. Under such circumstances, the patient frequently comes to idealize the therapist as the all-good, allpowerful parent figure. The patient, who is experiencing mental pain, is highly influenced by early, powerful yearnings to be comforted or cared for by the loving parent. Barbara Noël described her feelings for Dr. Jules Masserman by characterizing him as “my ‘healthy’ father figure.” Along with idealization of the therapist as a good parent comes the patient’s fear of losing this newly important figure in his or her life—a fear that increases the patient’s vulnerability to exploitation by the therapist.

  Transference is narrowly defined as the primary unconscious tendency of all individuals to assign to others in the present those feelings and attitudes that were originally connected to important figures in the course of their early childhood development. A more expansive, totalistic definition of transference includes the entire conscious and unconscious responses of the patient to the therapist. Transference occurs to some degree in all relationships but is particularly strong in fiduciarytype relationships. Mismanagement by the therapist of the patient’s powerful feelings from the past and the present is a key factor in the treatment boundary violations that lead down the slippery slope to sexual intimacy with the patient.

  Therapists’ and Patients’ Thoughts of Each Other

  The differential of power and aut
hority that exists in professionalpatient relationships intensifies transference. In psychotherapy, the patient usually identifies the therapist with his or her parents or other important early figures. Carolyn Bates, in the book Sex in the Therapy Hour, which she cowrote with psychologist Annette M. Brodsky, described the growth of her feelings toward her therapist:

  Over the months, in my weekly 45 to 50 minute sessions, I have no doubt that much of the trust and love I had for my father was directed toward Dr. X, for I perceived him as having both wisdom and an unconditional concern for my well-being.

  Unfortunately, Ms. Bates later found that her intense feelings toward Dr. X were exploited by him. That is not the usual case. Transference feelings can be an important part of the patient’s treatment. On one end of the spectrum, some patients may resist or deny transference feelings; on the other end, some patients may wish to live out transference feelings with the therapist.

  Therapists sometimes egregiously mismanage transference feelings when they accept at face value the patient’s expressions of love, adoration, and dependency. The well-trained therapist knows that, as with dreams, transference expressions are a surface presentation that hides a patient’s darker passions and attitudes. Feelings of love for the therapist may mask deeper feelings of hostility and anger that the patient must work out in the therapy. The psychodynamic, “insight” psychotherapist is trained to know how to manage the transference therapeutically and knows better than to exploit it for his or her own benefit. But insight psychotherapy is only one form of therapy. Although important, its use by itself has been declining in recent years. Today, the number of psychotherapeutic approaches, or “schools,” is above 450 and climbing. In all therapies, however, transference plays a role, either directly or indirectly, which means that all therapists, no matter what method of treatment they use, must be aware of the importance of transference in their work with patients.