SPECIAL SERIES: Bring sexual misconduct out of the shadows

Sexual misconduct by addiction counselors isn’t something treatment programs want to talk about. But it’s something they should be formally reporting to the clinician's professional credentialing authority, when there is an allegation involving a counselor's conduct with a patient. However, sources tell Addiction Professional, credentialing organizations are informed of these damaging incidents only one-third of the time, or less.

What many addiction treatment facilities do instead is hope to prevent any harms to their reputation by firing the counselor or, more often, letting him or her resign so they aren’t exposed to wrongful termination claims. This constitutes a violation of patients’ rights, according to counselor membership and credentialing bodies.

It’s also costly, because while sexual misconduct represents a fraction of the number of claims filed against addiction treatment programs, the cost of claims involving sexual misconduct runs high—sometimes more than $1 million. As long as sexual misconduct is allowed to proliferate, it will cost treatment programs substantially, both in insurance premiums and in patient settlements.

In any given year, member credentialing boards of the International Certification and Reciprocity Consortium (IC&RC) receive 300 to 500 sexual misconduct complaints, says IC&RC executive director Mary Jo Mather. “This is pitifully low,” she says. “I believe the figure should be triple that.”

Case examples

To illustrate the types of incidents that have occurred in treatment facilities, here are some of the cases that recently have been handled by Sean Conaboy, a sales executive with NSM Insurance Group in Philadelphia:

• A treatment facility client with programs in three states found that three of its male staff members all had sexual relations with a female patient who, it turned out, was HIV-positive. One of the men became infected. “All three guys have been fired, but so what?” says Conaboy. “This will be millions of dollars in legal fees and costs.” All three young men had worked the third shift in a residential program housing female patients. They claimed they were seduced.

• Misconduct that takes place between a counselor and a patient after the counselor is fired doesn’t get the treatment provider off the hook. In one of Conaboy's recent cases, the misconduct occurred toward the end of treatment and into early recovery. Even though the counselor was warned about his behavior and the treatment program tried to provide supervision and training, he violated the program’s well-defined policies and procedures by seeing the patient after he was fired. The patient’s attorney is suing both the counselor and the treatment program.

• An 18-year-old woman returned home from high-end treatment, and three weeks later discovered she had become pregnant after having sex with another patient. “Her parents probably paid $100,000 for her treatment, and what did they get? A girl who was not sober and was pregnant by a celebrity,” says Conaboy.

• Two female patients in an extended-care drug and alcohol treatment program both claim to have been sexually assaulted by a male patient, and didn’t file a police report at the time, but later filed a claim saying the facility failed to protect them and failed to conduct adequate screening of everyone they admitted to treatment. The facility had to pay nearly $500,000 to each woman to settle a lawsuit.

Importance of reporting

Reporting ethical violations is key—and may help facilities in a lawsuit as well. Typically, the treatment agency wants to get rid of the counselor, quietly.

“They don’t want to be charged with unlawful firing,” says Frances Patterson, who serves on the ethics committee of NAADAC, the Association for Addiction Professionals. “I’ve seen this over and over again: The director of the agency says, ‘If you resign, we’ll give you a letter of recommendation.’” The counselor then moves on to the next agency, and all that’s happened is the problem has been relocated. The problem is that no one is ever reported, says Patterson. NAADAC's code of ethics warns counselors to avoid dual relationships, and never to have a sexual relationship with a patient—even a former patient.

“The sad thing is that people don’t want to report,” says Patterson. “They don’t want the headache.” She says some counselors and supervisors have told her they were warned at their workplace that if they reported a sexual misconduct violation, they would be fired themselves.

“My response to that is, ‘Go ahead and fire me,” says Patterson, because then the employee would have grounds for a lawsuit. She does concede that this isn’t an easy position to be in—sometimes counselors are made so uncomfortable that they quit. “The people in power don’t want this reported,” Patterson says.

Kenneth Pope, PhD, who for many years chaired the American Psychological Association’s (APA's) ethics chapter, similarly found that only 10% of cases of sexual misconduct involving psychologists are ever reported. (Pope resigned from the APA in 2008 because he felt ethical standards were being loosened.)

Revocations and suspensions

IC&RC member boards, which oversee the process of awarding professional credentials to counselors, are required to have a code of ethics for every counseling professional credential they offer. The boards have ethics committees that receive and investigate complaints.

“If it’s a ‘he said, she said’ issue, the counselor is notified, and writes back what he thinks happened,” says Mather. Often an IC&RC ethics board will bring everyone together for a hearing. The result can be that the complaint is dismissed, or that the counselor loses his credential.

If it’s a gray area, there may be a reprimand, says Mather. “A gray area for me is the client who says, ‘This is what the counselor did to me,’ and the counselor says, ‘No, this is delusional; nothing happened,’” she says. “Then when you bring them together, they both stick with [their] story.”

In incidents of sexual misconduct, there usually are no witnesses, says Mather. If it can be proven, the counselor’s credential is revoked. “If we feel there was something that went on but can’t prove it, we might suspend the credential,” she says.

Recently IC&RC suspended the license of a counselor for five years due to sexual misconduct with a patient. In order to regain the credential, counselors are given a list of what they must do and document. “It might be treatment, it might be intense supervision, it might be 10 hours of training in boundaries,” says Mather. “Boards can apply any kind of conditions they want.”

In Illinois, the Illinois Certification Board (an IC&RC member) has had “four high-profile cases that ended with permanent revocation of the [counselor] certification,” says executive director Jessica Hayes. Over the past two years, there have been three cases resulting in voluntary surrender of the certification with no chance of reinstatement. There are about 6,000 addiction counselors overall who are credentialed by the Illinois board. “We follow a strict zero tolerance policy,” says Hayes.

An interesting shift has taken place in recent years, with more complaints lodged by male patients against female counselors than ever before. “It used to be always a male counselor and a female patient,” says IC&RC's Mather. The statistics aren’t surprising, since most counselors are women, she says.

Mather thinks treatment programs should be looking more at the issue of sexual misconduct, providing proactive training and supervision. “We know it exists; we know it happens,” she says.

IC&RC investigations involve many individuals, she says. One of the first steps is completing a complaint form, which includes a list of anyone else who is aware of the situation. “I have had to call CEOs of treatment facilities and tell them that I have this complaint that came from a patient or former patient,” says Mather. “Most are willing to assist, some will say the lawyers advised against providing any information, some will send the full-blown investigation that they have done internally.”

Mather adds, “We’ve had people give us things off Facebook, where you can see the counselor and client holding hands and kissing. There are cell phone records where they are talking about taking a vacation together. There’s more information out there than you might think.”

But boards can’t initiate investigations—the complaints have to come to them. “It’s not a witch hunt,” says Mather. “That’s why we have formal processes.”

Alison Knopf is a freelance writer based in New York.

Strategies to prevent misconduct

Those interviewed by Addiction Professional for this series say there are steps an addiction treatment facility can take, in addition to careful hiring and supervision, to seek to prevent sexual misconduct by counselors:

• Don’t put the newest, least-trained employees on the night shift, to work alone and unsupervised.

• Ideally, male counselors work on the male floor, and female counselors on the female floor. But that does not offer a complete solution, because same-gender sexual misconduct also exists, says Kathryn Benson, chair of the National Certification Commission for Addiction Professionals.

• Having ethics training also shows that a treatment program has taken this additional step to protect patients.

• Boundaries should be clearly outlined in the personnel handbook, and counselors should sign off on those.