Sexual Boundary Violations: Therapeutic, Academic, and Supervisory Contexts

by Andrea Celenza, PhD.
published by Jason Aronson, 2007.


Sexual Boundary Violations

Sexual boundary violations are considered the most serious ethical infraction in the mental health profession, as well as in higher education and pastoral counseling. Recognized as unethical due to the power imbalance inherent in the structure of the therapist-patient and teacher-student dyads, erotic contact between therapists and patients has been revealed in prevalence studies to occur at an unacceptably high incidence rate (9 to 12 per cent) among mental health practitioners. There exist few programs, teaching methods, and preventative measures that adequately address the problem of sexual boundary violations, despite the fact that discussing this problem openly is no longer taboo. Sexual Boundary Violations addresses this gap, providing educators, trainers, and clinicians with a resource to aid in developing programs, ethics workshops, seminars, and other educative or clinical teaching projects.

This book is distinguished from other texts in that it includes the publication of a preventative measure and assessment tool that caregivers may use to identify levels of risk or vulnerability at different points in their career. This measure derives form a research project that employed eleven reliable and validated psychological measures. This is an empirically controlled, double-blind study not previously published. Several of the measures are combined to develop a ‘Boundary Violation Vulnerability Index’ based on this research. This measure represents a preventative tool to aid therapists in training as well as those at different points in their careers in order to monitor levels of risk in an ongoing way. No other publication includes such a measure.

This book incorporates the latest findings in the area of sexual boundary violations. Similar books on the subject have not been published for over ten years. In addition, this book addresses problems in clergy counseling, an area not often included in books that address the problem of sexual boundary violations.


Andrea Celenza eloquently captures the damage–to themselves, their victims, their professions, and the wider social fabric–inflicted by professionals and clergy who transgress sexual boundaries. Her incisiveness about the non-negotiable need for sexual integrity is achieved, however, without unnecessarily demonizing those who cross lines that never should be crossed. Rather, she combines clarity tempered with compassion in addressing the characteristics of perpetrators. Most importantly, Celenza insists upon differentiating among transgressors. She challenges us to appreciate the unique humanity and circumstances of people many of us wish to lump together and dissociate from consciousness. She challenges us instead to hold in mind paradox and contradiction. This book is a vital component of continuing education and consciousness-raising for all of us who vow first to “do no harm.””
Mary Gail Frawley-O’Dea, Ph.D., author, Perversion of Power: Sexual Abuse in the Catholic Church; co-author, The Supervisory Relationship: A Psychodynamic Perspective; co-editor, Perpetrating Priests and Silent Victims: Sexual Abuse and the Catholic Church

Sexual Boundary Violations is an essential text for the mental health field and should become required reading for therapists, analysts, teachers, and clergy. I am sure that we will use it in our training program as part of the required course on professional ethics. Comprehensive, well organized, clearly written, with numerous and often gripping clinical illustrations, the book not only reviews the literature but provides practical and helpful guidance for clinicians and clergy as well as for those who teach and supervise them.”
Lewis Aron, Ph.D., New York University Postdoctoral Program in Psychotherapy and Psychoanalysis

Dr. Celenza holds the various phenomena involved in sexual boundary violations by therapists and clergy to a multi-faceted lens of clinical psychoanalysis, supervisory consultation, psychological testing, empirical research, ethics, law–and that metapsychologically elusive human attribute called decency. She extends and deepens the existing knowledge in this realm while introducing many intriguing and useful novel concepts of her own. Avoiding the pitfalls of sentimentality and moralizing, Celenza unmasks the ubiquitous vulnerability to such transgressions and the profound damage caused by them. She delineates ameliorative and preventive strategies aimed at minimizing such betrayals. Unerringly compassionate in its approach, Celenza’s work is a shining tribute to the essential humanity at the heart of the psychotherapeutic enterprise.”
Salman Akhtar, M.D., professor of psychiatry, Jefferson Medical College; training and supervising analyst, Psychoanalytic Center of Philadelphia

Andrea Celenza is one of a handful of mental health professionals who has studied the problem of sexual boundary violations in the helping professions. Where others speculate, she brings years of clinical experience to bear on the subject. The result is a highly informative and comprehensive overview of the causes, consequences and casualties of sexual boundary violations. She maintains a humane perspective and offers valuable strategies for rehabilitation and treatment. All mental health professionals would be wise to spend some time with this superb new book.”
Glen O. Gabbard, M.D., chair of psychoanalysis, The Brown Foundation; professor of psychiatry, Baylor College of Medicine, Houston, Texas

Table of Contents

Acknowledgments ix
Foreword Gary R. Schoener xiii
Introduction xxiii
Part I  Nature and Scope of the Problem
  1  How Do They Happen? 3
  2  This Couldn’t Happen to Me 15
  3  Precursors to Therapist Sexual Misconduct 27
  4  When Is a Couch Just a Couch? 43
  5  The Therapeutic Context 55
  6  Academic and Supervisory Contexts 65
  7  Sexual Misconduct in the Clergy 77
Part II  Reporting, Fallout, and Recovery
  8  Reporting and Other Ethical Responsibilities 95
  9  Collateral Damage and Recovery 111
  10  Helping the Victims 129
Part III  Rehabilitation
  11  Therapy of the Transgressor  145
  12  Helping the Helpers: Supervision of the Transgressor  159
Part IV  Prevention
  13  Responsible Responsivity 179
  14  Love and Hate in the Countertransference: Preventing Violations Through Supervision 191
  15  Boundary Violations Vulnerability Index (BVVI) 201
Appendices Empirical Research
Appendix A: Personal and Interpersonal Characteristics of Transgressors
Co-investigator: Mark Hilsenroth
Appendix B: A Rorschach Investigation
Co-investigator: Mark Hilsenroth
References 247
About the Author 269