Adverse Psychological Evaluations in Civil Suits Involving Sexual Misconduct by Professionals

Ralph Underwager, Ph.D.  and Hollida Wakefield, M.A.*

Psychologists are often asked to perform adverse psychological evaluations in cases of alleged sexual harassment, sexual contact by therapists with current or terminated clients, and sexual contact by clergy, teachers and other professionals.  Issues go be explored in such evaluations include the emotional status of the plaintiff, the probable causes of any emotional problems, the probability that the alleged event occurred as claimed, and whether the sexual misconduct fits the state's legal definition of actionable behavior.  Additional issues occur in cases involving children and when the plaintiff is claiming a recently recovered memory of repressed childhood abuse.

Civil suits against professionals have skyrocketed.  One law firm in Minneapolis is defending 75 suits against clergymen alone alleging sexual contact and seeking millions in damages.  One attorney, who has specialized as a plaintiffs attorney in actions against clergymen alleging sexual involvement, reportedly has over 300 such cases.

It is estimated the Roman Catholic Church has paid over $300,000,000 for actions involving sexual improprieties by priests.  The largest known court-ordered financial award for adult sexual abuse by a priest was $1,200,000 from the Colorado Episcopal Diocese (1).

A recent attempt to summarize the research evidence on therapist-client sexual involvement (2) concluded the frequency of sexual contact between a therapist and a client may have decreased in the last twelve years.  However, Schoener (3) observes that the evidence does not appear to support that conclusion.  The best stance now appears to be that there is no way of knowing the actual frequency of sexual contact between therapists and patients or former patients.  However, what is known is that sexual misconduct has been the leading cause of malpractice suits against psychologists since the mid-1970s (4).

A number of states have criminalized sexual involvement between therapists and patients and that number is likely to increase.  Psychologists and clergymen in Minnesota have been convicted and imprisoned.  Complaints against physicians in Minnesota went from about 500 in 1986-1987 to 1,399 in 1988-1989.  Health Board complaints went from 6 in 1974 to 1,500 in 1988 (5).

The stakes are high when there is an accusation of sexual involvement between a therapist and a patient or client. There is the nature of the institutions served by the professionals, the social contract between a society and its professional groups, that may be markedly altered both in reality and in perceptions.  There is the issue of the level of trust and confidence in a profession and its practitioners.  A society pays a price for a jaundiced view of its leading authority figures.  There are the individual emotional and personal costs to both victims and perpetrators of the sexual impropriety.  In addition, along with the increase in reports and civil suits, there goes an increase in false reports (5, 6). With the emergence of deep pockets in the insurance companies, the possibility of an accusation primarily aimed at getting money increases as well.

Professionals accused of sexual misconduct include psychologists, psychiatrists, clergy, social workers, teachers, and chemical dependency counselors.  Some child psychologists have been accused of sexually abusing child clients.  Surveys attempting to assess the extent of sexual involvement between professionals and patients indicate that a large number of professionals admit to sexual contact with their patients (7).  Psychologists have also been successfully sued for sexualized dual relationships with their students or supervisees (8).


Whereas in criminal cases, an adverse psychological evaluation is sometimes, but not usually, granted, in civil cases involving claims of emotional damage, such evaluations are almost always ordered.  Sometimes the attorneys agree to this without a court order but at other times a court order is necessary.  Frequently, the plaintiff's attorney will attempt to place limits on the evaluation in terms of time available, tests that can be given, and whether the evaluation is to be taped.  The attorney may ask to be present in the room during the evaluation.  The psychologist conducting the adverse evaluation should resist any limitations that interfere with the standards for an ethical and professional evaluation.  To permit another professional group to affect the inner workings of psychology's self-regulation so as to limit the psychologist's responsibility to do a thorough and adequate professional assessment is itself unethical behavior for the psychologist.  The Specialty Guidelines for the Delivery of Services by Clinical Psychologists contains these instructions in footnote 19 (9, p. 650):

Support for the independence of psychology as a profession is found in the following:

As a member of an autonomous profession, a psychologist rejects limitations upon his [or her] freedom of thought and action other than those imposed by his [or her] moral, legal and social responsibilities.  The Association is always prepared to provide appropriate assistance to any responsible member who becomes subjected to unreasonable limitations upon his [or her] opportunity to function as a practitioner, teacher, researcher, administrator, or consultant.  The Association is always prepared to cooperate with any responsible professional organization in opposing any unreasonable limitations on the professional functions of the members of that organization.

