Psychology

A psychologically disturbed or troubled person seeks professional help and receives service from mental health professionals such as psychologists and therapists in order to resolve his or her problem. Unfortunately, in some instances, the supposedly appropriate or professional relationship between therapist-patient becomes marred by sexual intimacies. In turn, the sexual involvement between a therapist and his or her client compromises the success of the therapy program. If such is already the case during therapy, then sexual relationships between therapists and their former patients after the therapy tend to become more difficult. This is because there are more potential harmful implications on the part of the clients while the therapists are possibly faced with different administrative, professional, and legal liabilities, making the issue of sexual intimacies with former therapy clients clearly unethical and clinically harmful (Seto, 1995). Thus, there is a need for therapists to be completely prohibited from being sexually involved with their former clients not only during but also after therapy (Behnke, 2004).

Rationale
The existence of a sexual relationship between therapist and client makes the activity a very sensitive issue (Gross, 2003). Hence, such occurrence sets for the creation of a clear guideline not only on the complete prohibition of sexual intimacies between therapists and their current clients but also on the partial prohibition with former therapy patients. Gross (2003) adds that empirical studies, which show the prevalence of sexual involvements between therapists and their clients, raise concerns in terms of their damaging effects to these professionals and their patients (2003).

However, in todays settings, the ethics code of the American Psychological Association (APA), known as the APA Ethical Principles of Psychologists and Code of Conduct, indicates that the existing policy is no longer appropriate. Hence, this calls for the implementation of a stricter rule, completely prohibiting sexual intimacies between therapists and their former clients. This is under the premise that such kind of sexual involvement is far more complicated especially if the post-therapy intimacy is to be taken under ethical and clinical perspectives (Behnke, 2004).

Additionally, it is during the post-therapy period when the situation becomes more problematic as psychological transference may even continue after the regular therapy program. This is because former therapy clients still need follow-up or succeeding sessions with their therapists, and this setup, in turn, result in tendencies of sexual intimacies between therapists and their former clients (Shopland  VandeCreek, 1991). Hence, Behnke (2004) emphasizes that it is the sexual intimacy between therapist and former client after the therapy which complicates the matter. The reason for this is that the time after the therapy only further weakens the professional relationship, and that sexual involvement is likely to intensify, making it disadvantageous to both parties (Behnke, 2004).

Statistics
Despite the policy concerning the prohibition of sexual intimacies between therapists and their current or former clients, Pope (2001) noted that statistics say otherwise. In fact, the author states that while the said prohibition dates back to the Hippocratic Oath, Freud, the Nigerian Healing Arts code, it was the statistical results of systematic studies during the 1950s which empirically showed or proved the existence of such activities. Since that time, the concerned medical professions started to realize the persistence, pervasiveness, and depth of the damaging effects every time therapists use or abuse their role, license, power, and the trust of their patients when they engage in sexual intimacies with the latter.

A particular survey included an item regarding therapists becoming sexually involved with a former client, which confirmed that the said medical professionals engage in sexual intimacies with their patients and such practice is actually happening (Pope, Tabachnick,  Keith-Spiegel, 1987, p. 996).  The 1987 research by Pope and company on gender proportions on sexual activities with existing or ex-patients also indicates that 14 percent of male therapists and eight percent of female therapists disclosed that they had sexual intimacies with their former clients.

Due to the undeniable figures of sexual intimacies during that time, over 95 percent of the public generally viewed sexual concerns like physical connection between therapists and their clients as an immoral behavior. In a more specific stand, around half of the survey respondents considered therapists having sexual activities with their former clients as unethical individuals.

Post-Therapy
Shopland and VandeCreek (1991) identified three theories which explain the principle behind the prohibition of sexual intimacies with former clients. First is the psychodynamic theory which manifests that ex-clients are in fact not yet finished with their treatments even with the termination of their therapies. Under such situation, patients continue to be rehabilitated with their respective transference issues hence, they may need the therapist to continue being a therapist (and nothing else) even if treatment is never reinitiated.

The second explanation concerns the feminist theory which centers on power differential in sexual relationships between therapists and former clients as well as the weakness and susceptibility of the ex-client as the less or likely person to be subjected to sexual exploitation. In this situation, it is the therapists who are considered as more powerful and the former patients are the ones who seek help because of their vulnerable and dependent mental and emotional states (Shopland  VandeCreek, 1991).

