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In the face of evidence suggesting that there is a substantial incidence of sexual contact between physicians of all specialties and their patients, the medical profession and the courts have not yet reached a consensus regarding appropriate responses. Some commentators, including the American Medical Association, have urged bans on sexual contact during treatment and extensive restriction of posttreatment sexual relationships. Others favor looser restrictions, particularly after termination of the physician-patient relationship. These differences in approach stem from the varying importance given the two conflicting values involved: (1) protecting patients from being harmed by unfair manipulation by physicians and (2) insulating choices about intimate relationships from intrusion by society. We propose a model for balancing these interests that would bar sexual contact during the physician-patient relationship and for a fixed period after termination; thereafter, in most cases, sexual relationships would not be proscribed. A waiting-period approach of this sort is likely to diminish most of the harms that might result from physician-patient sexual contact and may constitute a template for the resolution of similar issues elsewhere in society.

Therapist sexual misconduct has its genesis in the therapeutic relationship. The mental health professions have long recognized the delicacy with which the therapist must handle the therapeutic relationship, with its power imbalance, inherent vulnerability of the patient, and transference and countertransference reactions. The prevention of sexual contact starts with the careful attention to boundary violations, which, though themselves perhaps not harmful, may escalate into sexualized behavior. Methods of preventing this behavior include the establishment of clear guidelines for practitioners and the expansion of the educational process for therapists, therapists' employers, patients, and other professionals. Last resorts lie in the legal and quasi-legal proceedings available to victims, such as civil suits for damages, criminal complaints, board of licensing complaints, and actions before professional associations. The best method of preventing sexual contact with patients involves respecting the boundaries of the professional relationship and avoidance of the slippery slope.

Psychotherapists' and physicians' sexual contact with their patients has been long held as unethical conduct. However, lawyers' sexual contact with clients has been largely ignored in the professional literature. This article uniquely anatomizes the similarities in the vulnerabilities and power imbalances that exist between psychotherapists' and lawyers' relationships with patients/clients. These characteristics enable the professional to exert undue influence over the less-powerful party, and for these reasons lawyers should be held to fiduciary standards in their personal dealings with clients. The authors propose a rebuttable presumption that sexual contact between an attorney and client was obtained through the attorney's exercise of undue influence and was therefore a breach of the attorney's fiduciary duties to the client.

Controversy over the legitimate extent, if any, of sexual contact between psychotherapists and former patients remains intense. In this paper the authors review current approaches to controlling posttermination sexual contact, offer a conceptual framework within which the problematic aspects of therapist-patient sex both during and after treatment can be understood, and develop a set of recommendations for policies that balance the goals of protecting former patients and avoiding unnecessary interventions into consensual relationships. Review of ethical, legal, and administrative controls on posttermination sex revealed considerable heterogeneity of approaches, which appeared to be based on confusion concerning the rationale for restriction. An analysis of the problems with therapist-patient sexual contact suggests four areas of concern: impaired decision making, coercion, fraud, and exploitation of a fiduciary relationship. The nature and magnitude of these problems differ in pre- and posttermination sexual relationships. The authors conclude that clarity of restrictions on posttreatment sex is important, but an absolute ban is not essential to protecting former patients. Rather, a 1-year waiting period after termination, during which even social contact would be precluded, should minimize problems and allow former patients and therapists to enter into intimate relationships. The authors discuss the advantages and disadvantages of this approach over other approaches.

Legislative enactment of criminal penalties for psychotherapists' sexual contact with their patients is pending in several states. The arguments in favor of criminalization are that it serves as a deterrent, offers retribution, provides redress when other avenues are blocked, deals with unlicensed psychotherapists, makes victims' assistance funds available, and provides due process protection against false accusations. In opposition to criminalization are the arguments that civil and administrative measures already exist to deal with the problem, it may have a chilling effect on the reporting of misconduct, it may void malpractice insurance, it makes guilty psychotherapists place themselves in jeopardy if they acknowledge their wrongdoing in attempting to make amends, it removes control of the legal process from the victim, it fails to offer rehabilitation, and it singles out psychotherapists from other fiduciaries for more stringent treatment. APA district branches inevitably will be called on to take positions with regard to legislation criminalizing sexual exploitation of patients. The current public outrage over patient victimization, however appropriate it may be, appears to make it difficult to publicly justify anything other than support for criminalization.