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SPECIAL SERIES: Treatment centers have capacity to lessen chance of sexual misconduct

September 28, 2014
by Alison Knopf, Contributing Writer
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Leaders in the credentialing of addiction professionals insist that treatment facilities can wield influence in stemming inappropriate sexual behavior by staff—incidents that are under-reported and damaging to organizations' reputation and bottom line.

“If [clinical] supervision were more centered around the ethics of those counselors, we would see a decrease in the number of ethics complaints,” says Mary Jo Mather, executive director of the International Certification & Reciprocity Consortium (IC&RC), representing credentialing boards. “I can’t tell you the number of times I get a call from a counselor who’s asking me about an ethics question, and they never thought to ask their supervisor. There’s something wrong with that.”

Supervisors need to be aware of issues surrounding inappropriate actions toward patients, and not help treatment program administrators sweep them under the rug, says Patterson. One problem, she says, is that schools no longer are teaching about transference and countertransference, the phenomena in which a patient views the therapist as representing someone important in his/her life (such as a mother or husband) and the therapist in turn projects some feelings onto the patient.

Many addiction counselors come out of school thinking they’re supposed to be a robot, says Frances Patterson, a member of the ethics committee for NAADAC, The Association for Addiction Professionals. “They think they’re not supposed to feel, they’re not supposed to like a client or dislike a client,” Patterson says. “Then when they have these feelings, they think there’s something wrong with them.”

That’s a key part of supervision, which has to be ongoing, says Patterson, adding, “You never outgrow supervision—that’s what keeps us out of trouble.” It’s also helpful to remember that if you’re doing something you don’t want to talk to someone about, there probably is something wrong, she says.

Kathryn Benson, chair of the National Certification Commission for Addiction Professionals, which is run by NAADAC, frequently talks on the phone to counselors who are confused. “It’s not their fault if they’re not getting good guidance from their agencies,” Benson says. “They’re afraid of retaliation. I’m not going to let them hang alone out there.”

On the other hand, it also is hard to blame supervisors, because most of the time they are “doing the best they can with what they are working with,” says Benson. “This isn’t about pointing fingers—it’s about coming up with a solution.”

Sometimes the counselor is so afraid of the situation that he/she doesn’t tell anyone, including the supervisor. But this fear proves destructive, says Benson. “I tell people they will get trapped in their own fear, because if you find yourself attracted to a client, you’ll get trapped into thinking that there’s something wrong with you, and you’re defective as a counselor,” she says. “You’re having a human feeling.”

The counselor’s job is to convey this to the supervisor, and the supervisor’s job is to understand that this is human nature, and that the supervisor will help the counselor manage this.

“This is about real life,” says Benson. “You cannot prevent everything.” Even with the best policies and the best training, treatment programs still may not be able to prevent sexual misconduct. But where the true liability lies is in how the treatment program responds to a situation once aware of it.

Benson stresses that the absolutely wrong move to make when an incident of sexual misconduct occurs is to transfer the patient immediately to another counselor. “That’s the mark of a poorly trained supervisor and clinician, who believes that the first response is to transfer,” she says. “That’s harmful to the counselor and to the client.” Many people come to treatment with abandonment issues, and if the first time they show up they get rejected—which is how they will interpret a transfer to another counselor—they will feel that they really must be worthless if even the therapist doesn’t want to talk to them, Benson explains.

Patient blaming

Benson says patients don’t seduce counselors. Rather, the patient comes into a program and is at the level of coping that he/she has in life at the time. “It’s not at all uncommon, particularly for females, to use their bodies,” she says. “They use sex as a way of controlling and minimizing further damage to themselves.” It’s a convoluted sense of survival, but by being in control of sex, these women believe they can reduce their chances of being harmed.

Counselors are trained in how human beings developed coping skills to help them survive, says Benson. “The burden is always on the clinician, on the staff person, to manage themselves,” she says. “We’re the professionals.”

Patterson is outraged when she hears counselors claim to have been seduced by patients. “The patient is acting like a patient, using the coping skills she has,” says Patterson. “The only way she knows how to interact is sexually.”

Because of the disease patients arrive with, and the past trauma they may have experienced, it may take them months or more to report sexual misconduct, says IC&RC's Mather. “Maybe a year later they’re back in treatment someplace else, and they realize this wasn’t supposed to happen,” she says.

Dual relationships