By Joel A. Falco, Second Year Clinical

Introduction
In the wake of traumatic incidents of sexual violence, people frequently ask why. Faced with this perplexing question and this taboo topic, many people dismiss the offender as demonic or psychotic. Furthermore, people react with horror when the offender comes from the social service profession. Researchers report that between 1 and 12 percent of all professionals cross the boundary of therapist-client sexual abuse (Williams, 1992). However, the true number of therapists who abuse their clients is likely higher because this taboo topic is under-reported. When these news stories reach the public, most people conclude that the offending therapist was a monster. Yet, this conclusion belies the evidence and provides few solutions that help the therapist and the client to heal and to recover from their abusive patterns. By adding to the idea that the offender is evil, therapists distance themselves from their own vulnerability, leaving them unwilling to acknowledge the possibility that they, too, might enter an abusive pattern. By not acknowledging this possibility, therapists increase their underlying vulnerability. A new paradigm that promotes a useful explanation may equip therapists with ways to handle this problem in our field. A Model of Vulnerability (Trepper & Barrett, 1989) provides an effective framework within which to understand sexual violence.
A theory of vulnerability states that all human beings are vulnerable to being victims as well as to being offenders. These vulnerabilities emerge from a miasma of influences in social/political contexts, in familial contexts, and in individual contexts (see diagram). It is, therefore, imperative for all therapists to explore their personal vulnerabilities to this type of violence rather than to continue ignoring the problem. When therapists know their own vulnerabilities and seek consultation, supervision, or therapy when they feel out of control, sexual violence can be prevented in most cases. The unexplored factors of vulnerability can create situations of devaluation and powerlessness in the therapeutic relationship. Abuse can then occur when the therapist exploits the power and value differentials inherent in the relationship. This paper explores many of the possible vulnerability factors influencing the origin of therapist-client sexual abuse. Without vigilant introspection, the therapeutic dyad remains vulnerable to an unacknowledged taboo: therapist-client sexual violence.

Social/Political Contexts
The social/political context provides a cultural and social background for all individuals, providing a cultural milieu and an atmosphere that can create large-scale vulnerability. Because all are influenced by its implicit messages, therapists and clients maintain a level of vulnerability in this global context. The factors from this realm may become potent and under-
examined influences when they are discussed as stereotypical generalizations. When left unexamined these pervasive and pernicious factors may lead therapists down the path of sexual violence.
In American culture, taboo acts generate vast amounts of attention in the media. Themes of therapist-client relationships that bloom into romantic love are commonplace and, consequently, encourage sexual abuse. Similarly, American culture glorifies individualism to a point where lust for power has no bounds. A therapist, vulnerable to exploit this cultural standard in the power-infused, attachment-centered therapeutic relationship, may seek control and gain power without regard for their client's safety. Alternatively, cultural differences between client and therapist may create vulnerability because communication patterns contain culturally infused meanings. Without acknowledging these cultural vulnerabilities and social meanings that foster vulnerability, therapists and clients may find themselves involved in a relationship of sexual violence.
Through inadequate training and denial, the community of therapists further perpetuates vulnerability in the therapeutic dyad. The therapists are generally untrained in managing sexual feelings in therapeutic relationships (Pope et al.). This area is unfortunately a footnote in most courses in the field, even though some therapists will find themselves in relationships where they have sexual feelings for their clients and their clients have sexual feelings for them. Therapists who frequently deny these feelings because of the cultural taboo may become more vulnerable to act out their feelings with their clients. Compounding the problem of insufficient education, the profession requires each therapist to police him/herself with few external controls. The absence of external controls fosters the requisite isolation for a taboo act to occur.
Isolation also plays a major role for individuals with limited connections in personal or professional communities. These individuals experience vulnerability because they may gain value only in their therapeutic relationships. Because sexual attachment is an important human value, individuals may seek sexual relations within the therapeutic dyad as a means to gain value in their professional relationships. Isolation also keeps individuals from support networks, appropriate outlets, and information that might minimize this vulnerability factor. To combat isolation, therapists should maintain robust communities of personal and professional relationships. Therapists must, therefore, seek supervision, consultation, therapy, and outside relationships to maintain a vital and non-abusive lifestyle.
