Tuesday, March 9, 2010

(Hopefully) The Last of The Red Hot Lovers

The issue of sexual relationships between therapist and patient is serious, this one made the news recently: The following is a quote from the AP report.

TAMPA, Fla. — A psychologist is accused of having sex multiple times with one of his female patients and billing her insurance company $1,400 for "sessions," according to records from the Florida Department of Health.

Dr. Daniel Lerom, 49, and a 37-year-old patient identified only as "H.F." had a sexual relationship between February and May of 2009, department board members wrote in a report filed in January. Lerom also repeatedly asked H.F. for her prescription medications, saying he needed them for back pain.

The relationship ended when Lerom's wife discovered the affair, the report said.

Lerom's license has been suspended and the patient is suing him, claiming malpractice, gross negligence, breach of duty of care and infliction of emotional distress, among other things.

She claims in the lawsuit she suffered a "complete emotional collapse" and was institutionalized after being rejected personally and professionally by Lerom.

Lerom did not return messages left at his home and office. An assistant for patient H.F.'s attorney said the attorney would not be commenting on the case.

Both the lawsuit and the Department of Health documents are filled with extensive, and often salacious, details.

According to the report, Lerom would often text H.F. after their trysts, often at her condo or a hotel. He said that he was "falling in love with her" and gave her jewelry from Tiffany's.

"U r sooo hot!!! i worry that i m holding u back from a younger stud who can really meet your needs!! lol!!" one alleged text from Lerom to H.F. said.

Another: "if i were there i would rub u all over and kiss u all over!!! that's the dr. dan cure!!! XOXOXO."

The doctor also referred to himself as a "RHL," or, "red hot lover."


Some Thoughts:

1. That is so 1980's hollywood. At what point are those in the therapy biz gonna figure out that sleeping with your patient is malpractice?

2. As a professional therapist, he should lose his licence to practice, and face whatever legal or civil consequences come his way.

3. As a 49 year old man, for texting "u r sooo hot," and calling himself "RHL," he should receive the death penalty.

4. Did you know that many of the founders of psychotherapy had sexual realtionships with their patients? The list includes: Jung, Balint, Groddeck, Rado, Rank, Reich, and Tausk. One of Freud's inner circle, Sandor Ferenczi, had a particularly interesting number of such relationships including the following, noted in a letter from Elma Palos-Laurvik, his stepdaughter, whom he seduced and then abandoned amply demonstrated these factors. Mrs. Palos began an analysis with Ferenczi after the suicide of her lover, at the recommendation of her mother, Gisella Palos, Ferenczi's mistress. Mrs. Palos later recalled her "therapeutic" experience in a letter to Michael Balint:

"...So, after a few sessions (on the couch) Sandor got up from his chair behind me, sat down near me on the couch and obviously carried along by passion, kissed me and in a state of great excitement told me how much he was in love with me and asked me if I could love him. I don't know if it was true or not, but I answered him 'yes' and I hope that I really believed it...I don't remember for how many days or weeks Sandor came daily to lunch with us as my fiance before I realized that already I loved him less than I had thought during the analysis."

5. 19 States have enacted laws making it a crime to have sexual activity with a patient.

6. Yes, there are many factors involved in why such horrific boundary violations occur. Therapists should have a good education regarding the very emotionally sensitive nature of therapy. Transference reactions certainly are likely to be a large issue in these boundary issues. But, in my opinion, there should no longer be any excuse for such destructive behavior, and therapists who have sex with patients should be tossed out of the professional pool.


Jennifer said...

(made my way over here from Geoffrey's blog)

Very interesting post. The issue of transference and the erotic nature of the therapist-patient relationship has fascinated me for years. The one you cite is particularly appalling (and point 3 made me laugh aloud).

I wonder: Is there ever an instance in which it's okay for this relationship to become sexual? With a female patient and a male therapist, it seems it is almost inevitably erotic, sometimes deeply so. In a sense, this is good--it shows that the relationship is intense, that there's a connection between the two people.

I understand the danger in acting on the tension; it creates a relationship with drastically unequal power dynamics, ends the therapy, and can make for further emotional damage to both parties, especially the patient.

