Why Did You Keep Going for So Long?
Issues for Survivors of Long-Term, Sexually Abusive "Helping" Relationships
P. Susan Penfold, M.D.
People who consult health professionals or clergy for help with their health problems or counseling for their emotional difficulties or family problems place their trust in powerful authority figures. These professionals are accorded a sacred trust, and are assumed by patients, clients, or parishioners to have a professional privilege and role. [Please note that, in this article, professional is the word used to refer to health professionals and clergy, while client refers to patients, clients, or parishioners.] This privilege and role permits the professional to examine and treat bodies or explore the intricacies of mind and soul. The professional is expected to act only in the client's best interests. Breaking of this sacred trust constitutes an immense betrayal, such as when a professional sexually violates a client. Two or three levels of sexual misconduct are often described: sexual impropriety, which includes any behavior such as expressions, gestures, or touching that is sexually demeaning to a patient or demonstrates a rack of respect for the person's privacy; and sexual violation, which refers to sexual contact between patient and physician, regardless of who initiates it, including but not limited to sexual intercourse, genital-genital contact, oral-genital contact, oral-anal contact, and genital-anal contact (College of Physicians and Surgeons of Ontario, 1991). Because of the parent-like dimensions of the professional's relationship to the client, sexual abuse of an adult has some parallels with incest and may have severe and long-lasting effects.
Sympathy and understanding for child victims of sexual abuse flows more readily than that accorded to adults. Adults are often presumed to have colluded in, or even caused, their victimization (Wohlberg, 1997). As I began to disclose my own sexual abuse by a psychiatrist (Penfold, 1998), sympathy was often tinged, or even clouded, by disbelief. I was asked, “Wasn’t it really an affair?" "How could you keep going for so long?" "Didn't you, as a psychiatrist yourself, realize what was happening?" and "Why didn't you just leave?" As I talked to other survivors and read published accounts of sexual victimization by professionals (Bates & Brodsky, 1989; Maes & Slunder, 1999; Miller, 1993; Noel & Watterson, 1992; Plasil, 1985; Walker & Young, 1986) it was clear that their struggles with profound self-blame and massive shame were huge obstacles to both disclosure and healing. These inner struggles were reflected and reinforced by the victim-blaming attitudes they encountered from friends, relatives, professionals, health professional and religious organizations, courts, and boards of inquiry.
Our society has a long tradition of victim-blaming (Ryan, 1976) which allows us to attribute responsibility to, ignore, or distance ourselves from victims. Lerner (1980) argues that people's belief in a just world (BJW) explains victim-blaming. In this just world, which guarantees security and success if your behavior is appropriate and your personal characteristics positive, people are believed to get what they deserve. The BJW is maintained by rational and irrational strategies to eliminate threats to its presence. Rational strategies include prevention and restitution by social agencies, taxes, donations, and volunteer work. Non-rational strategies described by Lerner, as applied to victims of sexual abuse by a professional, include the following.
Denial-withdrawal. Removing oneself from any information about, or contact with victims. Sensational cases may cause a stir, but the general public and many professionals quickly go back to their apparent blindness to violence against women, children, and vulnerable adults.
Reinterpreting the event so that the injustice disappears. The betrayal of trust, of a fiduciary relationship, is forgotten and the sexual abuse by the professional is termed an affair between consenting adults.
Reinterpreting the outcome. Victims of abuse by health professionals and clergy are thought to have benefited from most of the relationship or to have become stronger or more resourceful as a result.
Reinterpreting the cause. The victim is thought to have seduced the professional.
Reinterpreting the character of the victim. It is believed that the victim is a dangerous, vindictive, seductive, manipulative person who outwitted and trapped the professional in a sexual relationship.
These powerful and pervasive beliefs color attitudes of judges, jurors, lawyers, and members of boards of inquiry and invade the sentiments of those attempting to support victims, as well as the victims themselves. Victims' therapists, particularly those who appear in court on behalf of victims, need to have a clear understanding of how and why these adults are abused and become trapped in these relationships.
Experiences of Survivors of Long-Term, Sexually Abusive "Helping" Relationships
People who have been caught and trapped in these relationships describe feeling mesmerized, feeling like helpless puppets, feeling terrified of losing the relationship, and feeling convinced that their healing depended on the professional. At the same time, they were unable to see that their interests and needs were being blatantly disregarded, their bodies used, their values sabotaged, their self-esteem undermined, and their emotions manipulated, trivialized, or ignored.