This insistence upon professional autonomy has been upheld over the years by the affirmative actions of the courts and other public and private bodies in support of the right of the psychologist — and other professionals — to pursue those functions for which he [or she] is trained and qualified to perform.

Organized psychology has the responsibility to define and develop its own profession, consistent with the general canons of science and with the public welfare.

Psychologists recognize that other professions and other groups will, from time to time, seek to define the roles and responsibilities of psychologists.  The APA opposes such developments' on the same principle that it is opposed to the psychological profession taking positions which would define the work and scope of responsibility of other duly recognized professions.

The psychologist must go into the evaluation with an open mind Pope (10) stresses that "each accusation and denial must be painstakingly evaluated on an individual basis" and states that "Psychologists serving as expert witnesses in court settings...or other deliberative bodies have an especially significant responsibility to ensure that they render a thoroughly honest, truly professional judgment."  Gonsiorek (11) notes that there has been a great change in consciousness about therapist sexual misconduct in the past decade and a half with the result that, contrasted with several years ago, false reports can now pay off.  Gonsiorek also stresses that assumptions cannot be made and that each case must be assessed on its merits.

At the beginning of the evaluation, the psychologist should make his or her role clear to the client.  The nature of the evaluation should be explained and the client asked to give informed, written consent to provide the results of the evaluation to the attorney for the defense and court.  Ordinarily, the report is provided to the attorney who retained the psychologist who then gives the report to the plaintiff's attorney.  The raw test data should be made available to the plaintiff's expert if requested.  However, we require that such data, including any computerized interpretations of tests, such as the MMPI-2 and the MCMI-II, not be shown directly to the client or used by anyone not qualified to interpret them.

Documents, such as medical, job, and school records should be requested and reviewed.  School records will often contain information about behavior problems, health, and referrals for counseling, in addition to grades.  This will help determine what problems may have predated the abuse incidents.  With adults, there sometimes will be an MMPI or other evaluation records prior to the date the abuse was said to have occurred.

Such records can provide extremely useful information in evaluating the claims.  In one repressed memory case against a school teacher, the young man maintained he began gaining weight in fifth grade, the year the alleged abuse took place.  He said that he changed from a happy, normal boy into a fat and unhappy child who was then scapegoated through school.  However his medical and school records had weights noted at different ages so his weight could be charted from early childhood through high school and his claim of a sudden weight gain in fifth grade disproved.

The psychological evaluation should include a diagnostic interview, a social/sexual history, and a battery of psychological tests, with emphasis on objective tests such as the Minnesota Multiphasic Personality Inventory-2, Millon Clinical Multiaxial Inventory-II, and the California Psychological Inventory.  We use the Shipley for intellectual screening, and if necessary perform a Wechsler Adult Intelligence Scale.  Depending upon the responses to the initial tests, we may add other tests.  The basic selection criterion for tests should be demonstrated validity and reliability.  Projective techniques such as the Rorschach (unless the Exner system is used), the House-Tree-Person, and the Thematic Apperception Test should be used only with the ethically required appropriate qualifications and limitations (12).

In the interview, attention should be given to details of the plaintiff's adjustment before, during, and after the sexual relationship with the defendant.  The plaintiff should be encouraged to describe specific symptoms or observable behaviors that underlie general complaints such as depression or anxiety.  Other events that occurred that might have contributed to the plaintiff's problems should be explored.

Although in some civil cases the major defense is that the abuse did not occur, in others, the abuse is admitted.  There may be acknowledgment of the abuse but dispute as to its intrusiveness and extent.  Therefore, in conducting an evaluation of the plaintiff, the following questions should be addressed:

1) What are the personality characteristics and current psychological functioning of the plaintiff?
2) What is the probable cause of any emotional problems?
3) What is the probability that the alleged event occurred as claimed?
4) What are alternative explanations for the statements being made by the plaintiff? This is possibly the most important element in the assessment.
5) (In recovered memory cases with adults) When did the plaintiff realize he or she had been sexually abused?  This goes to the statute of limitations.
6) Did the sexual misconduct between the plaintiff and the defendant meet the state's legal definition of actionable behavior?
7) What are the future treatment needs, if any, of the plaintiff?

