Utah has a “safety problem” when it comes to the state’s licensed mental health professionals, officials acknowledged in a recent legislative hearing — and lawmakers may soon debate whether steps should be taken in order to better protect patients.
Jeff Shumway, the director of Utah’s new Office of Professional Licensure Review, cited data that showed Utah ranks far above the median for the number of reports to a national data bank for licensed mental health workers.
The National Practitioner Data Bank is a confidential information clearinghouse created by Congress which tracks “adverse actions” — like the loss of a license — and medical malpractice payments for health care professionals.
In addition to the higher number of reports, Shumway noted to legislators, Utah sees those practitioners reoffend at a rate that is “very high” — 44.5% have another report to the database, compared to the nationwide median of 25%.
That puts Utah at fourth in the nation for the highest proportion of such repeat offenders, he said.
Among his office’s suggestions for how Utah can improve: Requiring mental health workers to give patients more safety information, such as how to look up a professional’s license status online, how to file a complaint with state licensers — and what is never appropriate care.
This year, The Salt Lake Tribune and ProPublica are investigating cases of Utah health care workers allegedly abusing their patients, and the obstacles those patients face to justice. Our investigation found that of the nearly 200 mental health professionals disciplined by licensers since 2012, more than a third had been punished for sexual misconduct. We identified at least five mental health workers who have been disciplined multiple times for sexual misconduct.
Our recent investigative report highlights experiences of several former patients who say their therapist sexually abused them. Some of the men we spoke with expressed feeling uncomfortable during therapy sessions, but said they did not understand at that moment that the way they were being touched may have been inappropriate.
[Read more: A Utah Therapist Built a Reputation for Helping Gay Latter-day Saints. These Men Say He Sexually Abused Them.]
We have created a guide to help others understand what physical boundaries experts say should exist between a therapist and a patient. It’s not intended to be medical or legal advice.
To be clear, victims are never to blame for sexual assault. And Utah law says that patients cannot consent to sexual contact in a medical setting if the touching is done under the guise of therapy or as part of a treatment plan.
Romantic relationships between a therapist and their patient are inappropriate
Utah licensers say that any sexual or romantic relationship between a patient and a mental health professional is considered inappropriate conduct, which could result in the therapist losing his or her license or being put on administrative probation.
State rules also say that a mental health professional cannot have a sexual relationship with a past patient within two years of when they were last treated.
Sexual touching is never acceptable during a therapy session
Sexual touching in a therapy session is considered unethical by all major mental health professional organizations. And two experts whom The Tribune consulted with about appropriate boundaries said there is never a legitimate reason for a therapist to touch their patients’ genitals.
“There is no conceivable reason,” Jacob Appel, director of ethics education in psychiatry at the Mount Sinai School of Medicine. “Even in a psychiatric emergency room, if that need ever arises, I will call a medical consultant to do that kind of work.”
Utah law says patients can’t consent to sexual acts with a health care professional if they believed the touching was part of a “medically or professionally appropriate diagnosis, counseling or treatment.”
Hugs and handshakes may be OK — if you’re comfortable
Hugging as part of a talk therapy session is more of a gray area. Appel said a hug is ethical if it’s initiated by the patient, and ideally takes place when someone else is in the room. He gave an example of an elderly woman he treated who asked for a goodbye hug at the end of their last session. He was comfortable with that type of touch, he said, because the woman’s daughter was also in the room.
Gary Schoener, a clinical psychologist in Minnesota who has consulted on professional boundary issues for 50 years, said embraces that go beyond a quick hug become problematic.
“If you ask therapists, do you ever touch your clients, you’ll get a subset who say, ‘Never.’ You’ll get a subset who say, ‘Sometimes,’” he said. “When you ask though about specific things like hugging — hugging is not actually easy to define. Is it a sideways arm around the shoulder? What parts of the body are touching? And where are the hands, and what are they doing? What is being said?”
[Help The Salt Lake Tribune and ProPublica investigate sexual assault in Utah health care settings. Tell us your story here.]
Any type of prolonged hugs are not appropriate, Schoener said. And Appel warned that any kind of regular physical contact with a therapist is crossing the line. He added that the therapist-patient relationship has an unequal power dynamic, which can make it difficult for a patient to voice concerns.
“The power dynamic is simply one-sided,” Appel said. “So patients may not feel comfortable saying to their doctor, ‘This is what makes me uncomfortable’. So the burden really exists on the provider to not even test the boundaries.”
What to do if you think your therapist has touched you inappropriately
Appel said that if you are a patient who feels like a touch in therapy was wrong or inappropriate, trust your instincts.
“It’s very unlikely it’s all in your head,” he said. “It’s very unlikely that you’re the only person who has been victimized in this way.”
Appel said patients don’t need to confront their therapist about perceived inappropriate touching, but he advises that they should let someone know — whether that’s a supervisor at a clinic or the state medical board. Patients in Utah also have the option of going to the police.
He added that a patient doesn’t need to explain to their therapist why they are stopping treatment if they are uncomfortable. You can make an excuse — like that you’re moving away — or simply tell your therapist that it’s not something you want to talk about, and that you’d like a referral for someone else.
If you aren’t sure where to start, you can speak with someone who is trained to help at National Sexual Assault Hotline at 800-656-HOPE (4673) or chat online at online.rainn.org.
To report a licensed professional in Utah, you can file out a complaint form online with the Division of Professional Licensing. If you live outside of Utah, you can find your local medical board here.
A licensing body may respond to a case more quickly than a police investigation. Their process protects patient privacy, and may ask for a single report to be filed. If licensers find misconduct has occurred, the division can revoke a therapist’s license or put them on administrative probation. Reporting to a state medical board does not initiate a criminal investigation, and licensers in Utah are not required to report alleged abuse to the police.
Reporting to local police can take more time, and the process may involve you being asked to reshare the events more than once. Your privacy cannot be guaranteed if the case goes to a trial. If a therapist is found guilty, they could be sent to jail or fined.
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