Gender as a vulnerability factor has received the most attention. Individuals who hold gender roles that define females as submissive and males as dominant increase vulnerability in therapeutic dyads. Female clients working with male therapists accentuate the inherent power differential, creating a potent vulnerability. In addition, males are vulnerable to offending behavior because they are socialized to equate sex with attachment and females are vulnerable to being victims because they are socialized to equate intimacy with attachment (Trepper & Barrett, 1989). This gender socialization increases vulnerability in female clients because therapy is an intimate relationship and in male therapists because attachment is imperative in therapy; thus, combining vulnerabilities to create a highly vulnerable relationship.
In addition, males are vulnerable to offending behaviors for various other reasons. Themes of conquest in male roles increase their vulnerability to offend (Jenkins, 1990). Men are also socialized to abdicate social-emotional responsibility to women and to restrain emotional expression, minimizing their ability to attach to others (Jenkins, 1990). Sexual feelings, then, become one of the few ways for men to attach. With these confused attachment issues and overdrawn power issues, men become highly vulnerable to sexual violence within the intimate bonds of the therapeutic dyad. In addition, men often perceive a woman's behavior as sexually motivated (Pope, Sonne, & Holroyd, 1993). This male perception may increase the vulnerability in male-female dyads because the man will equate therapeutic intimacy with sexual desire. Overall, therefore, gender differences create a high degree of vulnerability to therapist-client sexual violence.
A therapist's sexual orientation may also affect his or her vulnerability to therapeutic abuse. Homosexual therapists may become over-involved with homosexual clients because of the minority groupÕs strong communal bond. This enmeshment in an intimate relationship like the 'herapeutic dyad increases vulnerability to sexual violence because power differentials are ignored and attachment issues are highlighted. Therapists, then, become too close to their clients to evaluate the relationship objectively. Enmeshed relationships are not limited to sexual orientation, but homosexuality can increase vulnerability because of the strong communal sense of the gay community. In addition, homosexuality may create vulnerability because the mainstream culture rejects their lifestyle, thereby devaluing homosexual individuals. Being oppressed creates power differentials that can be exploited in therapeutic dyads. Homosexuals, however, are not the only people with increased vulnerability from sexual orientation factors. Biased heterosexuals may sexualize the relationship by focusing too narrowly on sexuality (Pope et al, 1993). Consequently, their focus on sexuality may create an atmosphere where the therapeutic bond and the therapeutic attachment is sexually defined. Therapists must, therefore, be aware of and challenge their biases about sexual orientation or they may be vulnerable to sexual violence.
Oppression in sexual orientation is similar to power differentials in socioeconomic class, in age, and in race. Therapists from a higher socioeconomic class, a higher age category, or the majority race create a context intensifying the client's feelings of powerlessness (Pope et al, 1993). The therapist may feel entitled to all that the client has to offer, including sex, because of his/her status. This lack of power creates a context where individuals may seek power through offending or through being victimized. Clients may seek a sexual relationship to decrease the fees for therapy or balance the power differential. In addition, race relations in America have become sex relations (Pope et al, 1993). Thus, biracial dyads create a context of sexual curiosity and intrigue, possibly leading to a sexualized therapeutic connection. Overall, the differential in socioeconomic class, in age, or in race can amplify the power differential in the relationship, creating a higher degree of vulnerability in the therapeutic dyad.
Lastly, religious factors, in addition to reinforcing gender roles, often require blind faith to the powerful one(s). This blind faith demands followers to obey powerful figures, amplifying the power of the therapist and increasing the dyad's vulnerability to sexual violence. Religious beliefs also influence attitudes toward sexuality, guiding our attachments and power through its rules (Pope et al. 1993). Religious beliefs often support destructive acts to uphold alleged higher causes and, therefore, increase the vulnerability of potential abusers.
The social/political context, therefore, creates a web of influences that can make a therapist or a client vulnerable to sexual violence in the intimate bonds of therapy. This context is frequently overlooked because these factors influence many individuals who never cross the boundary of therapeutic sexual violence. Yet, the messages we receive from these pervasive ideas do influence our thoughts and behaviors. When these influences are unacknowledged, vulnerability increases drastically because it remains unexamined and unchallenged. As therapists, then, we must explore our vulnerability so we can overcome the factors that create a context ripe for therapist-client sexual abuse.