Other considerations include: What is the defense strategy for the case?  Is the goal to reach settlement or to go to trial?  Reports may differ depending upon whether the goal is trial or settlement.  Some attorneys may not want a formal, written report.  Others may want only the relevant data and conclusions but not a long, detailed report that will give the plaintiff's attorney the opportunity to prepare a lengthy cross-examination.  Also, while the final test of truth or falsity is for the fact finder — judge, jury, licensure board — the clinician needs to have a personal opinion sufficient to base the decision to accept or reject the task~


In conducting an adverse psychological evaluation, an important question is whether the behavior of the defendant, even if it occurred as alleged, meets the state's legal requirements for actionable behavior.  The psychologist should know the applicable statutes for the state in which the lawsuit takes place.  Gonsiorek (11) observes that there is enormous variability in the statutes from state to state.  It is also important to learn from the attorney whether this is an issue of dispute.

In some cases, the statute of limitations may apply and the behavior is not actionable.  However, there has been increasing civil litigation involving claims of recovered memory of childhood sexual abuse (13-15).  In such cases, there are no memories for years because the abuse is said to have been completely "repressed" until, generally with a help of a therapist, it is then "recovered" (16, 17).  Because of this, many states have extended the statutory period of limitations in civil cases until several years after abuse is remembered and/or after it is understood there was damage done by the abuse (13, 14, 18-21).  Therapists and survivors' groups often encourage such litigation (22-24).  Although most of the claims are of abuse by parents, there are also lawsuits against professionals such as teachers and the clergy.

Whether a particular professional is liable depends on the state statutes.  Some professionals may be liable whereas others, engaging in similar behaviors, are not.  For example, in Minnesota, if the professional is a psychotherapist and the complainant a patient, a sexual relationship is prohibited.  If a member of the clergy engages in behavior that can be defined in any way as psychotherapy, the church and the clergy may be sued.  A sexual relationship with member of the clergy who is not in a counseling role cannot be used as the basis for a lawsuit.  In Minnesota there are dozens of ongoing cases involving the clergy.

Also, in some states, a therapist may be liable for sexual behavior with a former patient after treatment is terminated.  In Minnesota, the professional is criminally liable for sexual behavior that occurs within two years of termination of therapy if the former patient is "emotionally dependent" on the former psychotherapist, rendering the patient unable to consent, or if the contact occurs "by means of therapeutic deception" (25).  Minnesota Statutes 148A.01 subd. 2 defines emotionally dependent as follows:

"Emotionally dependent" means that the nature of the patient's or former patient's emotional condition and the nature of the treatment provided by the psychotherapist are such that the psychotherapist knows or has reason to believe that the patient or former patient is unable to withhold consent to sexual contact by the psychotherapist.

In 1986 Minnesota created a civil statutory cause of action against a psychotherapist, and current and past employers for sexual exploitation of patients and former patients.  As in the criminal statute, the violation with former clients who were treated within two years prior to the onset of the sexual contact exists if there has been therapeutic deception or emotional dependence.  Gartrell et al. (25) note that even before this statute passed, civil suits against therapists for sexual misconduct were common in Minnesota.

Cummings and Sobel (26) reviewed cases handled by the APA Insurance Trust and noted cases where treatment had been terminated, a sexual relationship started, and a malpractice suit was subsequently filed.  They observe that the courts have ruled that the emotional transference is still present even though therapy was terminated.

In a case involving a lawsuit against a chemical dependency counselor who began dating a former client a year after she completed treatment, this was a primary question addressed in the adverse psychological evaluation.  The records documented numerous incidents in which the plaintiff initiated contact, sought out the defendant, and controlled the relationship.  These events indicated that the plaintiff was unlikely to be emotionally dependent upon the defendant and that the defendant most likely perceived them as involved in an equal relationship and had no reason to believe that the plaintiff was unable to withhold consent to the sexual contact.  The jury accepted this defense and gave no monetary damages.


