Did His Doctor Love Him to Death?

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The psychiatrist concedes that her treatment of Lozano was "somewhat unconventional" but says she turned to it only after routine therapy failed and after Lozano suggested that he found the notion of a loving, nonabusive mother comforting. Role-playing mother and son, she says, was a useful method of calming his behavior and helping him confront traumatic childhood memories. As for the flash card mentioning "phenomenal sex," the psychiatrist says it was a statement dictated by Lozano referring to his relationship with a girlfriend. She admits the sexual fantasies are her own dreams but says they were never meant to be shown to Lozano: he broke into her office and stole them, she contends. Far from cutting his life short, Bean-Bayog says she helped sustain him for four years. She believes his death was accidental.

Wherever the truth may rest, the Lozano case illustrates the tangle of emotions and desires that wind through many doctor-patient relationships. Surveys indicate that between 7% and 13% of healers within an array of specialties -- including psychologists, gynecologists, surgeons and family practitioners -- have had some erotic contact with their patients. Public outrage over such cases has led eight states to pass legislation in recent years making sexual abuse of patients a crime.

Medical organizations have been revising their ethical codes. Last year a Canadian task force recommended that doctors wait two years between treating a patient and becoming sexually involved. For psychotherapists, the prohibition is much stronger: intimacy with a former patient is never acceptable. While U.S. doctors are fairly unanimous in opposing sex with a current patient, they are divided over guidelines concerning former patients. In the view of the American Medical Association, a relationship with a former patient is unethical, no matter how much time has elapsed since treatment, if it exploits the "trust, knowledge, emotion or influence derived from the previous professional relationship."

The greatest potential for such exploitation arises in the field of mental health, because of the intimate and emotional nature of psychotherapy. According to one study, 86% of therapists acknowledge sometimes feeling attracted to their patients. Another study showed that half of psychologists have seen at least one patient who has been sexually intimate with a prior therapist. (In about 90% of those cases, a male therapist was involved with a female patient.)

On the other hand, mental-health professionals are supposedly better trained than other doctors to deal with the sexual feelings that arise during treatment. A patient's emotions toward the therapist are in fact a major tool in therapy. In a process known as transference, patients shift to the counselor the myriad feelings -- love, lust, anger, hate, admiration, envy -- that they harbor for significant people in their lives, including parents, siblings, lovers. By discussing those feelings in the safe shelter of a therapist's office, clients can confront troubling issues from their past.