The feminist theory-related sexual activities between therapist and former clients are likewise compared to parent-children cases like incest. It is in such situation where the therapists are analogous to parents who abuse their authority and manipulate their ex-clients who, like the children, depend and trust on these medical professionals for treatment, safety, and care. Hence, the power differential continues in the post-therapy period or even after the treatment program has culminated just as incest is likely to continue even if the children victims are already adults and live with their own families in separates houses.

The last explanation involves what is called the family systems theory. This theory attests that the violation of boundaries in a sexually-characterized rehabilitative activity, wherein the former patient is made to feel that he or she satisfies the therapists sexual needs, creates harmful effect on what is supposed to be strictly therapist-client relationship (Shopland  VandeCreek, 1991). Shopland and VandeCreek (1991) view that sexual intimacy with a former client is regarded as an outcome of boundary violation since sexual desire and seductive conduct possibly started but was not correctly managed or even stopped during the therapy program. Therefore, given these theories, the authors support the need for therapists to be completely prohibited from having sexual involvements with their former clients.

Corroborating Shopland and VandeCreeks (1991) position that therapists must not engage in a sexual relationship with their former clients, Vasquez (1991) explains that this is the fundamental reason for the revision of the APA ethics code. Citing the consideration made by APAs Revision Task Force of the Ethics Committee, Vasquez (1991) further states that under the moral principle which is to do no harm to ex-clients, it is only right to propose that sexual intimacies between therapists and their former clients are not allowed. This is attributed to the probability that the post-therapy sexual involvement with former patients could pollute the therapy-client connection during therapy sessions and prevent the clients from attending the post-therapy activities (1991).

Additionally, Vasquez (1991) points out that sexual intimacies with former clients encourage conflict of interest. This is because the professional obligations of therapists, such as adherence to confidentiality or possible involvement in court proceedings and which should continue even after the therapy, are terminated. As there appears to be abuse in the power and influence of therapists not only during but most alarmingly, after the therapy,   groups like the APA should protect ex-patients.

Complicated
Taking into consideration APAs position, as the concerned medical professional association, Behnke (2004) argues that sexual intimacies with former clients pose a sensitive balance of fundamental ethics or values. There is no argument concerning the harms resulting from therapists having sexual relationships with their patients while the therapy program is currently in effect. The author adds that the damaging effects are too evident that the associations code, just like the standards of the rest of mental health associations, definitely prohibits sexual activities between therapists and current clients.

However, sexual intimacies with former clients after the therapy has ended are more complicated or pose more harmful situations under the ethical point of view. As Behnke (2004) explains Time may attenuate the intensity and even the likelihood that an involvement will result in harm (p. 76). Thus, Behnke (2004) stresses that it is necessary to analyze the existence of sexual relationships between therapists and former clients so as to determine when, if ever, the sexual intimacies could be morally allowed or viewed in a different manner, as well as whether or up to what level it could be disallowed.

Hence, a therapists post-therapy sexual intimacy with former client is a complicated matter based on two clear perspectives. The first view involves the human values, where societal standards dictate such as an unethical act. The second perspective is the human cognition of the sexual acts data, dynamics, and implications. In short, the therapists sexual involvement with their former clients presents several clinical or research and ethical views. The code settles sex with current client as something harmful hence, absolute or complete prohibition is needed. However, in cases involving former clients or post-termination sexual involvements, the idea of lessened harms only makes the matter worse.

The ethical and clinical complications are explained based on several circumstances. One is that the therapists knowledge on the possibility of post-therapy sexual relationship affects the effectiveness of the current treatment. The clinical recommendation of additional or after-treatment therapy leads to sexual intimacies considering the change from complete to partial prohibition two years after the therapy. Another is that former clients do not have true autonomy in their choice to be involved in sexual activities with their former therapists. Lastly, complications set in when autonomy is already compromised and harm can possible to happen, which then supports the premise on the immorality of after-therapy sexual intimacies with former clients.

Conclusion
It is expected of a doctor-patient relationship to be ideally professional and aimed at resolving the problem of the client. If the existence of sexual relationship between a therapist and a client is by itself ethically unacceptable, then sexual intimacies with ex-patients after the therapy are all the more unacceptable. However, the clear liabilities of therapists, the firm association code, and glaring harms to clients appear to be insufficient factors to stop such activities thus, it is high time to settle the issue. Ultimately, it is essential to enforce a complete prohibition of sexual relationships between therapists and clients not only during but most importantly after the therapy since it is the post-therapy period which is critical in the eventual recovery of the patient.