A direct causal relationship between the behaviors of the defendant and the plaintiff's current problems is difficult to establish.  It is unlikely that all of a plaintiff's emotional problems will have any single cause.  To claim a direct, specific and singular cause for anything human beings do goes far beyond any evidence in the science of psychology (27-30).  When psychologists attempt to meet the demands of the legal system and assert that the litigated cause of action is the sole cause of emotional damage to the plaintiff, this exceeds the competency of the science itself and leaves the psychologist vulnerable to serious impeachment.

No mental health professional can respond to this expectation with anything other than subjective opinion.  Psychologists who try to predict that sexual exploitation will result in long-term damage are likely to produce false positives.  The dilemma this creates is analogous to the prediction of violence.  Mental health professionals are notoriously poor at predicting violence, especially in the absence of a history of violence, and they consistently overpredict violence (31-34).

In sexual abuse, although some victims of childhood sexual abuse are reported to have a number of symptoms, including depression, anxiety, low self-esteem, distrust, social isolation, sexual dysfunction, eating disorders, and difficulties in close interpersonal relationships, these problems are not specific to a history of sexual abuse.  The behaviors frequently offered as behavioral indicators of sexual abuse are instead nonspecific stress responses which can be linked to any number of stressor experiences.  Beitchman, Zucker, Hood, daCosta, and Akman (35) conclude that, with the exception of sexualized behavior, the majority of short-term effects noted in the literature are problems that characterize child clinical samples in general. Two recent review articles on the long-term effects come to similar conclusions.  Beitchman, Zucker, Hood, daCosta, Akrnan, and Cassavia (36) and Pope and Hudson (37) report that empirical research has not established a relationship between disorders frequently claimed to be caused by sexual abuse (bulimia, multiple personality disorder, borderline personality).

Also, the type of abuse is important.  There appears to be more emotional harm if the perpetrator is a father or stepfather, if coercion, force, or violence are present, and if the abuse consists of more physically assaultive, intrusive acts (35, 36, 38, 39).

Family dysfunction must be considered.  Although few of the studies on the effects of abuse have controlled for family characteristics, those that have indicate that it is difficult to separate the effects of abuse from the effects of the accompanying family dysfunctions.  This is because both extrafamilial and intrafamilial sexual abuse are closely associated with families that are dysfunctional and pathological (35, 40-45). Since the problems observed in an adult who was sexually abused as a child may be a function of a pathological home environment rather than an effect of the sexual abuse, family characteristics must be carefully explored and considered.

In addition, it must not be assumed that sexual abuse will inevitably cause long-term psychological problems.  Not all victims of childhood abuse show later adjustment problems.  Finkelhor (39) reports, "Almost every study of the impact of sexual abuse has found a substantial group of victims with little or no symptomatology."  Parker and Parker (46) observe, "It is far from clear if the abusive experience itself plays a significant causal role in subsequent maladjustment."

Therapist-patient sexual contact is often compared to child sexual abuse, rape, and incest (10).  The literature on the effects of therapist-patient sexual contact reports a wide range of problems including inability to trust, hesitation about seeking further help from professionals, depression, suicide attempts, guilt, sexual confusion, suppressed rage, emotional liability, and cognitive dysfunction (47).  In fact, Pope (47) postulates a "Therapist-Patient Sex Syndrome."  However, as with child sexual abuse, this research suffers from a variety of problems.  Borys and Pope (48) note that there is much that is not known about the frequency, nature, and effects of patient abuse and discuss several validity issues in the research.

It cannot automatically be assumed that clients who have sexual contact with a therapist will have the above problems and it cannot be concluded that most, if not all, of their problems were caused by the sexual contact.  Schoener (49) notes that some clients who have been the victims of outrageous and unconscionable behavior by their therapists emerge with little damage whereas others suffer greatly as the result of much more innocuous behavior.  In evaluating plaintiffs he stresses focusing on the actual damages rather than the outrageousness of the therapist's alleged conduct.

Another factor to be considered is the the fact that many personality characteristics appear to have a high heritability (50, 51).  The University of Minnesota twin studies have produced powerful evidence that personality factors are strongly affected by genes.  This must be considered when forming conclusions concerning the cause of an individual's emotional problems.


