Therapist±Patient Sexual Involvement: Risk Factors and Consequences Franz Moggi*, Jeannette Brodbeck and Hans-Peter Hirsbrunner Psychiatric Services, University of Berne, Switzerland The purpose of the present study was to examine factors that put patients at risk for sexual abuse in psychotherapy and to assess the psychological consequences of therapist±patient sexual involvement. To date, there is a lack of controlled research based on larger samples for both of these controversial issues. In this survey, female patients sexually abused by their psychotherapists (n  57) did not differ from female patients reporting no sexual abuse (n  43), in almost all of the risk factors. However, sexually abused patients had poorer treatment outcomes ( p < 0.05) and almost all reported negative consequences of therapist±patient sexual involvement. In the regression analyses, only sexual abuse but no risk factor could account for the group differences in the treatment outcomes ( p < 0.01). Emphasizing therapists' charac- teristics, future studies need to examine factors of the therapist±patient relationship that increase risk for sexual abuse. Copyright # 2000 John Wiley & Sons, Ltd. INTRODUCTION Civil and criminal statutes, and the ethics' codes of various professional associations and licensure boards prohibit therapist±patient sexual involve- ment, which is considered as sexual abuse. Jehu (1994) defined sexual abuse in psychotherapy as `sexual humour, suggestive looks and remarks, kissing, nudity, fondling, oral sex and intercourse, and other sexual acts with patients. Touching and hugging are not generally regarded as abusive, although there are circumstances in which they are inappropriate and potentially harmful. Finally, sexual attraction and fantasies are commonly viewed as natural reactions which are not in themselves abusive, provided that they are not acted out with patients' (p. 4). Risk factors for sexual abuse is a controversial issue (Williams, 1992). Jehu (1994) has argued that the therapist is always fully responsible for the sexual abuse. From this perspective, research on risk factors has exclusively to be focused on thera- pists. Bates and Brodsky (1989) stated that the only risk factor for a female patient to be sexually abused is a male therapist. In contrast, some clinicians have proposed factors that render patients vulnerable to sexual abuse (e.g. Smith, 1984; Rutter, 1990), implying that patients' characteristics might con- tribute to therapist±patient sexual involvement. Pope and Bouhoutsos (1986) demonstrated that abusive therapists often use these characteristics in their argumentation to blame the victims (see also Jehu, 1994; Becker-Fischer and Fischer, 1996). The effects of therapist±patient sexual involvement have also been debated. In most studies, predomi- nantly harmful psychological consequences of therapist±patient sexual involvement has been Copyright # 2000 John Wiley & Sons, Ltd. Clinical Psychology and Psychotherapy Clin. Psychol. Psychother. 7, 54±60 (2000) *Correspondence to: Dr F. Moggi, Psychiatric Services, University of Berne, Bollingenstrasse 111, CH-3000 Berne 60, Switzerland. Tel: 41 (31) 930 9111. Fax: 41 (31) 930 9404. E-mail: moggi@puk.unibe.ch. Contract grant sponsor: Swiss National Science Foundation. Contract grant number: SNF 823B-050302.