I think it's safe to say that when it comes to creating a good public image, you can chalk up the past year as a very bad one for psychotherapists.
No other group -- with the exception of politicians, of course -- has caught more flak or taken a harder pounding recently than the professionals engaged in the psychotherapeutic treatment of patients in a one-on-one setting behind closed doors.
From their portrayal in such films as "The Prince of Tides" and "Final Analysis" -- films in which psychiatrists played by Barbra Streisand and Richard Gere sleep with siblings of clients -- to recent revelations about numerous real-life cases of sex between therapist and patient, to the controversial release of private tapes to a biographer by the late Anne Sexton's psychiatrist, therapists have taken it on the chin lately.
Of course, the issue that has evoked the sharpest response is that of sex between patient and therapist -- a situation, by the way, that generally involves a female patient and a male therapist.
It is not a new issue, however. Given the very nature of the psychotherapeutic situation -- one that involves an intense degree of intimacy and privacy between two people over a long period of time -- sexual involvement with a patient has always been recognized by the therapeutic community as a potential problem.
Almost a century ago Sigmund Freud, the father of psychoanalysis, warned his disciples not to become romantically attached to a patient. Such an attachment, he cautioned, could only have a disastrous outcome for both the patient and the treatment.
It's a view still held by the therapeutic community. Not one of the more than 400 variations of talking therapy practiced in the United States considers sex with a patient as a desirable or helpful treatment. Indeed, it is considered by professional mental health groups to be an entirely unethical act -- it violates, for instance, the American Psychiatric Association's Code of Ethics -- and one in which the therapist is always at fault.
Of course, codes and rules are one thing -- emotions are another.
And even the best psychotherapists have emotions. Just listen to what one experienced psychoanalyst tells writer Janet Malcolm in this passage from "The Impossible Profession":
"There have been many times when I've entertained fantasies of dating and marrying patients and having sexual intercourse with them. These are common countertransference [feelings of the therapist toward the patient] reactions. . . . Every other analyst has had them, too, and they're not the issue. The issue is whether the analyst is in an emotionally desperate situation that prevents him from analyzing his reactions and causes him to do something dire."
Which leads to the question: What makes a Freudian slip? Or, for that matter, what makes any therapist practicing any form of talking therapy slip?
Any number of things can affect a therapist's inability to refrain from acting out his sexual feelings -- including suffering from serious personality disorders -- says Dr. Robert Simon, director of the program in psychiatry and law at Georgetown University School of Medicine.
But he has found that therapists who are poorly trained or who have not been in psychotherapy themselves may be more vulnerable to acting out their sexual feelings toward a patient.
"I personally believe that therapy is necessary for the therapist who's going to do any kind of intensive therapy," says Dr. Simon. "The studies have shown that the vast majority of therapists -- maybe 90 [percent] to 95 percent -- have had sexual feelings toward a patient. But it's analyzing the feeling and not acting it out that becomes the issue."
But even with therapy, he says, there is no guarantee that the current approach to psychiatric training prepares a therapist to deal with patients. "Many psychiatrists today are being trained in pyschopharmacology [the use of drugs to treat patients]. And they don't know how to handle transference. They don't know how to deal with patients."
But at best -- even with a well-trained, experienced therapist who is able to analyze his feelings rather than act them out -- this emotional pas de deux between patient and therapist remains tricky.
"If two people are repeatedly alone together," wrote psychoanalyst Phyllis Greenacre, "some sort of emotional bond will develop between them."
And if you add to that the extraordinary closeness and deep level of understanding that often arises in a therapeutic setting, it's possible to appreciate the restraint exercised by the vast majority of therapists.