The diagnosis of Post-traumatic Stress Disorder is often found in civil suits involving sexual misconduct.  The sexual misconduct is said to have caused the plaintiff a variety of significant problems.  The PTSD diagnosis sometimes is used to support the assertion that abuse that may be in dispute is, in fact, true.

According to the DSM-III-R, PTSD cannot be diagnosed in the absence of a verified traumatic event that is "outside the range of usual human experience ... (and) would be markedly distressing to almost anyone, and is usually experienced with intense fear, terror, and helplessness" (52).   Observed present behaviors on the part of the alleged victim cannot be used to reason backwards to prove that the claimed prior event actually occurred.  This is the logical error of affirming the consequence.  It has been identified as an unacceptable form of reasoning since Aristotle.

The Task Force Report of the American Psychiatric Association (53) maintains that a DSM-III-R diagnosis cannot be used to conclude that criminally actionable conduct has occurred.  They state that "In the absence of a scientific foundation for attributing a person's behavior or mental condition to a single past event, such testimony should be viewed as a misuse of psychiatric expertise."  Also, the basis for the diagnosis must include sufficient documented symptomatology to meet the requirements of DSM-III-R.

In addition, we have seen the diagnosis of PTSD given when the alleged abuse was admitted but consisted of gentle fondling over the clothing, or as the sequelae to what appeared to be a consensual relationship with a member of the clergy or a job supervisor.  This is not the type of traumatic event needed for a diagnosis of PTSD.


There is no dispute that there are professionals who have inappropriate, unethical, illegal, and/or actionable sexual relationships with parishioners, clients, and students.  Some of the behaviors are unconscionable.  Surveys indicate high enough prevalence rates for this to be a serious concern.  But some alleged behaviors are simply not probable.  It is important for the evaluator to be aware of the low base rates for behaviors that are sometimes alleged.  However, we often see highly improbable and uncorroborated behaviors accepted without question.  For example:


A third-grade teacher was alleged to have removed her clothes in the classroom and made the children touch her genitals, to have forced the children to eat spinach and to eat their vomit when they threw up, and to have locked the children in a storeroom.  This case was pursued even when the records indicated spinach was never served at that school, there was no such storeroom as described, and no one had ever observed anything unusual.

In a recovered memory case, a fifth-grade teacher was accused of taking a boy to a construction site, tying the boy up and making him perform oral sex.  When the boy vomited, the teacher became enraged and anally raped the boy and licked his private parts.  The teacher later abused the boy at school, in the class-room, sometimes in the presence of other children.
A woman accused a psychologist of raping her when she helped him return materials to his hotel room following the first day of a workshop.  She claimed that he used force and violence.  She described making a telephone call to her mother from his room, saying that she would be home late.  But when this call was shown to have been made on the next evening, she changed her story to add that she also attended the second day of the workshop, again came voluntarily to the psychologist's room, and was raped by him a second time.
There are often civil lawsuits following the criminal prosecutions in many of the highly publicized day care cases.  These cases often involve bizarre ritual abuse and the civil lawsuits are pursued even when the criminal cases are dismissed or end in acquittals.  When there are allegations of feces and urine, animal torture, and miscellaneous objects stuck into the genitals of children during the regular course of the day care routines, the allegations are highly unlikely to be true.


Therapists specializing in uncovering repressed abuse claim that large numbers of women have been sexually abused but that up to half of all incest survivors do not remember their abuse.  Therefore abuse survivors must be helped to retrieve their memories in order to recover.  The therapists generally use intrusive and unvalidated techniques such as leading questions, hypnosis, reading books, attending survivors' groups, age regression, dream analysis, and a variety of unorthodox procedures to uncover the memories (22, 54-58).  Although concepts such as repression, dissociation, traumatic amnesia, body memories, and multiple personality disorder are used to support their assumptions, there is no support in the scientific literature for the way these concepts are used (16, 17).

When there is litigation involving claims of recovered memory, a psychological evaluation of the plaintiff is essential.  In addition to what was discussed above, this evaluation must include an analysis of how the memory was recovered and all influences on the plaintiff such as therapy, books and television shows.  (See Coleman [59] for an example of this type of analysis in a recovered memory case involving civil litigation.)  The psychologist performing the adverse psychological evaluation needs detailed information about the individuals involved, the origin of the disclosure, and the nature of therapy (16, 60, 61).

