Updated: Aug 30
By Devon Frye - Psychology Today - 30.08.2023 [USA] No one visits a doctor, dentist, or therapist—including a massage or physical therapist—expecting to be sexually assaulted. And when a credentialed professional crosses a line, especially one with a good reputation, there may be a reluctance to acknowledge what really happened.
High-profile cases involving disgraced professional predators, from coaches to team doctors, demonstrate the extent to which status and position can sometimes conceal predatory inclination. But there are ways to gauge the true intentions of the person behind the persona.
Credentials Create Credibility
Natasha Mulvihill addressed the issue of “professional” abusers in a piece aptly entitled “Professional Authority and Sexual Coercion.” [i] She began by recognizing that professionals enjoy a “position of esteem” within modern society. She also notes that when it comes to public trust, doctors and health professionals are high on the list.
But that doesn’t make them immune from misconduct. Mulvihill recognizes sexual violence and abuse by medical professionals towards patients as a serious breach of confidence and explores how professional authority can contribute to and conceal sexual coercion through the dynamic of dependency.
In Professionals We Trust
We tend to recognize professionals through accomplishments, education, and position. Mulvihill describes professionals as people who hold an occupation characterized by organization, such as those governed by an overseeing body or association, specialized knowledge (which often includes educational credentials), and a code of ethics. She recognizes that professionals tend to command public confidence and esteem, especially professionals who are responsible for young people, tasked with securing safety, or making sure justice is done.
In support of the public esteem of professionals, she cites a 2020 Index regarding the most trusted professions in Britain. When the general public was asked if they expected certain professionals to tell the truth, they noted doctors 95 percent of the time and nurses 93 percent, followed by teachers 85 percent and police 71 percent of the time.
Mulvihill notes that this confidence is of critical significance because of the personal disclosures individuals may make to such professionals, in addition to submitting to “physical and intimate examinations” which Mulvihill describes as “unthinkable in any other context.” Within this relationship, she recognizes that sexual violence and abuse would constitute a serious breach of trust.
Although Mulvihill recognizes there is no evidence that professionals offend disproportionately, their position of trust and status affords them a higher level of social power, which can make their offenses harder to identify and address.
Status Facilitates Sexual Coercion
Mulvihill describes how perpetrators can use status and opportunity to both abuse and conceal abuse, discussing how professional authority has the potential to be sexually coercive. She cites prior research presenting a model of “idealising transference” where a patient feels bonded through making disclosures, which can create a feeling of dependency.
She also notes that patient dependence can be prompted by perpetrators encouraging more frequent office visits than necessary, which can turn into a form of adult sexual grooming. Victims can become desensitized to intimate interactions and fail to recognize warning signs when boundaries become blurred through a process of normalization. In fact, Mulvihill notes that the process of establishing trust with a victim and his or her family can create a relationship that is socially, psychologically, emotionally, and even physically reinforcing.
Professional Situational Awareness
Within relationships of power imbalance, when we or our loved ones are in the position of client, patient, or other position of potential vulnerability, the key is to remain objective. Acknowledging that the vast majority of healthcare providers are caring, compassionate professionals, we nonetheless remain attuned to the red flags that might indicate we should proceed with caution—especially if faced with requests or suggestions that appear to test boundaries or are otherwise arguably unprofessional. Professional situational awareness gives us the power to receive the care that we need and protect ourselves and our loved ones. If you have been affected by any of the issues raised in this article, you can contact Dignity4Patients, whose helpline is open Monday to Thursday 10am to 4pm.