For years after I stopped seeing a psychiatrist I call "Dr. A" (Penfold, 1998), I blamed myself for the sexual involvement, believing that I had seduced him or, at the very least, induced him to act out my transference. Telling myself that most of the therapy was positive, I viewed myself as the one who had failed.
Some years later, when the onset of panic attacks and flashbacks drove me to seek further therapy, I realized that Dr. A had gradually descended the slippery slope of boundary violations. He told me about his wife, his job pressures, and other patients. He held my hand, stroked my hair, and told me that I was an "attractive problem." He wrote me letters, but insisted that I hide them from my husband. He dismissed my feelings about him as a parent figure and my fantasies that I was his toddler daughter, and told me that I was experiencing adult sexual feelings for him. Sexual intercourse began when he moved his office and worked without a secretary,
Over the next few years, I felt bonded to him by this special, intense, secret relationship. The role reversal continued; many sessions consisted of me giving him support about his worries and difficulties. Yet he retained total control, often blaming me for being seductive. My angry feelings were attributed to early experiences with my mother or my lack of womanly graces. Years later, when I started to disclose my abuse, my secretaryamong otherswas clearly aghast. Her confidence in me obviously shaken, she asked how such a thing could happen to adult women.
Trapped for 5 1/2 years in a bizarre, sexually and emotionally abusive relationship with Dr Leonard, Ellen Plasil (1985) found that his outlandish behavior reinforced her confusion as she struggled to love him and comply with his prescription for perfect health. She never knew when he was going to invite her into his bedroom. Automatically obedient to his every whim, Plasil learned to detect his moods and wishes by reading his face, gestures, and tone of voice. She felt that he was her lifeline, and he told her repeatedly that she could not get that kind of help anywhere else. Increasingly numb, she experienced less and less anger about being used sexually.
World-famous psychiatrist Dr. Masserman repeatedly raped Barbara Noel (Noel & Watterson, 1992) over a period of 17 years while she was unconscious after injections of sodium amytal. Unknowingly addicted to amytal, Noel's dependence on Dr. Masserman was heightened by psychological means. He repeatedly questioned her judgment, undermined her self-esteem, and sabotaged her autonomy to the point that she felt cowed and defeated. Her focus in sessions had to be on pleasing him and preventing him from getting angry. Noel's escape from this entrapment began when she awoke early from a drugged state and found Dr. Masserman having intercourse with her. Until other victims started to come forward, Noel's attempts to lodge a complaint against Dr. Masserman were met with disbelief by other professionals and professional associations, and lawyers would not take the case against this famous and powerful man. Like other victims, Noel describes intense shame about her sexual exploitation, suggesting that she deserved the "Fool of the Year" award.
During a year of monthly sexual encounters, Carolyn Bates' psychologist, Dr. X, seemed unconcerned that she was becoming emotionally distant and automaton-like (Bates & Brodsky, 1989). She felt guilty and ashamed about having sex with a father figure, yet powerless to resist. Often Dr. X talked about personal issues: his unhappiness about his relationships with his colleagues and his parents, his anger toward his estranged wife, and his helplessness in the face of an upcoming divorce. Even though he was spending most of the time talking about his problems, he continued to charge her. Afraid to leave therapy and frightened that she would never get well on her own, she clung to the hope that he could give her answers, make sense of her confusion, and lift her depression. Even when she was seeing another therapist and pursuing a civil suit, Bates worried about hurting Dr. X, the man who had seemed like a replacement for her father. These feelings did not dissolve until she witnessed him making false accusations about her in court and accusing her of lying.
Exhausted by her work in Lesotho, Yvonne Maes (Maes & Slunder, 1999) attended a spiritual retreat in Durban, South Africa. A Catholic nun at the time, she hoped to renew her faith and confront the effects of her childhood molestation by her father. During private sessions, the retreat director, himself a Catholic priest, became more and more familiar. Programmed into automatic obedience to male religious authority, she was powerless to resist his eventual insistence on sexual intercourse. Devastated, her faith shaken, she was consumed with guilt. Her attempts to remedy the relationship made her vulnerable to repeated abuse over the next 8 years. Subsequently, her search for justice was met with denial, minimization, trivialization, and cover-ups by church authorities. Re-victimized by the process, she finally decided to leave both her order and the Catholic Church.
"Joyce" felt snared and unable to resist her family doctor's demands for sex. He was giving her pills and injections for migraines, and had cosigned a car loan for her. When she tried to leave, he threatened to refuse to give her medication and to tell other doctors she was an addict so that they would not prescribe for her. Other women described similar experiences when they tried to terminate a relationship with an abusive professional. They were told that they were far too sick or too emotionally disturbed to manage, and that they would never find such good treatment or counseling anywhere else.