Some professionals have proposed ways of evaluating claims of alleged sexual abuse based on recently recovered memories (16, 17, 61-63).  Since there is little empirical research in this area, these suggestions are based on existing knowledge about memory, social influence, suggestibility, conformity, the psychotherapy process, hypnosis, and the characteristics and behavior of actual sexual abusers.


Children can also be sexually exploited by professionals.  Bajt and Pope (64) report that 24 percent of the psychologists they surveyed were aware of instances of sexual contact between therapists and patients who were minors.  However, there are also false allegations in such cases and a careful evaluation of the child therefore is extremely important.  An adverse psychological evaluation of the child witness will most likely be granted in civil cases.

When the abuse is acknowledged, the focus of the evaluation is in assessing the damage.  The observations made previously about the effects of abuse are relevant and should be considered in the assessment.

The interview of the child should include information concerning the child's current life as well as the abuse incidents.  Parents should be interviewed about their perception of the child's problems.  Psychological testing, such as the WISC-R and the Bender, will provide information about the child's developmental level as well as give another opportunity to observe the child's behavior.  Parent inventories, such as the Personality Inventory for Children and the Louisville Behavior Checklist, give information both about the child and about the parents' perceptions of the child.  These latter tests can reflect a tendency to exaggerate problems.  If the parents are parties to the lawsuit and claiming damages, they can also be evaluated.

The child is likely to have been placed into therapy for the abuse.  The therapy notes are important in assessing the probable long-term damage.  Such notes are likely to contain the therapist's observations concerning the child's response to therapy and the parents' reports of problems.  In some cases, the therapy provided may appear ineffective or even iatrogenic.

When the defense is that the abuse never happened, the psychologist may be asked to assess the probable truthfulness of the allegations.  In such cases, the prior interviews may have been so leading and suggestive that the information obtained is simply not reliable.  A number of writers have examined memory development, cognitive and moral development of children, and suggestibility of children to adult social influence (65-72).  Some recent studies have provided dramatic demonstrations of the degree to which young children can be influenced by an interviewer (73-76).

Even when there are videotapes of prior interviews, a new interview can help sort out what may have actually happened.  Young children can provide useful information, but adults have to know how to get it from them (65, 67).  Although young children can provide accurate information, they recall less than do adults (69).  But the less information the child gives in free recall, the sooner the interviewer may start using leading questions, which can influence the child and distort the story.  Also, young children may perceive the interview task differently from adults and try to tell the interviewer what they believe the interviewer wants them to say (77, 78).  They may answer questions they do not understand and about which they have no information (79).

Therefore, the interviewer must attempt to tap into a child's accurate free recall by encouraging the child to tell in his or her own words what has happened. Several professionals have suggested guidelines for conducting an unbiased evaluation and noncontaminating interview (72, 80-87).  A promising procedure for interviewing children and analyzing the resulting interview is Criterion Based Content Analysis/Statement Validity Analysis (CBCA/SVA) (88-91).  All interviews of the child should be video- or audiotaped, since a tape is the only means whereby the procedures and information obtained during the interview can be accurately documented (72, 84, 92-95).

In assessing the case and writing the report, the procedures followed by the previous evaluators must be carefully examined to assess possible contamination (72, 96).  The influence of multiple interviews and leading questions is discussed by several researchers in the American Psychological Association book, Suggestibility of Children's Recollections (66).  Ceci and Bruck (65) stress examining carefully the conditions at the time of the initial disclosure and the process since then to which the child has been subjected.  Although the anatomical dolls are most frequently used, books, puppets, drawings, projective cards, play dough, games, and play therapy should be noted.  None of these are reliable or valid for assessing possible sexual abuse and their use may contaminate the statements children may make, especially if the interviewer encourages the child "to pretend" (95, 97-99).

