Managing boundaries under pressure: a qualitative study of therapists’ experiences of sexual attraction in therapy

Aim: to identify therapists’ views on sexual boundaries, their experience of them and the strategies they employed to manage them. . Method: in-depth qualitative interviews were used with a sample of 13 accredited practitioners of psychotherapy or counselling to elicit accounts of experiences of sexual attraction in the therapy encounter and consequent pressure on therapy boundaries. A strategic, primarily thematic analysis, informed by principles from Free Association Narrative methodology, was used in which team members used debriefing sessions for extending the depth of understanding of the interviews. Findings: there is consensus about what boundaries are essential at the extremes, but variability about fantasy, flirtation and touch. A core process was identified in the accounts of successful management of sexual attraction. There were four problematic ways of reacting to boundary pressure, two of which may lead to future therapist vulnerability and two others that may harm clients and therapy. Discussion: A participant-observer stance was conceptualised as essential for managing threats to boundaries. Minor boundary crossings were seen not only as potential precursors of more serious transgressions, but as opportunities for understanding the client’s difficulties, by many practitioners in this sample. Implications for practice: there are implications for training and accrediting organisations as well as for practitioners and supervisors. These include: organisations providing clarity over third party reporting, training facilitating the development of a theoretically based internal ethical model, supervisors contracting that discussion of attraction is expected and challenging while normalising attraction to clients, and practitioners noting apparently minor boundary crossings and taking them for discussion in supervision