Editorial

Dear Reader:On the psychiatrist's couch


At last Noseweek is able to provide you with the long-awaited update on Sylvia Ireland’s complaint – first made to the Health Professions Council of South Africa in early 2008 – that she had been sexually abused by her psychiatrist, Dr Ray Berard, over a two-year period of psychotherapy.

The Berard case might, ironically, be lent some undeserved glamour by the forthcoming release of A Dangerous Method, a film based on the lives of the two founding fathers of psychotherapy, Sigmund Freud and Carl Jung. In the film, Keira Knightley plays Sabina Spielrein, an 18-year-old Russian-Jewish beauty, suffering from hysteria, who is treated by – and ends up having a relationship with – Jung.

In his Introductory Lectures in Psycho­analysis, published in 1917, Freud noted the erotic feelings his female patients exhibited toward him, labelling them transference. In later writings he clearly indicated that the therapist should not take advantage of the patient’s “longing for love” and should abstain from sexual involvement. Freud also noted that the therapist had to struggle with his own countertransference love feelings.

In a letter to Freud in 1909, Jung claims that Spielrein was “systematically planning [his] seduction” and wins Freud’s sympathy. But just weeks later, he concedes: “Caught in my delusion that I was the victim of the sexual wiles of my patient, I wrote to her mother that I was not the gratifier of her daughter’s sexual desires but merely her doctor, and that she should free me from her.”

In further justification, Jung told Spielrein’s mother that he had moved from being her doctor to just her friend “the more easily” because he had not charged a fee.

Read Noseweek’s update on page 10 and you’ll see that in certain quarters nothing much has changed in 100 years.  The sexual abuse of patients by their psychotherapists was from the start – and remains – problematic for the health professions to address.

In defence of Jung, his contemporary Bruno Bettelheim wrote: “True, Spielrein paid a very high price in unhappiness, confusion, and disillusion for the particular way in which she got cured, but then this is often true for the mental patients who are as sick as she was.”

After his suicide, it emerged that Bettelheim had himself sexually abused patients and staff members.

John Kerr, in A Most Dangerous Method, writes of this history: “Jung was scarcely the only therapist to become involved with a patient. Gross’s exploits were legendary, Stekel had long enjoyed a reputation as a “seducer”, Jones was paying blackmail money to a former patient, and even good Pastor Pfister was lately being entranced by one of his charges...”

In the 1970s, Masters and Johnson (in their classic report on Human Sexual Inadequacy) reported that a sizeable number of their clients had reported having had sexual contact with a therapist. They labelled such conduct “rape” in a widely reported address to the American Psychiatric Association convention in 1975.

A 1973 survey of 1,000 physicians in Los Angeles County found that 10% of psychiatrists and other physicians acknowledged “erotic contact” with clients, establishing the seriousness and scope of the problem.

“Since then, complaints… and malpractice actions related to sexual misconduct by therapists have steadily increased. There is no evidence, however, that all of this action, or even the refinements in ethics codes, have changed professional behaviour,” noted K S Pope (in a widely acclaimed research paper titled “Therapist-patient sex as sex abuse”).

By the mid-1990s more than 20 US states had introduced laws making it a crime for psychological counsellors to have sex with clients.

Until the recent past, women have largely been blamed for these events rather than seen as victims, mirroring similarly male-dictated responses to rape. 

Pope notes the contrast between the detailed interest that (predominantly male) legal and mental health professionals have taken, in eliciting from patients who have been victimised, information about their “promiscuity”, sexual history, “predisposing” clinical conditions, and so forth – and their less-than-vigorous efforts to obtain such information from professionals who have been sexually intimate with their patients.

When asked to explain why the US Psychiatric Association did not support the anonymous survey of its members (in the late 1980s), the chair of the Ethics Committee declared: “The association does not believe in asking its members for sensitive information about themselves.”

Says Pope: “A certain critical level of visibility is necessary before either the profession itself or the community attempts to intervene in a meaningful fashion to prevent or remedy sexual misconduct with clients.”

Noseweek is happy to help give it that visibility. (See update Are Ireland's eyes smiling - in this issue.)

The Editor

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