A child's behavior in play therapy may be used to substantiate abuse or to support a claim of emotional damage and behavior problems resulting from the abuse.  Such therapy may focus on reenactments and talking about the alleged abuse.  Although there is no evidence that play therapy is an effective therapeutic procedure (72, 94, 99, 100), children are frequently given play therapy for sexual abuse even before there has been any legal determination that sexual abuse has occurred.  However, there is no support for the supposition that behaviors in play therapy can be used as signs to establish the truth of past events.  Campbell (101) notes that play therapy can influence children to accept the beliefs of the therapist and can be a contributing factor to false allegations.  Therefore, the case notes from therapy may provide extremely important information in assessing a claim of emotional damage from sexual abuse.

Important factors to consider in analyzing the progress of a case include the origin and timing of the original disclosure, the age of the child, the nature of the alleged abuse, and the characteristics of the child's statement (98, 99).


When there is a dispute concerning the behavior of the defendant, a psychological evaluation can be performed.  Such evaluations are not usually performed when the defendant admits the behavior.  An evaluation of a defendant who denies the accusations can provide information concerning the likelihood that he or she would engage in the behaviors alleged.  There is a regularity to persons and a link between personality and behavior.  A shy, introverted, individual is unlikely (unless under the influence of drugs or alcohol) to tell loud jokes and become the center of attention at a party.  This behavior would not be unusual in a histrionic, uninhibited extrovert.

Psychological evaluations are less helpful when the behaviors alleged are closer to normal, acceptable behavior.  But if the allegations are of more intrusive, deviant or sadistic behaviors, a psychological evaluation gives extremely useful information.  A psychologically normal individual is unlikely to violently assault a preschooler, force students to eat vomit, or rape a client during a therapy session.

Therefore the individual must be evaluated in light of the specific behaviors that are alleged.  When it cannot be demonstrated that an accused person has the level of pathology expected given the behaviors alleged, the likelihood of a false accusation increases.  However, the presence of psychological problems does not mean the abuse is real, since most people with psychological problems are not sexual abusers.

The psychological evaluation should include a diagnostic interview, a social/sexual history, and a battery of psychological tests, with emphasis on objective tests as is discussed above under conducting the adverse psychological evaluation.  Tests intended for sex offenders, such as the Multiphasic Sexual Inventory, should not be used for individuals who are denying abuse.

The one consistent finding from the literature on therapist-patient sexual involvement is that males are much more likely than females to have engaged in sexual relationships with their clients.  Gonsiorek (11) reports that the Walk-In Counseling Center finds that the most common pattern is for a male therapist to sexually exploit a female client (80 percent).  The next most common pattern is a female psychotherapist with a female client (13 percent), followed by a male psychotherapist with a male client (5 percent) and least frequent, a female psychotherapist with a male client (2 percent).

However, no differences have been found between specific fields, such as psychiatry, psychology, and social work nor does there appear to be a relationship between theoretical orientation and propensity to engage in sexual contact with clients.  No studies have supported the premise that therapists who become sexually involved with patients have less formal education or professional recognition (2).

Keith-Spiegel and Koocher (102) note that psychologists who sexualize relationships with clients tend to be impaired and troubled and that the stereotype of the sexually exploitive psychologist as dashing, debonair, and self-assured is not true.  Therapists who engage in sexual intimacies with clients have been found to have one or more personal problems, including vulnerability, fear of intimacy, crises in their own personal sex or love relationships, feelings of failure as professionals or as persons, high needs for love or affection or positive regard, poor impulse control, isolation from peer support, and depression.

The Walk-In Counseling Center in Minneapolis, which has handled 3500 cases where clients have alleged sexual exploitation by their psychotherapists, has found a great diversity in the types of therapists who sexually exploit their clients.  Although there are a few psychopathic types, these are in the minority.  Most are socially isolated, become overinvolved with work, and when they encounter a client who fits their psychopathology, countertransference and boundary erosion begins (11).  The types they have observed include uninformed therapists who lack professional training and knowledge about standards of care and professional boundaries; basically healthy or mildly neurotic therapists who behave inappropriately because of stresses in their lives, whose behavior is often limited to one client, and who feel genuine remorse; severely neurotic or socially isolated therapists with significant emotional problems who are vulnerable to eroding professionals boundaries; impulsive character disorders who have long-standing problems with behavior and impulse control and who have a long history of inappropriate and unprofessional behavior; sociopathic or narcissistic character disorders who are similar to the above but who are more deliberate and cunning in their sexual exploitation of clients; psychotic or borderline personalities who are characterized by poor social judgment, impaired reality testing, and disordered thinking (11).


