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Chemistry in the Consulting Room Post 8

My motivation for giving this talk was the unbelievable number of tales I was hearing of professional sexual abuse, ranging from the mundane to the gross. From people who had been asked intimate questions about their sex lives at a first visit, without any warning, sandwiched between urination and respiratory complaints, to patients who had their breasts examined when they’d gone with tonsillitis, to others who had become sexually involved with their homeopath.

Our sexuality is a most private and vulnerable part of who we are. It deserves a special attitude. We do not in general socialize our sexuality; we do not discuss it over the kitchen sink – not really discuss it. Many people in Britain grow up not having talked about sex and never having heard their parents talk about sex, having heard it talked about only within the framework of smutty jokes or the cold, biological facts of mating from a biology teacher. Some people have never talked about sex. They may never have discussed “it” with a lover, husband or wife.

We have a fine tradition in the UK of intimacy; it is swept between the sheets, at night, with lights out and eyes shut. You don’t ask for anything, and you don’t complain. This is not the only sex we have in our country, but it makes up a significant proportion. Just imagine a patient who has never talked about sex, and let’s put him or her in a consulting room with one of us, and imagine how they will feel. Shocked? Distressed? Turned-on?

Lacking in confidence in us?

Patients do feel uneasy about being asked if they’ve had gonorrhea or syphilis, if they masturbate, how long they’d been doing it for, what their fantasies are, what their sexual preferences are, whether they’ve ever had or wanted to have a sexual relationship with someone of the same sex, and so on, when it isn’t put into a context, when it comes, apparently, out of the blue. I actually believe that people who do not experience it as an abuse are the ones with a problem. People are generally more sensitive now, more aware of their own personal and sexual boundaries. We must respect those boundaries.

We can sexually abuse our patients by touching them inappropriately:
by asking intimate questions about their sexuality inappropriately or stupidly or needlessly, without first putting our questions in a professional context.

by projecting our sexual values onto them.
by assuming or implying that they should be having sex if they are not; that is to say, if they have chosen celibacy.
by assuming or implying that they should be having sex with another person if they are not and if they have chosen to have an intimate relationship with themselves; i.e., have chosen masturbation.
by suggesting that they should be having sex with a person of the opposite sex if they are not; i.e., if they have chosen someone of the same sex.

by having sexual fantasies about them when they are in the consulting room (or out of it for that matter).
by ignoring or doubting or denying what they tell us, especially what they tell us about their own abuse.
by playing sex therapist, without telling them that is what we are doing, especially if we do not have the training to do so.
by becoming involved sexually.

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