Responding to Sexualised Comments: Option 3

I’ve had a few moments in therapy when personal boundaries have felt challenged – more earlier on and I’m not sure whether this is a function of loss of physical attractiveness due to ageing and/or clearer therapeutic boundaries due to experience.  I think I may have taken the ‘pretend it didn’t happen and hope it goes away’ approach early in my career – often my non-verbal responses may have alerted clients to the inappropriateness of their comments. Women are probably less likely to make such comments from my experience, and I think at least half of the comments I’ve dealt with have been from males.

For the vignette you’ve posted, my thoughts would be along the lines of:

• Name the process: “I’ve noticed that you tend to make comments about my appearance and the sound of my voice during our sessions”
• Raise the issue/dilemma: “I’m not sure what you intend by these comments, however they seem to me to be of a personal nature and therefore not appropriate within the context of our therapy sessions.  Can you tell me what is it that you mean by these comments?
• Explore further and delineate the differences between personal and professional boundaries, as well as the normal nature of personal attraction in relationships “how might our relationship in therapy be different from if we had met socially?”  “attraction is not unusual in relationships of all kinds, however it is important that we keep clear professional boundaries and continue to focus on the issues that you’ve brought to work on…how does this sound to you? “any questions about this?” etc.
• Agree/contract more appropriate boundaries: “I’m glad that we’ve been able to talk through this issue. Can we agree then that you’ll refrain from making personal comments during our therapy sessions, and that we’ll focus on the goals that you’ve come to work on”

I haven’t used the word ‘sexual’ in the above, and have used ‘personal comments’ & ‘attraction’ instead.  I prefer to use the client’s words/meanings. I would probably wait for the client to make clearer that the comments were of a sexual nature before constructing their communications as ‘sexual’. If their comments were very explicit, I would then of course be much readier to call them ‘sexual’. 

Comments

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[Alexander S. Isaac, M.D.]

My repsonse depends on tone, body language, and context. I try to use the "clarify and confront", and I usually say thank you if it is a polite compliment. I usually try to interpret it if they tolerate the redirect. I find that the interpretations, if they are even 30% accurate, are negatively reinforcing enough, and can even move things forward. Patients who rely on classically neurotic defenses warm up if some openly sexual talk is tolerated. Patients with externalizing or impulsive defenses are deflated by an interpretation that shifts the issue back to their work, marriage, personal conflicts

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Therapist may help, but the main ingredient in overcoming this situation is yourself.

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