The allegations are less likely to be true when there is no corroborating evidence and the allegations are of extremely deviant, low-probability behaviors.  This becomes even less likely when a psychological evaluation of the defendant indicates no pathology.

If the case involves "repression" until the memory is uncovered in therapy, the abuse is unlikely to be true.  If the recovered memory is for abuse that occurred at a very young age, it is extremely unlikely that the memory is for a real event.

If the accusations only emerge following reading The Courage to Heal (22), hypnosis, survivors' group participation, or dream analysis, the recovered memories are apt to be the result of therapy.  However, if the abuse has always been remembered but the individual is only now disclosing, it is more likely to be true, especially if the allegations are consistent with what is known about the behavior of actual abusers and the dynamics of actual abuse.

Although personality disorders or serious emotional problems may make individuals more susceptible to the influence of a therapist, this does not appear to be a necessary factor.  Therefore the presence or absence of a history of emotional problems in itself does not prove or disprove alleged abuse.  Also, any claims that the individual must have been abused because she has problems that are associated with being the victim of sexual misconduct must be viewed cautiously.  The existence of eating disorders, sexual dysfunction, anxiety, depression, or low self-esteem cannot be used to support the probability of abuse since these can all be caused by a variety of factors (36, 37).

When the abuse allegations progress across time to ever more intrusive, bizarre and improbable behaviors, the growth of the story is likely to represent the effect of therapy.  Also, allegations of ritual abuse by intergenerational satanic cults are extremely unlikely to be true.  Despite hundreds of investigations, no corroborating evidence for the existence of these cults has ever been found (105, 106).

Corroborating evidence obviously makes the allegations much more likely to be true.  Such evidence includes a childhood diary with unambiguous entries, photographs that support the plaintiff's accounts, letters documenting the relationship, or witnesses to the alleged events.  Ambiguous evidence, however, such as a childhood story or drawings now reinterpreted in light of the believed-in abuse, cannot be used as support that the abuse actually occurred.  Also, the defendant's denial of the alleged sexual misconduct can be supported by witnesses to events that contradict the allegations, letters, consultations about a difficult patient, and case notes.

A credible admission by the defendant makes the allegation more likely to be true.  However, the circumstances of the admission should be carefully evaluated.  We have seen cases of childhood sexual abuse where there are coerced confessions, where the defendant is hypnotized to help uncover memories of committing the abuse, or where the confession takes the form of "I don't remember doing anything but she wouldn't lie ... maybe I did it when I was asleep" (107).

If several clients who do not know each other and have not spoken to one another provide similar accounts about the same person this makes it more likely the allegations are true.  However, frequently in such cases the clients do know one another.  They may attend the same support or therapy group where they discuss the abuse.


Although the above suggestions may aid in sorting out what has happened, there are no easy answers.  The psychologist must begin the evaluation with an open mind and each case must be be assessed on its merits.  A psychological evaluation based upon sound scientific data and representing the highest standards of the profession can provide useful information that is legally relevant to the finder of fact.



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Ralph Underwager, Ph.D. and Hollida Wakefield, M.A. are licensed psychologists at the Institute for Psychological Therapies in Northfield, Minnesota.  They provide treatment to victims, families and perpetrators of child sexual abuse and have consulted or testified in cases of alleged sexual abuse in thirty-six states and several foreign countries.  They have presented workshops and seminars on the topic and are the authors of Accusations of Child Sexual Abuse (Hardcover)(Paperback), published by C.C. Thomas in 1988 and The Real World of Child Interrogations (Hardcover), published by C.C. Thomas in 1990.

* Correspondence should be addressed to Ralph Underwager, Institute for Psychological Therapies , 5263 130th Street East , Northfield, MN 55057-4880[Back]

Copyright 1993 American Journal of Forensic Psychology, Volume 11, Issue 4. The Journal is a publication of the American College of Forensic Psychology, P .0. Box 5870, Balboa Island. California 92662.

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