Gonsiorek, John C, ed, Breach of Trust: Sexual Exploitation by Health Care Professionals and Clergy, Thousand Oaks, CA: Sage Publications, 1995, 427 pp, $59.95 h, $26.95 p.
This book of 28 chapters by 31 authors traces its origin to the Second International Conference on Sexual Misconduct by Clergy, Psychotherapists and Health Care Professionals held in Minneapolis in October 1992 and attended by over 450 people. However, it is not simply the proceedings of that conference; considerable revisions were subsequently made to many of the papers by the authors. The editor claims that the material is current as of January 1994 and that seems to be true.
Clergy malfeasance has received abundant publicity. Sexual contact between mental health professionals and their patients needs to be spotlighted too. When a drug is found to have two percent of adverse effects, the Food and Drug Administration bans it. "If psychotherapy were a drug, the FDA would be required to ban it simply on the basis of the high prevalence of sexual exploitation by mental health professionals" (p 2).
A twelve-page chapter accurately reviews betrayal and collusion among the clergy. And a similar length chapter is devoted to psychotherapists who transgress sexual boundaries with patients. Not only clergy and counselors but also doctors caring for physical health violate boundaries all too often. A ten-page chapter summarizes the results of a 1990 survey. A questionnaire mailed to 10,000 physicians had 1891 respondents among whom ten percent of the males and four percent of the females acknowledged sexual contact with one or more patients. Another indication of its prevalence is that "23% of the respondents had encountered patients who had been sexually involved with other physicians" (p 27). Among other suggestions, the authors recommend that medical schools should better address the need for training in boundary maintenance.
After 40 pages of historical and factual background, there are 90 pages on the victims of professional abuse, then nearly 100 on the perpetrators and, finally, about 60 on responses to the problems. Several chapters consist of personal stories of sexual abuse by professionals. A few chapters are accounts by therapists who have treated victims. Since all the essays in this book began as oral presentations, they are not burdened with numerous references within the text itself as articles written for scholarly journals tend to be. However, they are well informed as well as very readable. Instead of a separate list of references with each chapter, there is one combined reference list, 14 pages long, at the end of the book.
Several contributions are specifically about the clergy: on clergy who abuse; on assessments for their rehabilitation; on how Churches respond to the victims and to the offenders; and on preventing clerical misconduct. Readers of this book might find the above essays especially interesting but the entire work pleased this reviewer. The content is rich, the style is engaging. Some chapters are of an overarching nature, eg, "A Systems Perspective on Sexual Exploitation of Clients by Professional Helpers." Some are rather narrow, eg, "Boundary Challenges When Both Therapist and Client are Gay Males." And some have a technical focus, eg, "Employer/Supervisor Liability and Risk Management."
In the epilogue, the editor notes that over the past 20 years there has been a broadening and deepening of genuine concern regarding these problems. Nevertheless, something is missing: prevention. "Prevention is not educating clients about their rights or about how to spot early stages of inappropriate conduct; although these are important. Prevention is having professional abuse never happen at all. In this regard, professional training programs have generally remained as they have always been: negligent. Prevention training is a rare exception, not the rule" (p 393). He goes on for several pages to discuss ways in which we might respond to the challenge of prevention. And there is in this book not only a chapter on "The Art of Advocacy" but also one on "Training for Prevention of Sexual Misconduct by Clergy." The latter is only eight pages long, but it shows that some progress towards genuine prevention is already being made in Churches. The author calls attention to videotape resources, pamphlets, training programs, workshops, and other preventive efforts. He concludes with a sentence that, in effect, supports the aims of ISTI: "What is needed now is for expertise to be shared across denominational, international, and faith barriers as well as for building a sense of professional solidarity in eradicating this pernicious and ancient abuse" (p 375).
This book is well edited and easy to read. The essays are by very competent people from various backgrounds, with various specialization. Reading them is perhaps even more satisfying than having listened to the presentations at the conference on which they are based. Most essays will interest the general reader as well as researchers and practitioners.
Other contributing authors: J Alex Acker, Elizabeth Barnhill, Mindy Bernowitz, Walter Bera, Nancy Biele, Estelle Disch, Marie M Fortune, Glen O Gabbard, Nanette K Gartrell, William H Goodson III, Donald Houts, Richard R Irons, Linda Mabus Jorgenson, Andrew W Kane, Hannah Lerman, Laurel Lewis, Bernard Lo, Ellen Thompson Luepker, Laura Lyn, Margo E Maris, Kevin McDonough, Jeanette Hofstee Milgrom, Nancy Milliken, Signe L Nestingen, Melissa Roberts-Henry, Peter Rutter, Gary R Schoener, Sue Thiemann, William L White, and Janet W Wohlberg.
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