Dr. David Ley, PhD, CST-S, is a clinical psychologist in practice in Albuquerque, New Mexico. He earned his Bachelor's degree in Philosophy from Ole Miss, and his Master's and Doctoral degrees in clinical psychology from the University of New Mexico. Dr. Ley is licensed in New Mexico and North Carolina, and has provided clinical and consultative services in numerous other states. He is the Executive Director of New Mexico Solutions, a large outpatient mental health and substance abuse program in Albuquerque, NM. Dr. Ley also serves on the advisory board for the Sexual Health Alliance.
Dr. David Ley will be presenting at Sexual Health Alliance’s event, Ethics, Ethical Dilemmas, Decision Making, and Countertransference Online Sexceptional Weekend on June 1st and 2nd, 2024. He will be sharing information on how to make ethical decisions, learning from the mistakes of others, dealing with complaints, and sex therapy ethics in the modern world of social media. SHA’s Community Development Coordinator, Michelle Melville-Kashon, interviewed Dr. David Ley on sex therapy ethics and the unique situations sexuality professionals can be faced with. It was a great conversation and we hope you enjoy these highlights!
Learning from the mistakes of other therapists
Michelle: So what can people expect if they're going to attend our ethics event at Sexual Health Alliance?
Dr. Daivd Ley: You know, ethics trainings in general can be pretty boring and focus a lot on telling people, “hey, you know, don't have sex with a patient”. We're all aware that you're not supposed to have sex with patients, and yet it still happens. And I decided a long time ago that as I taught people about ethics, that it was more effective to come from a place of understanding how we end up in these situations and developing a process to make good decisions when we're in these complicated situations.
Part of my ethics training, and we'll be doing it during this during this weekend, is a section I called “There Go I: Lessons from the Ethical Missteps of Other Therapists”. And for gosh, 15 or almost 20 years now, I've had this really interesting opportunity to actually see ethics malpractice license complaint cases for therapists around the United States.
And so I have this 10,000 foot view, and I get to see some of the just wild circumstances that therapists end up in and then have to deal with. And so deidentified I present some of these examples because unfortunately, a lot of us in the helping professions, therapists and coaches and counselors, we're all a little voyeuristic. We all kind of like watching other people dealing with these really awful situations while we sit there and go, “Whew, it wasn't me”.
Good Intentions Can lead to Complicated Places
Dr. David Ley: But part of me doing that training is asking people to think, “Which one of these is you”? Which one of these ethical problems is one that you could see yourself accidentally ending up in? Because we all have hooks and like, you know, a strange one for a lot of female therapists, I would say I've never seen a male therapist end up in this situation. A strange one for female therapists is dogs. Now, what the hell did dogs have to do with therapeutic ethics? So I am not kidding. I have seen a therapist that had so-called therapy dogs that weren't actually therapy, dogs that were farting during therapy to the point that the patient got upset and filed a complaint.
I've seen other situations where patients had dogs and the patient was not well. And the therapist in a couple of different cases, different processes, ended up taking the dog from the patient to take care of it until the patient was well, but then the patient came back and wanted the dog back and the therapist says, “Well, but you're not well enough yet to take care of the dog”. And they keep the dog and eventually, a complaint gets filed. And in that situation, the therapist was trying to do good, and trying to, you know, be a dog lover and everything else. But as therapists, it's not your job to take the dog. And so well-intended stuff can oftentimes end up in these really complicated places.
And I like to put out these examples because again, there are lots of therapists, and no judgment, but there are lots of young therapists. And I was there, who say, Oh, I'm never going to end up in these situations. Oh yeah, I'm going to follow all the rules, black and white, crystal clear, no touching, stay away. But the reality of the work we do is not that simple.
Preparing yourself for ethical dilemmas through role-play
And so I want to help folks, number one, recognize in themselves and in their practice where risk might happen and then process and think through and practice how they would address it. And so that's the other thing we're going to be doing in this training that is unique is we're going to be asking people to do some role play in small groups and in large group thinking through and talking through and actually practicing.