But aren't all relationships inherently unequal? In fact, inequality is an essential part of erotic attraction. And don't all relationships carry the risk of emotional damage? In fact, don't most end that way?

Yes, the therapist has a greater obligation to his patient than any man would to any woman he met on the street. But all relationships are complicated and risky. I don't think we can expect therapists to be models of perfect chastity. Sometimes, when people are attracted to each other, they act on it. If they're both consenting adults, it's difficult for me to object.

(I don't know that I really believe these relationships should be allowed. I just think there are valid arguments for that position.)

Dreaming again said...

Point three made me laugh out loud too.

This is horrific. I had a psychiatrist who lost his license under such circumstances. I don't know what was in my chart, but there was enough to get me a 2 hour grilling about boundaries, did I understand proper and improper touch ...and evidently nothing that was said about MY behavior, but the notes he put regarding me. CREEPY

Doc said...

First, thanks for stopping by! I would submit that, in the early days of psychotherapy, the undertstanding of the damage that could be done by sexual contact between therapist in patient was not well understood. It certainly seems like a number of the early analysts were sleeping with their patients! Fortunately, those percentages of (male) thearpists having sex with patients has decreased from around 12% in the 1970's to 3% in the 1980's.

(An interesting sidebar would be to recall the usage of vibratory massage "medical attachements" for the treatment of anxiety, stress, and depression by many physicians in the early 20th century)

I do not know if there is ever an instance where it is "okay" to have a sexual relationship with a patient. Given that the therapist would have to know that he or she is causing possible significant damage to an already damaged individual, as well as violating thier own professional ethics (and possibly some laws), I'm not sure I can think of an instance.

You hit the nail on the head with one of the biggest problems of such actions: it ends the therapy. Perhaps, if we view it as a contract, as opposed to a relationship, it may be clearer in analogy. A patient goes to a therapist for help with emotional problems, sexual contact is far from the contract. Honoring that contract does not require perfect chastity.

The aspect of erotic transference is fascinating. In the safe environment of therapy, those thoughts and feelings (as one of my professors like to say) are all "grist for the mill." And probably a good topic for a blog post or two in the future.
Good to hear from you--drop on by anytime!

Creepy is often the case in these therapists, I think. Two hours of grilling? I hope it was completely with your consent.

Thanks for the comments!
-RHP (Red Hot Psychiatrist)

moviedoc said...

All the names you list I would recognize as founders, not just of psychotherapy, but of psychoanalysis. Today, ironically, analytic and dynamic psychotherapies seem to be the biggest sticklers for boundaries. Perhaps this is appropriate since I believe those methods, which I believe place excessive importance on the relationship between patient and professional, are a setup for boundary violations.

Doc said...

A good point, moviedoc-- although I would note that almost all of the pioneers in the very early history of therapy were analysts, save the behaviorists, I guess. I haven't checked as to if Maslow, Rogers, Beck, Kernberg, Winnicott, et al were also involved. (Politically incorrect musing: could you imagine a transcript of such boundary violations in Gestalt Therapy?!)
I also guess that the amount of time in such a therapy setting may play a role, as analytic therapy is almost always going to have a greater amount of therapy time than the other modalities.
I wonder if the rates of sexual boundary violations are greater in the more analytic therapies compared to other modalities. So far, I have been unable to find any data in that area, and would welcome any stats.

Thanks for dropping by!

moviedoc said...

Please elaborate on your comment about Gestalt. I'd like to know more. It would be good to have numbers, and I agree that the time factor is important.

Give my regards to Beau J.

Doc said...

It is tongue-and-cheek. Gestalt therapy is a form of "experiential therapy" and involves the expression of thought in a real-time, almost existential manner.
Sex between two gestaltists (I changed the aforementioned paradigm) would sound like a really bad romance novel, written by Camus, in the first person, on acid. To wit:
"I observe the perspiration and skin flushing across your breast." "The room is filled with an electric odor of your desire." "I picture a nipple." "Finish your business with me!"
(Apologies to any gestaltists out there-- this is just in fun!)

moviedoc said...