Sex and human sexuality are sensitive subject. To deal effectively with any problem of human sexuality , one has to constantly evaluate its merits and demerits from social, scientific, moral, ethical and most importantly from the legal angle. Following are some of the guidelines for therapist to keep in mind while dealing with clients with sexual problems.
Taking informed and expressed consent is of utmost importance while managing any patient. Examining and / or treating a patient without consent would amount to assault and battery which is punishable under criminal law irrespective of absence of negligence or successful outcome of treatment. The consent should be free willed, informed, intelligent , specific and express. Person giving consent should be competent to do so, failing which, consent should be obtained from the lawful guardian of the patient (In cases of minor and/or mentally retarded).
Examination of a female client
Besides obtaining a valid consent, in case of female patient, the therapist should always have a female assistant present when examining a female patient This is important for the therapist in order to protect himself from a possible charge of indecent behaviour, molestation or even sexual offence like rape etc. being leveled against him . Mere presence of husband or any male companion of the female patient is not enough. A sex therapist, in particular, is most vulnerable and therefore should be most careful.
Use of surrogate partners
Use of surrogate Partners for sex therapy is questionable both ethically as well as legally. Sexual involvement of the therapist is universally accepted as unethical. There have been a number of cases where the therapists themselves, having acted as surrogates, have been punished for sexual molestation of their patients. It may also invite a criminal charge of adultery in some countries, including India. There are cases on record where the therapists have been charged with and convicted of rape.
Unlike some other countries, the socio-cultural set up in India is different. The laws governing sexual behaviour are neither liberal nor evolved as much as in some of the western countries. Besides, surrogacy is likened to prostitution by many. Even if one were to consider surrogate partner as a therapist, then the ethical code prevents a sexual relationship with a client. Moreover, there is every possibility of a disease being transmitted. Particularly the HIV infection, in view of sex with multiple partners by a surrogate person.
Therapist should have uppermost in mind the special values of intimacy and love that our culture teaches us to nurture.
It is the ethical responsibility of every sex therapist to maintain high standards of professional competence and integrity. Competence without integrity or integrity without competence is an unsatisfactory compromise of professionalism. It is most important to protect the public and the other professionals from persons who represent themselves as sex therapists who are in fact lacking in competence and integrity.
Competence in another primary discipline such as psychology, psychiatry or counselling is not equivalent to competence in sex therapy.
A sex therapist should possess adequate knowledge of the following:
- Sexual and reproductive anatomy and physiology.
- Developmental sexuality from a psycho-biological point of view.
- Marital, Family and Interpersonal Relationship and Socio-cultural factors in sexual values
- Physiological and medical factors that may influence sexual functions such as pregnancy, contraception and fertility, illness, disability, medications .
- Multi-model techniques and theory of sex therapy and psychotherapy.
- Pharmacology of the medications used to treat sexual dysfunctions particularly with respect to their adverse effects and interactions with the drugs being consumed for other ailments.
- Ethical issues in sex therapy and principles of evaluation and referral.
- Laws related to sexual behaviour.
POINTS TO BEAR IN MIND
- All forms of sex therapy which violate the local laws should be handled with care recommending oral sex as a part of therapy is violation of section 377 of the Indian penal code which deal with unnatural sexual offences.
- The Hippocratic oath forbids the physician to take advantage of the therapeutic context in order to engage in either homosexual or heterosexual relationship.
- It is a universal rule that whenever dealing with reproductive functions is involved, express consent of both the spouses should be obtained.
- Proof of competence is the ability to provide objective and responsible services to the clients.
- There does exist a potential liability under the laws of the land prohibiting consensual conduct such as prostitution, fornication, lewd and lascivious behaviour and adultery which might arise from therapeutic or non- therapeutic sex research activities.
- Sex between therapist and client is always unethical. No matter how therapeutic the rationale might appear, there is no justification for a therapist having sex with a client. The purpose of sex therapy is to improve function, not to change values or beliefs of the client.