Okay, so your patient comes into therapy and is not wearing underwear. You're the therapist and I'm the patient. And I just flashed you: tell me how you're going to respond. And I say that because exactly that situation happened to me. And I had to deal with it. So, yeah, I mean, to a degree, we want to make we want to make this fun. Well, and real world. Yes, we're going to be showing you the ethics codes in the standards because you need to know where they are. Because as you make a decision in these situations, you have to you have to you have to know what rules you're being held to, but you also have to recognize that you as a helping person in this situation, have to weigh the principles of do no harm, benefit the person you're working with, and protect your career and license and follow the rules. These four things, they're not all the same.
Michelle: Yeah, and I think what you had said earlier reminds me a lot of parenting. Like everybody thinks they're going to be a perfect parent, like until they have children. And then you're like, Oh, wait a second. And then you actually get put in these situations and you're like, Oh, yeah, right. The role-playing can be so helpful because there are tons of things I'm sure people haven't even thought about that could happen. And so getting in there and acting it out with somebody else in a safe space with other sexuality professionals can be so helpful.
Dr. David Ley: Absolutely. I mean, it’s the issue of, you know, therapists having sex with patients again. Yeah. I said, you know, we're all clear not to do it, but it keeps happening. My wife is a teacher. And, you know, we we keep seeing in the news, you know, high school teacher, female high school teachers getting arrested for having sex with teenage boys. And I asked my wife, I said, you know, what do they what do they teach you about in teaching about this issue? And she said, well, they tell you to have sex with students. And I'm like, and that's it. I said, Well, you know, do they teach you how to recognize these feelings in yourself? Do they teach you that it is normal for some of these feelings to maybe come up and how to then get support to deal with the feelings?
And she said, No, no, no. They just say, don't do it. Well, we all know how effective that is. So the same thing here, you know, the clinicians that I see that get in trouble for having sex with patients, by and large, they're not super bad people. But they've got other stuff going on in their lives and they're in a position where for one reason or another, some of their internal boundaries kind of get dropped and they don't notice. Part of the work I want to do with folks in this training is teach them how to notice when they're in these vulnerable places, because that's the time to ramp up your internal monitoring and and caution.
Michelle: Exactly. And people think, oh, it probably doesn't happen that often. But we just shared a statistic in one of our Sexual Health Alliance newsletters that I think it's up to 12% of therapists have slept with their patients. That's a lot.
Dr. David Ley: Yeah. So, you know, these are complicated numbers and that's largely kind of 12% over an entire career. It's different for males and females. Females are generally less likely to have sex with patients across their career. It's also different for younger therapists and older therapists, largely because, again, the length of time. So let me ask you, in addition to that number, what is the most common or the average number of years a therapist has been practicing who has sex with patients?
Michelle: Oh, gosh. I wonder if it's the younger therapists like one or two years?
Dr. David Ley: You would think. But most of us, as you know, when we get out of grad school, we're like, really paranoid, right? We're following the rules. Ten years. The modal most common number of years practicing as a therapist for a person, for a clinician, that has sex with a patient is ten years. And what we think that is, is that that's the point where they start feeling, oh, confident. And they're like, oh I know, I know when I was in grad school I was told this is wrong, but in this situation I think I can make it work.
I had one clinician that I saw where a female former patient came to him and wanted to have an intimate relationship with him. And he sat down with her and he went over the ethics code and standards and he said, See, look, this says, I'm not supposed to have sex with you because you could end up feeling taken advantage of or exploited. And she said, Well, I don't feel taken advantage of or exploited. And he said, Oh, great, then let's have sex. And then after the relationship didn't go very well, she turned around and filed a complaint. So it's a good example of, Oh, I can navigate this. No, you can't. And that overconfidence is probably the greatest risk.
Ethics in sexuality professions are unique
Michelle: I know at this event we're going to have a lot of sexuality professionals like sex therapists or future sex therapists, educators, counselors, and coaches. How do ethics differ a little bit between your typical mental health therapy and sex therapy?
