Confronting Therapy's Ultimate Ethical Violation

A Therapist's Cautionary Tale on Breaching Sexual Boundaries

Susan Rowan

I doubt that I'd fit many people's image of a therapist who would violate sexual boundaries with a client. On the day I first met Cara, I was a well-respected social worker at a venerable psychiatric hospital in the Midwest. I viewed myself as a caring and conscientious professional. Yet over the course of two years, I progressed from sympathizing with Cara, to over-sympathizing with her, buying her groceries, paying her rent and, finally, sleeping with her. At first, I didn't think I was doing anything harmful---I was going the extra mile, helping Cara until she could take care of herself. But my previous dedication to all my clients became an obsession with one.

Starting Down the Slope

Therapy began routinely enough in the summer of 1993. Cara, the attractive mother of young, twin boys, had been hospitalized following the latest in a series of suicide attempts and self-mutilations. Despite her troubles, I found her to be bright, sensitive, and a talented visual artist. Subjected to severe physical abuse as a child, Cara had been given the diagnosis of Dissociative Identity Disorder, and her childlike alter-personalities and novel diagnosis intrigued me. I extended our meeting times in preparation for her marital sessions and took long walks with her on the hospital grounds.

After four months of marital therapy, Cara's husband discovered she'd had an affair before her hospitalization. Their marriage ended. Soon afterward, Cara was discharged. My job was now officially over: it required me only to provide short-term family therapy until a patient's discharge. But then, Cara called me at my hospital office a week later to discuss a personal problem, and in one of my first major boundary slips, I took her call.

Not long afterward, I gave Cara my beeper number, and within a couple of months, we were talking on the phone almost daily. I rationalized we were becoming friends. It was an odd sort of friendship.

One day, she called me in distress, saying she had no money to feed her sons. I called the department of social services on her behalf, rationalizing that I was merely being her advocate. A month later, after an alarming, drugged-sounding call from her, I drove to her home and found her lying in a pool of blood, having severely cut herself. I called the ambulance and stayed behind to clean up her blood, hoping to protect her young twins from trauma when they returned home from daycare.

Again, I ignored my violations of clinical boundaries---boundaries as much for my own protection as for hers. I was skiing out of control. A few weeks later, Cara asked for rent money, and then for help with her gas and electric bill. I paid them both, and she told me she didn't know what she'd do without me.

Why on earth did I do it? I've spent years since then examining the risk factors that led me to destroy my professional career. Part of the explanation lies in personal vulnerabilities. My own mother had been seriously ill throughout my childhood, and had died when I was 18. A sister 20 years older than I had been my surrogate mother and paid for my college and graduate school. As I stacked Cara's groceries that day, I rationalized that I was helping her and her children---as my sister had helped me---just until she could function on her own. I was dead wrong.

Over the next month, we had a few tentative sexual encounters. After each one, I felt disgusted and upset with myself.

As she became more desperate and demanding, I became more miserable. I stopped returning her increasingly angry phone calls. She finally left a message on my answering machine telling me that she could ruin me.

Finally, depressed and on the edge of financial collapse, I told her that I was going to end all contact and financial support on a set date two months hence. When the date came, she was back in the hospital and reported our sexual relationship to the hospital authorities. When they asked me, I told the truth. I couldn't fight anymore.

I lost my job. My clinical reputation was destroyed and my license was revoked for two years pending rehabilitation. Cara sued me and I had to declare bankruptcy. I lost a promising career spanning more than 20 years, as well as the respect of many friends at my beloved hospital.


Since that day seven years ago, I've been fortunate enough to be allowed to return to practice. I passed a forensic evaluation and my licensing board has reinstated me, under strict conditions that include having a mentor. I work now in a community mental health clinic at about half the pay I used to receive. Every day, I try to be aware of any sign that I could be taking a first step down that slippery slope. Recently, on a windy day, a poor client asked me for bus fare home. It seemed like a simple request, one that I could easily honor. I said no.

This blog is excerpted from “The Slippery Slope” Read the full article here. >>

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Tags: ethical issues

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