Like many other victims, "Olivia's" secret relationship with a priest gave her a sense of being special. She felt safe and secure with him in the little room off the church, and barely noticed that his sexual demands were becoming more and more outlandish. Any concerns on her part were met with the assurance that they were truly blessed and communing in the sight of God. Estranged from her husband, she withdrew from her friends, and felt comfortable only with her children. Eventually her husband, suspecting an affair, engaged a private detective to follow her. When she was found out, her life fell apart. Her husband divorced her and obtained custody of the children. He, and the rest of the congregation, assumed that she had seduced the priest. She was left destitute; the priest was merely relocated.
Entangled in a sexual relationship with her chiropractor for more than two years, the sex made “Antoinette” feel very special. The degree to which she felt special and worthwhile depended on the length of time they spent together after the treatment session ended, and the amount of physical involvement. Yet by the time she stopped seeing him, she had developed an eating disorder, her marriage was in tatters, and her career derailed. When she lodged a complaint about the chiropractor, he came to her house and begged her not to proceed. Although she eventually went ahead with the complaint, she had many qualms about betraying the man who had seemed like a god to her.
“Jill's” pastoral counselor came out as a lesbian shortly after their counseling sessions became sexual. She urged Jill to move into her home with her. Although enjoying an improved lifestyle, Jill felt constricted and embarrassed. She could not discuss the relationship at work, withdrew from friends and family, and felt increasingly dependent on the counselor. Later, when she tried to assert herself, Jill found herself locked out of what had become her home. Consumed with shame, feeling helpless and hopeless, she entered a transition house for abused women claiming that a man had abused her.
There may be many complicated and interrelated reasons why people are not able to leave abusive situations. These can be psychological, social, cultural, gender related, physiological, neurochemical, hormonal, and/or behavioral. Some individuals may be more vulnerable than others because of childhood abuse, illness, or current distressing situations or life crises. Added to this are the mystique and power, conveyed by the status and role of health professionals and clergy, which lead people to trust them and comply with their directions.
Various authors have tried to explain why people get caught up in abusive relationships. There is no single explanation. The thoughts and ideas of various writers overlap, but all strike a chord for me when I try to understand what happened to me and to other victims who were similarly trapped and enslaved. The useful concepts include (a) Marilyn Peterson's (1992) description of the four factors operating during boundary violations, (b) issues in female socialization, (c) Peter Rutter's (1989) thoughts about “sex in the forbidden zone,” (d) attachment theory, (e) traumatic bonding, (f) Judith Herman's (1992) theory of “traumatic transference,” and (g) Leonard Shengold's (1989) description of "soul murder." All these can aid our understanding of the complex, interdigitated reasons why peopleparticularly womenstay in situations that are so destructive and inimical to personal growth.
In every account of a boundary violation, states Peterson (1992), four issues emerge: indulgence of professional privilege, role reversal, secrecy, and a double bind. These four characteristics interlock and set in motion a series of relational changes that create a new system with a life force of its own. Entitlement allows the professional to shift the emphasis from helping the client to meeting the professional's needs. Rationalizing this behavior by claiming that the client’s needs are still being met is common. Victims have been persuaded that sex is part of therapy, or, as in my case, that "you have found yourself through love of me,” and “you are learning to trust men through your relationship with me.” When roles are reversed, the client becomes the caretaker and caters to the professional’s needs. But the professional retains control and still defines the boundaries according to his or her needs. For example, I was hearing all about Dr. A's problems and difficulties, but I did all the traveling, went to his office at times convenient to him, and paid him or gave him gifts.
Peterson's description of secrecy encompasses the client's lack of awareness of the professional's true motives or agenda. The professional has an unfair advantage. The client's reality is obscured, and the bond of trust between them is a farce. Secrets can also produce three-person triangles, wherein two people are aware of the secret and one person is not. Professional and client share this conspiracy, and the person outside is likely to be damaged. In my case, my husband was the third person. He was deeply hurt, and eventually permanently alienated by the secrecy. Clients experience double binds during boundary violations, according to Peterson. If they try to resolve the situation, they risk losing the relationship. Fears of abandonment lead to paralysis, to inability to take any action. At the same time, they lose self-respect by failing to listen to the inner voice that tells them that something is wrong. Thus, clients selectively blind themselves to the reality of their circumstances. For instance, ravaged by an eating disorder, marriage and career in tatters, Antoinette clung to the belief that her relationship to the chiropractor held the answer to all her problems.