Familial Contexts
The familial contexts consist of the interpersonal relationships which may increase vulnerability through relational issues. In this case, the therapeutic dyad is the primary context. The factors within this context create personal and interpersonal vulnerability through their interaction. The typical hierarchy of a therapeutic dyad places the therapist above the client, creating a vulnerable power differential. The dominant therapist is vulnerable to control the client and the submissive client is vulnerable to seek power through sex (Jehu, 1994). Differentials in this context provide the immediate climate in which the abusive patterns emerge.
Beyond the hierarchical factors of the relationship, communication patterns can create increased vulnerability in the therapeutic dyad. Unclear communication patterns create confusion through undefined levels of meaning, complicating and compounding messages of power and of attachment. Beyond clarity, communication patterns that are defined by sexuality, like flirting, risk increased vulnerability (Jehu, 1994). Similarly, individuals who disclose sexual fantasies in sessions are vulnerable because they sexualize the relational context. Beyond the content of the communication, therapists who excessively self-disclose create a vulnerable relational structure by becoming the clients' peer or by allowing the clients to become their peer (Pope & Bouhoutsos, 1986). These factors influence the relational context which, in turn, can increase vulnerability. Communication patterns, therefore, can lead to
factors that increase vulnerability to therapeutic sexual violence.
Similar to the communication patterns, certain relational styles create vulnerability in therapeutic alliances. The most common styles of therapeutic relationships are affectionate and erotic. Affectionate styles are vulnerable because they amplify basic therapeutic relational goals, a caring, loving, emotional relationship. Magnifying these factors, a therapist and a client can become enmeshed, blurring the therapeutic bonds and crossing the boundaries into sexual violence. Erotic relational styles also create increased vulnerability by sexualizing the dyad, often because the issues are sexually stimulating (sexual abuse, incest, erotic transference, etc.). Sexual abuse is more likely to occur within these relationship styles than in more professional and ethical styles.
Within all relationships, rules and roles contribute to the familial vulnerability to sexual violence. In therapy, the rule of confidentiality, however necessary, increases the dyad's vulnerability because it may be used as or may be perceived as secrecy. Transforming confidentiality into secrecy through one member's perceptions, the dyad operates like an incestuous family. Taboo behavior can only be maintained through secrecy because social constraints can only intervene in an absence of secrecy. Roles of relationships work like rules because they govern behaviors and color perceptions. The relational roles most often played out in the therapeutic dyad are the therapist as savior and the client as victim. These roles can amplify the inherent power differential within the dyad. Thus, all clients are vulnerable to victimization because of the dependent nature of their role. In addition, clients often idealize their therapist, which further can magnify the power differential (Jehu, 1994). Without constant vigilance about the vulnerability inherent in the rules and in the roles of the therapeutic alliance, therapists allow the vulnerability to sexual violence to remain unchecked.
Within the relationship, therapists need to maintain a balance between boundaries and adaptability to limit their vulnerability to taboo behaviors like sexual abuse. Therapists must clearly delineate the therapeutic boundaries or they may, wittingly or unwittingly, use their power to victimize their clients. Therapists who maintain limited or blurred boundaries, even seeing their clients in other contexts, increase their vulnerability. Ultimately, therapists are responsible to maintain clear and ethical boundaries in an overt manner to decrease their vulnerability. Alternatively, therapists cannot maintain a stance of rigidity in the therapeutic bond without creating vulnerability. A lack of adaptability increases vulnerability by inequitably sharing power because rigid relationships do not adapt to situational factors. Individuals with limited adaptability have increased vulnerability to sexual violence because they perceive the world in extremes, which allows them to build excessive attachments, including ones which are sexual. Consequently, therapists need to balance therapeutic boundaries with a healthy adaptability to limit their vulnerability to sexual abuse.
Transgenerational patterns impact vulnerability, especially for therapists who because of emotional or sexual abuse in their own families of origin often become impulsive affection seekers (Trepper & Barrett, 1989). Clients who have had similar experiences in their families of origin are more vulnerable because they may expect sex with the therapist, believing perhaps that objections would not be respected. Therapists who had poor primary relationships with their caregivers have increased vulnerability because they did not learn appropriate ways to share power (Trepper & Barrett, 1989). Female therapists who were sexually involved with educators, supervisors, or therapists are more vulnerable to offend (Jehu, 1994). Frequently individuals with transgenerational patterns continue the abuse through a Victim Survivor Cycle, in which individuals continually recreate the system of abuse in their relationships. Consequently, individuals who carry these patterns into the present increase their vulnerability to therapist-client sexual abuse.

