Undertaking therapeutic work with StopSo clients is not conventional sex therapy. Some clients’ behaviour could be dangerous, both to the therapist or to the wider public. Here are some guidelines on how to work with them safely online:

1. 1. Sex therapists are, understandably, comfortable in talking about sex. But it might the prospect of having sexually explicit conversations with someone online or in a therapy room that turns a client on, and he or she may lack the understanding of how to behave, and thus may become flirtatious, making sexual innuendo, or even overtly becoming sexually aroused in order to tempt or alternatively shock the therapist into a response. Or you might have a client who has autistic traits, or who has a trauma history of sexual abuse and has internalised it as being ‘normal’ to be sexualised with strangers. A clear form of contracting with the client at the outset is essential, ensuring the client is made aware of the parameters in which you will be working/practising, and as the work progresses, identifying what is acceptable and unacceptable behaviour.

2. 2. So, a helpful question to ask ourselves is, “is anything sexual okay in the therapy room, both in words or deed?” People who cross the line into a forensic population usually have very distorted boundaries or a complete lack of boundaries in regard to other people around them. So, we need to think about the type of issue the client is being referred for, and to check out what triggers a client into thinking that is okay for them to cross the line. For example, a client who does not understand that when women look at him in the street and smile at him, this does not mean they want to have sex with him.

3. 3. In addition, such clients may have significant trauma histories and/or attachment difficulties and thus have never been taught what is an appropriate boundary to maintain. There is a wealth of literature that strongly indicates that most men and some women who cross the line and violate sexual boundaries with children and adults, do have distorted thinking styles, so making the assumption of knowing how the client may respond in certain situations is fallacious.

4. 4. Most of the clients we see will know that, for example, wanting to have sex with a child is wrong. But some may well believe that it isn’t harmful and may see children as ‘sexually knowing’ and ‘able to cope with sexual contact with an adult’, and that it is a mutually consensual love relationship. Such cases are not unusual where the client’s thinking style has become so distorted through looking at so many images of sexually abused and exploited children that they argue that the children looked happy as they were smiling, so they must have they liked it.

5. 5. Quite often the internet is involved in our StopSo cases. We need therefore to think about how clients may have boundary violated online and/or in chat rooms. The form of sex life they have with their computer, for example, using a webcam sex, may give some indications as to how the person may interact with the therapist online. And to remember that with significant online sexual activity, the computer per se may become a fetish, and cause arousal at the click of a mouse or a keyboard. If so, you will need to be open with them about the use of the media and that should any issues arise, such as the media itself being in some indirect way arousing, that you can address it collaboratively, but they are not to become sexual with you in any way. So essentially you are looking to ensure they do not start to offence-parallel within your sessions.

5. 6. As therapists, our role is to help the client to learn to recognise and reinforce appropriate sexual boundaries. Some clients cannot communicate without expressing sexualised behaviour. We therapists are there to encourage the client by compassionately challenging any distortions they may have about boundaries. Our role is not to collude with the client by ignoring it, because this will not help him or her and may reinforce or increase his or her risk to themselves or to others.

7. 7. What should we consider when working with StopSo clients face-to-face?

As therapists, think about what we need to know or to do to maintain our own safety and public safety when working with the client.

• What do you know about your client?
• What sort of issues are there for you to consider concerning their (alleged) offence, particularly stranger male or female inappropriate behaviour or accusation of sexual assault.?
• Are you okay to be alone with this particular client?
• Are you working alone in the building with this client?
• If you are working in a shared building, do other services know about the potential clients attending, for example children’s social services. Are waiting areas shared?
• Do you have a panic alarm installed or a means of accessing help quickly?
• Are therapists aware of the risks from the distorted thinking of some clients as they look into the presentation or dress of the therapist, for example showing bare flesh, cleavage, tight clothes (especially tight jeans for men) or very short skirts.

This dovetails with setting out our professional boundaries to some degree – think about how you are setting up your session and setting up clearly your expectations of how you expect the client to participate.

8. 8. What should we consider when working with StopSo clients online?

Many of our StopSo clients are individuals who compulsively view images of children being sexually abused and exploited. As Internet addiction may underpin some of this behaviour, we need to consider the effect of working with that person online. We also need to present ourselves as we would professionally in a therapy room.

• Being appropriately dressed as in item 7 above.
• What am I disclosing to the client about myself from my own background? Different practitioners have differing levels of personal self-disclosure. However, self-disclosure should be in the best interests of the client and not the practitioner.
• Not undertaking therapy from our bedroom, or if absolutely necessary, to disguise the bed with throws and cushions, or using the virtual backgrounds provided by the software.
• What message are you conveying to your client about your own sexuality by the photographs, paintings or ornaments they are seeing in the background? Remember clients can take screen shots.
• Be aware that some clients with a preoccupied attachment style can become preoccupied with their therapist.
• If you are speaking to a MAP (minor-attracted person), you should not have pictures of your children or grandchildren displayed.
• If you have pets in visual space, how will that be for a client turned on by sex with animals?
• And of the client – are they suitably dressed?
• Are they in an appropriate space? Are they in their bed as they talk to you? Do you know what is going on under the covers?
• Can they move from the bed to a chair and to sit up so that more of the body can be seen?
• What can I see of the client on zoom, teams or skype? Can I see what their hands are doing?
• What are they doing if they switch the video off?

9. 9. These thoughts and ideas are based on assessing the risk of working therapeutically with StopSo clients who have openly violated boundaries and may therefore have distorted thinking and values. Having said that, they should still be offered the same professionalism, compassion, respect and tolerance as we would any other client.

Dr Terri van Leeson & Dr Glyn Hudson Allez, 2020