) to respect the decisions of patients to engage in sexual contact with their psychotherapists during treatment. In other words, the likelihood is that the patient has a significantly impaired ability to decide for sexual intimacy with the therapist.
Addressing this impairment, Feldman-Summers (1989) has noted that the impairment results from two sources: (1) the underlying distress that motivated the client to seek treatment which may cloud the client's judgement; and (2) transference which can operate to compromise the client's ability to weigh the risks and the benefits of sexual involvement.
Added to prohibitions against sexual involvement on the grounds of the impaired ability of the client to choose, is the fact that there is (or can be) a coercive element. The therapist is the patient's hope for release from turmoil. Thus, the patient is vulnerable to interpreting the therapist's sexual advances as a statement saying, "Have sex with me or else I, one of your few hopes for release from inner pain, will reject you." This same point has been made by several authors (e.g. Coleman, 1988; Gonsiorek & Brown, 1989; Herman, Gartrell, Olarte, Feldstein & Localio, 1987). Specifically, they have noted that there is a "power imbalance" in the therapeutic relationship (which is to the therapist's advantage) and which can covertly subvert the patient's freedom to choose through its coercive components.