Issues in female socialization, and in the kind of bond that women establish with helping professionals (Lott, 1999), may explain women's special vulnerability to entrapment in these subservient relationships. Despite changes wrought by the women's movement, a woman still tends to be socialized to defer to and serve men, and to view herself as primarily responsible for mediating relationships. Believing in the authority of a male professional's contention that she should stay and that she is being helped, basking in attention from a valued male, buying into his blaming of her for the vicissitudes of the relationship, thinking that if she tries hard enough all problems will be solved, she stays on and on. This is even more likely to happen if the man is a prominent or famous member of the community.
Writing about female socialization from a Jungian perspective, Rutter's (1989) work has helped many women understand the dimensions of their betrayal and victimization and start to heal. He outlines three key factors in the "masculine myth of the feminine" that facilitate abusive sexuality. Women's deference, expected in the prevailing culture, sets the stage. Next are the enormous healing, nurturing, and sexual powers that men believe that women can give. This archetype's opposite is the third factor, the conviction that women have dark powers of evil and destructiveness; this factor comes into play when men are disappointed. Rutter suggests that women who get sexually involved with healers are galvanized by danger and feelings of powerlessness. Trying to preserve hope in the relationship, a woman reaches out to the wounded man who is exploiting her. Although the man has destroyed his ability to help her by consummating the relationship, this consummation reinforces the woman's perception of the man's wound. Now, as well as exploiting the woman's sexuality and spirit, he is misusing her compassion.
Views about preexisting vulnerability to exploitation range from Kluft's (1990) description of the "sitting duck," who was sexually abused as a child, to Schoener's (Schoener, Milgrom, Gonsoriek, Luepker & Conroe, 1989) contention that client characteristics do not predict sexual involvement with a therapist. Many victims do describe childhood experiences of abuse, neglect, deprivation, separation, and perceived conflict with or lack of attention from parents. The lack of a secure and rewarding attachment to parents can create a lifelong tendency in people to cling to important others, be possessive, and fear abandonment (Bowlby, 1977). It seems likely that these people would be more inclined to form a symbiotic relationship with a professional, to cling, to fear abandonment, and to be unable to leave the relationship, even if it were damaging and exploitative.
These people, too, may be more vulnerable to traumatic bonding. While this term is more often applied to violent relationships (Walker, 1979), the person who is being sexually exploited by a professional suffers similar captivity, isolation, and lack of outside influences or support. Survivors of sexually abusive relationships with professionals often describe concurrent emotional abuse of a cyclical nature. At times, the professional would be warm, nurturing, and respectful; at others times, harsh, demeaning, blaming, and belittling. Like a battered woman, the victim of an abusive professional who experiences anger followed by reprieves may develop an intense dependence on an all-powerful authority figure. Living in fear of the professional's anger or rejection, the victim may also view him as a source of strength, guidance, and life itself (Herman, 1992).
The psychological, social, and behavioral aspects of traumatic bonding may be augmented by a neuro-chemical component. It has been postulated that people can become addicted to their victimizer. The stress of the abusive interaction can liberate opium-like substances, so that the person can become accustomed to feeling especially energized and euphoric after the abusive interaction (Van der Kolk, 1989). In addition, people exposed to severe ongoing trauma may experience a chronic state of increased arousal with changes in body chemistry (Golier & Yehuda, 1998). These changes may give rise to anxiety, agitation, insomnia, weight loss, headaches, stomach problems, and other physical symptoms. This state of hyper-arousal has cognitive effects, including interference with a person's ability to make an objective analysis of the situation and formulate ways to understand and deal with the trauma (Van der Kolk, 1989). In my case, I was rendered vulnerable by childhood abuse and separations from parents. Traumatic bonding to Dr. A was promoted by the isolation and secrecy and Dr. A's variable and unpredictable responses. Sometimes he was warm and caring; at others times he was cold, distant, rejecting, and blaming. At the time, I experienced periods of severe insomnia, anxiety, and weight loss.