Dr. David Ley: So, yeah, that's a good that's a really good question, Michelle, and it's complicated. First, there are different standards and ethics across different disciplines. So, you know, in New York, I believe it’s New York, you know, a psychologist or psychiatrist might be able to have sex with a former patient ten years after the end of therapy. But a social worker can never have sex with a former patient. Right. Sex therapists, our ethics get a little more complex and nuanced as we're obviously dealing with, you know, complex, intimate sexual issues. But, you know, if you're certified by AASECT you can't ever touch a patient. And however, if you're a somatic psychologist or somatic therapist, oftentimes they do touch, right?
If you're a pelvic floor practitioner. Right. You're touching patients. And all of these things get really kind of complicated. And then coaches, there actually are some ethical standards and guidelines for coaches, but they're not mandatory because coaches aren't certified or licensed. They now, if you get sued as a coach and you can, one of your best defenses is going to be I am following the overall guidelines, but because coaching is kind of voluntary and unlicensed and unregulated, a lot of coaches don't know the importance of following those guidelines and why in the end, it's going to serve you.
The last kind of case, I'll sort of throw out there this: this guy wanted to be non-monogamous and took his wife to a female coach that was working with them, helping the wife to, you know, to incorporate some alternative sexuality into their practice and into their marriage and be more open to the idea of sex outside the marriage, etc.. And then come to find out, the wife discovers that this coach they're working with used to be an escort and was an escort sex worker who worked with the husband previously. And the wife felt pretty betrayed right, because this was a relationship and a triangle and a dynamic that she didn't know anything about. Was the coach out of bounds there? I think so. But if you're a coach, you know, are you thinking through these kinds of issues and setting some internal boundaries for yourself in your practice to avoid maybe not even a lawsuit in that situation, but just harming people? These are some of the things that I want people to think about and, you know, this is one of those situations where just like sex education for kids, ethical practice needs to be 100 one-minute conversations and questions, not one 1,000-minute conversation.
Sexual Health Alliance Invites Radical Conversations
Michelle: For sure, 100%. And I think it's so great that we're doing this event and that we talk so much about ethics at Sexual Health Alliance. Because there are other sexuality coaching programs out there, and, you know, I'm sure they're great and have good content, but they might not talk about ethics the way that we do. We're very thorough about it at Sexual Health Alliance.
Dr. David Ley: Yeah, I mean, Sexual Health Alliance wants to invite and encourage radical conversations. Radical conversations that, you know, wrestle with: these are not black and white issues and we want to make healthy decisions for ourselves. We want to help our clients make healthy decisions for themselves. But we also want to embrace conversations that can be a little dangerous by not pretending this stuff is simple. This is gray zone stuff. And if you want to work in the gray zone, you've got to be prepared. They want to prepare you.
Michelle: Exactly. So who do you think should attend this event? Who is this event for?
Dr. David Ley: Anybody and everybody, I'll be honest. I mean, you know, obviously, future sex therapists, current sex therapists, future sex counselors, current sex counselors, sex coaches. But if your work, your life, your profession, involves kind of any sort of touching of sexuality, not sexual touch, maybe that would be a really interesting conversation and a different training “ethics for sex workers”. But if your profession is adjacent to sexuality issues, these are questions you need to think about.
Michelle: Yeah, definitely. Well, thank you so much for meeting with me today and talking about this topic. I'm really excited for this event. It's happening in June. For anybody watching this video, we're going to have a link below that has all of the details for this ethics event. It's a two day event, so it's going to be jam packed with lots of good things.
Dr. David Ley: And a lot of guests and we're bringing in we're bringing in, again, a lot of other folks with thoughtful, insightful ideas and new voices.
Michelle: Exactly. We have an amazing lineup of people coming to speak, and then the students always have such great feedback and input at these events, too, so it just makes it really fun.
Dr. David Ley: I agree. Looking forward to it.
Watch the interview with Dr. David Ley here:
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