Individual Context
Characteristics within the individual may foster a context in which sexual violence is more likely to occur. Within the individual context, sexual dysfunction may cause one to seek sexual gratification within the intimate bonds of the therapeutic dyad. Therapists who suffer from personal distress are at increased vulnerability to offend because they need attachments to regain their power (Jehu, 1994). Individuals with mental illness generate vulnerability, especially clients with Antisocial Personality Disorder or Borderline Personality Disorder (Jehu, 1994). Clients with these diagnoses lack morality and exhibit impulsive behaviors, creating vulnerability. These individual characteristics, therefore, may leave both clients and therapists ultimately more vulnerable to a sexually abusive experience within the dyad.
Either individual in the therapeutic dyad at one extreme of the dissociation continuum increases the vulnerability of that context. A disinterested individual may inadvertently encourage the other person to strive harder to gain attention, even to the extreme of sexual behaviors. At the other end of the continuum, people with Dissociative Identity Disorder are vulnerable to the other person's reality. The person dissociating has no way to make a competent decision about the situation. Dissociation from sexual advances creates vulnerability directly through unawareness and indirectly through silent 'acceptance' (Jehu, 1994). When in a dissociative state, the individual may not able be to attend closely to signs of sexual violence.
Dysfunctional coping mechanisms (self-medication, denial, intellectualization, cognitive distortions, minimization, etc.) also increase an individual's vulnerability. Clients who have been victimized in the past often exhibit learned helplessness by externalizing power (Jehu, 1994). By recognizing only external forces, individuals believe they cannot control themselves or others. Externalized power can only be gained by clients from others, possibly through victimization. A highly developed rationalization schemata allows a therapist to 'devise' sex as beneficial for the client.
Therapists frequently have difficulty admitting fallibility; consequently, they often do not have adequate support systems within which to process such powerful emotions as intimacy and sexual attraction (Pope & Bouhoutsos, 1986). People who cannot admit their faults may abuse their power to remain in control. Grandiose therapists may feel entitled to use unorthodox methods, even sexual ones (Jehu, 1994). In addition, a lack of education about the intimacy of the therapeutic relationship in training and educational programs does not prepare therapists for these inevitable feelings. Then, therapists may infuse meaning into the feelings, allowing them to act on their (or their client's) 'unusual' feelings of affection and love. Therapists must exhibit professional ethics in all their clinical interactions to limit this vulnerability factor's potency.
Individuals with impulse control problems, especially individuals with Borderline Personality Disorder, become vulnerable by making boundaries illusory. Therapeutic dyads create deep emotion that can lead to abuse by impulsive individuals because they externalize power and, therefore, create vulnerability.
Individuals with addictions also create vulnerable contexts within the therapeutic dyad because power and control are externalized for addicts. Addictions create vulnerability because the addict does not control all of his/her actions; some or many of the person's behaviors are motivated by the addiction. Addicts often behave without regard for morals or others' safety, leading to vulnerable narcissistic actions. People with sexual addictions are vulnerable to abuse because they tend to sexualize situations and people.

Recommendations
The numerous vulnerability factors of therapist-client sexual abuse create a web of influences difficult to counteract. This abuse can be prevented by a dually pronged awareness approach focusing on both therapists and clients. Each professional school should train all students to manage sexual feelings effectively. Professional associations and agencies should also train professionals about these issues while providing opportunities to explore their own vulnerability and seek resiliency.
Professionals should provide all clients with written information and a verbal summary describing important concepts about therapist-client abuse and ways to prevent it. This information may contain a checklist of warning signs, but should contain a plan for managing abusive situations and a list of supportive resources. With these precautions, therapists can minimize the potential for abuse within therapeutic relationships. All professionals must take responsibility for educating themselves as well as their clients to limit the vulnerability to therapist-client sexual abuse. All therapeutic dyads are infused with some vulnerability to sexual abuse; therefore, we have a professional mandate to acknowledge this vulnerability through awareness. If we fail, this unacknowledged taboo will damage our profession and hamper our work to reduce the incidence as well as the harmful effects of violence.