Closely allied to the concept of traumatic bonding is that of traumatic transference. This refers to the intense, life-or-death quality of the reaction of a survivor of childhood abuse to a person in authority. Herman (1992) postulates that the emotional responses of a childhood trauma victim have been deformed by experiences of terror and helplessness. The survivor may cast the professional in the role of an omnipotent rescuer while simultaneously mistrusting him or her, and thus the survivor may be prey to all kinds of doubts and suspicions and try to control the relationship. Herman notes that, "The protracted relationship with the perpetrator has altered the patient's relational style, so that she not only fears repeated victimization but also seems unable to protect herself from it, or even appears to invite it. The dynamics of dominance and submission are reenacted in all subsequent relationships, including therapy" (Herman, 1992, p. 138). Individuals who were sexually abused as children may assume that the only value they can possibly have to another person, particularly if this person is powerful, is as a sexual object.
Also closely allied to the concept of traumatic bonding is the term soul murder. While Shengold (1989) is addressing the physical and mental torture, sexual abuse, and emotional deprivation of children, he argues that a patient seduced by a therapist is in a similar situation. Soul murder is "the deliberate attempt to eradicate or compromise the separate identity of another person. The victims of soul murder remain in large part possessed by another, their souls in bondage to someone else" (Shengold, 1989, p. 2). Soul murder evokes a combination of rage and helplessness, feelings that must be suppressed for the victim to survive. This happens by a form of brainwashing or "double think," and the victim retreats from positive as well as negative feelings. The victim's deepest feelings are focused on the soul murderer. Survivors of sexual abuse by health professionals and clergy commonly say that they lost their identity, felt totally in thrall to their abuser, incapable of any independent decision-making, their usual moral scruples dissolved.
Issues for Professionals Who Are Sexually Abused by Other Professionals
Although there are many questions, little information exists about professionals who are sexually abused by other professionals. Are professionals more or less vulnerable? Were they alerted to the slippery slope of boundary violations and the dangers of professional-client sexual contact during training and supervision? If a professional in the same field abused them, how did this affect their feelings about their profession? Are they able to disclose their abuse? Are there some similarities between victim and offender, in that they both appear to deny and rationalize the destructive nature of the relationship? Are professionals who are sexually abused more likely to abuse their own clients in the future?
Victims who are professionals themselves may be particularly reluctant to disclose. Written accounts are just starting to appear (Maes & Slunder, 1999; Penfold, 1998). Firsten, Wine, and colleagues (Firsten & Wine, 1990) studied Canadian helping professionals who had been sexually abused by their own therapists and attribute their difficulties in completing the study to the victims’ vulnerable positions in their own profession. Several health professionals who were sexually abused by other health professionals have told me that they are neither able nor willing to identify themselves as victims, as this makes them like other victimspeople they view as extremely fragile and emotionally unstable. Other victims who are professionals have admitted intense shame and self-blame. They have sought therapy and have disclosed to a trusted few but fear that public disclosure would damage their reputations and perhaps devastate their careers.
There are indications that a sizable proportion of victims are pro-fessionals. In 1985, a nationwide survey of U.S psychiatrists showed that 4.4% of female psychiatrists and 0.9% of male psychiatrists had sexual contact with their own therapists (Gartrell, Herman, Olarte, Feldstein & Localio, 1986). In 1994, hoping to generate more understanding and discussion of the abuse of health professionals (at that time veiled in secrecy), I put a notice in the newsletter of the American Association of Women Psychiatrists which has a wide circulation in North America. It included a brief statement describing my own abuse, my long struggle with feelings of shame and self-blame, and the results of the board of inquiry on the psychiatrist who abused me. This was followed by a request for participation in a research study aimed particularly at how abuse had influenced the victim's attitude toward her profession. I received only two replies, and only one woman filled out a questionnaire!
Those of us who are mental health professionals may be more adept than other health professionals at attributing some responsibility to ourselves or even blaming ourselves totally for the abuse. For years, I was able to find all sorts of reasons that diminished Dr. A's responsibility or absolved him altogether. They included the fact that I had problems in the first place, that I was an extremely difficult "borderline" patient, that I had a sexualized transference that Dr. A "couldn't help" acting out. Gradually I realized that this guilt and self-blame were serving to give me a sense of control, and that they veiled other painful issues such as betrayal and the recognition that I was not special and that he had blatantly disregarded my interests and needs.
We do not know whether professionals are more or less likely to be victimized, or whether the current attention (in training and supervision) to boundary violations and sexual attraction between professionals and their clients will eliminate or ameliorate the problem. In my field, psychiatry, there is teaching about ethics to residents and medical studentsbut still, I fear, a great deal of denial. The problem of psychiatrist-patient sex is often assumed to have happened only in the 1970s, to have been a product of just a few "bad apples" who are no longer in the profession and who failed to recognize the perils posed by seductive patients (Penfold, 1991). It seems likely that professionals and nonprofessionals alike may be vulnerable because of early experiences of abuse, neglect, or other family dysfunction and current experiences of illness, losses, and stresses. Perhaps the most important factor, though, is the bad luck entailed in consulting an abusive professional who is able to abdicate his or her fiduciary duty and exploit the client.
Although a process of rationalization and denial is described for both perpetrator and victim, any similarities end here. The client entrusts the professional with body, mind, or soul and assumes that the professional is acting in the client's best interest. This is essential with a psychotherapy client, for example, who needs to set aside all defenses and confide all his or her most intimate feelings or secrets. If that client remains guarded or suspicious (a stance which might be recommended in view of the prevalent problem of sexual exploitation of clients), therapy is likely to progress slowly, if at all. The professional has particular knowledge and abilities and is usually sanctioned and licensed by society. He or she accepts the trust and confidence of another to act in that person's best interests. Clients who are abused use denial and rationalization to overlook boundary violations and buttress their belief that the professional was trustworthy and had their interests in mind. They need to think that the interaction was constructive, and that they have not been duped and used. Abusive professionals, on the other hand, have broken boundaries and ignored professional codes. Their denial and rationalization are likely to be self-protective in nature.
Are professionals who have been sexually abused themselves by professionals more likely to abuse their own clients? In 1979, a nationwide study in the U.S. (Pope, Levenson & Schover, 1979) indicated an increasing incidence of intimate sexual relationships between educators and students in psychology training programs. Overall, 10% of students in psychology graduate training programs had engaged in sexual relationships with their teachers and clinical supervisors. One out of four recent female graduates had engaged in such sexual relationships. The authors suggested the possibility of a modeling effect for later professional behavior, finding that 23% of women who had experienced sexual contact with their educators also reported sexual involvement with their clients, compared with only 6% of those who had no sexual contact with their educators. Although other studies have examined the incidence of sexual contact between educators and future health professionals (Gartrell, Herman, Olarte, Localio, & Feldstein, 1988; Carr, Robinson, Stewart, & Kussin, 1991), their findings have not confirmed a modeling effect. In Gartrell and colleagues' study, none of the psychiatric residents who had been sexually involved with an educator acknowledged sexual contact with a patient.
Until we are able to study the aftereffects of sexual abuse on a professional by other professionals, we will not be able to answer the question of whether they are more prone to sexually abuse their own clients. It is likely we will find that abused professionals are less likely to violate boundaries. All the professionals who have spoken to me in confidence about their own abuse have stressed that they are extremely careful about preserving appropriate boundaries and are aware that even the slightest deviation can be upsetting to clients.
Without awareness of the explanatory concepts, the long enslavement of victims, the victims' ambivalence about their abusers, and the victims' impaired ability to recognize damage can seem puzzling or even inexplicable. Victims can be construed as emotionally disturbed, seductive, vindictive, or lying; their abuse can be relabeled as an affair between two mutually consenting adults. Struggling with a contaminated identity, consumed with shame and self-blame, victims often hold themselves responsible.
It seems likely that professionals who are abused by professionals may have an even harder struggle to transcend self-blame and shame. Only gradually can most victims of these long-term sexually abusive relationships begin to understand what happened to them. In many cases, they start to recognize how the abusive professional gradually enlarged and then broke the boundaries of the relationship. They may recall the professional's self-disclosure, flattery, insistence on secrecy, self-aggrandizement, reinforcement of dependency, and undermining of family and other supportive relationships. They may remember that they were given the last appointment of the day, after the secretary left, or that the professional arranged to meet them outside of the office or church setting. It is with growing understanding and liberation from the corroding effects of shame, that healing begins.
Courts and boards of inquiry, victims' relatives and friends, practitioners and students of the health professions, lawyers and law students, and clergy and trainees also need to have information that challenges victim-blaming attitudes. This knowledge should provide understanding of why some victims are trapped for so long and are so slow to acknowledge that they have been duped and used. Peterson's (1992) description of the four factors operating in a boundary violationindulgence of professional privilege, role reversal, secrecy, and a double bindis relevant to all cases. Shengold's (1989) concept of soul murder is useful to explain the pervasive indoctrination and enslavement that victims endure. The vicissitudes of female socialization, augmented by Rutter's (1989) Jungian perspective, are germane to most female victims. The remaining explanatory conceptsattachment theory, traumatic bonding, and traumatic transferencemay be relevant in certain situations. However, explanations must never be used to excuse the perpetrator who has violated a sacred trust and heinously abused professional privilege.
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