St. Paul Fire & Marine Ins. Co. v. Love

• Decision Date: 31 August 1990
• Docket Number: No. C7-89-1268,C7-89-1268
• Citation: 459 N.W.2d 698
• Parties: ST. PAUL FIRE & MARINE INSURANCE COMPANY, Petitioner, Appellant v. Ronald W. LOVE, Defendant, Mary Anderson, et al., Respondents.
• Court: Minnesota Supreme Court

Page 698

459 N.W.2d 698

ST. PAUL FIRE & MARINE INSURANCE COMPANY, Petitioner Appellant v. Ronald W. LOVE, Defendant Mary Anderson, et al., Respondents.

No. C7-89-1268.

Supreme Court of Minnesota.

Aug. 31, 1990.

Syllabus by the Court

When a sexual relationship arises within a therapeutic alliance pervaded by the psychological phenomenon of transference, the patient's claim is within the coverage of the therapist's policy as resulting from professional services provided or withheld.

Kay Nord Hunt, Philip A. Cole, Lommen, Nelson, Cole & Stageberg, Minneapolis, for appellant.

Robert J. Hajek, Warchol, Berndt & Hajek, Minneapolis, for respondents.

Heard, considered, and decided by the court en banc.

SIMONETT, Justice.

This case asks whether sexual conduct between a licensed psychologist and his patient, under circumstances where transference has occurred, may give rise to a claim by the patient which is covered under the therapist's professional liability policy. We hold that it may and affirm the court of appeals.

Defendant Ronald Love is a licensed psychologist practicing in the areas of marital therapy and behavior modification. In December 1985 Dr. Love began counseling Mary Anderson for marital difficulties and also for problems relating to being sexually abused as a child. In March 1986, Dr. Love began counseling the patient's husband, Robert, as well.

According to Dr. Love, sometime after Mary began counseling, she began asking him personal questions and became flirtatious, telling the doctor that she thought of him all the time. Mary stated, "I felt that he liked me, so I felt that I had to be sexual." In late May or early June 1986, sexual contacts began between them. Thereafter, for about 2 months, the couple engaged in sexual intimacies at the Counseling Center, at an apartment to which the doctor had access, at a park, in a car, and at the Anderson home. Eventually, on June 20, 1986, they were discovered by Mary's husband in the apartment. Dr. Love and Mary stopped seeing each other in late July 1986, although they continued to talk on the telephone for 3 more weeks.

Dr. Love says he did not consider their relationship to be that of therapist and patient and that he so told Mary. He claims that subsequent meetings between them at the office were on a nonprofessional basis; and, indeed, after the first intimacy Dr. Love stopped billing the Andersons for their sessions. Mary, however, testified she believed the patient-therapist relationship was continuing, even when they met outside the office. Dr. Love had only one therapy session with Robert after the sexual contact with Mary began. Dr. Love admitted his sexual relationship with Mary "[b]asically eliminated my effectiveness and helpfulness as possible ongoing therapy basis [sic]."

Mary and Robert commenced a lawsuit against their therapist alleging negligence, breach of contract, psychotherapy malpractice, and infliction of emotional distress. Dr. Love tendered defense of the lawsuit to his professional liability insurance carrier, St. Paul Fire & Marine Insurance Company. The policy reads, "We'll pay amounts you're legally required to pay for damages resulting from: * * * Professional services that you provided or should have provided."

The insurance company denied coverage on the ground the claims did not result from professional services, and commenced this declaratory judgment action to resolve the coverage issue. After depositions were taken, plaintiff St. Paul moved for summary judgment. In opposition to the motion, defendants also submitted the affidavit of a licensed psychologist who was of the opinion that the psychological phenomena known as transference and countertransference had occurred and that Dr. Love had mishandled the transference.

The trial court ruled there was no coverage for the claims of Mary and her husband and granted plaintiff St. Paul Fire & Marine summary judgment. The court of appeals reversed. St. Paul Fire & Marine Ins. Co. v. Love, 447 N.W.2d 5 (Minn.App.1989). We granted the petition of St. Paul Fire & Marine for further review.

The issue, then, is whether a claim for damages arising out of a patient's sexual relationship with her treating psychologist can ever be a claim for damages resulting from professional services provided or which should have been provided.

The starting point for our discussion is Smith v. St. Paul Fire & Marine Ins. Co., 353 N.W.2d 130 (Minn.1984). In that case, with similar policy language, we held that there was no coverage for claims against a medical doctor who took sexual liberties with three young boys whom he was treating for assorted medical problems. The boys were young, impressionable, quite sexually naive, and they thought, so they said, that the doctor's improper actions were somehow related to their medical treatment or examination. Id. at 133 (dissenting opinion). We held that the doctor's acts of sexual contact did not involve the providing or withholding of professional services. St. Paul argues that Smith governs, while the claimant patients contend this case is different. Mary argues her claim is based on Dr. Love's failure to provide proper professional services, i.e., his mishandling of the transference phenomenon, resulting in a sexual relationship harmful to Mary which aggravated her preexisting emotional disorder.

To better understand this case, we need to describe transference. This phenomenon is "[t]he process whereby the patient displaces on to the therapist feelings, attitudes and attributes which properly belong to a significant attachment figure of the past, usually a parent, and responds to the therapist accordingly." S. Waldron-Skinner, A Dictionary of Psychotherapy 364 (1986). Transference is common in psychotherapy. The patient, required to reveal her innermost feelings and thoughts to the therapist, develops an intense, intimate relationship with her therapist and often "falls in love" with him. The therapist must reject the patient's erotic overtures and explain to the patient the true origin of her feelings. A further phenomenon that may occur is countertransference, when the therapist transfers his own problems to the patient. When a therapist finds that he is becoming personally involved with the patient, he must discontinue treatment and refer the patient to another therapist. ¹

"The medical and legal communities uniformly agree that a psychiatrist's mishandling the transference phenomenon during treatment and taking sexual advantage of his patient is malpractice or gross negligence." Louisell & Williams, 2 Medical Malpractice p 17A.27, at 85-86 (and cases therein cited) (1989). Our inquiry here, however, is not whether Dr. Love may be liable to his patient but whether there is insurance coverage for the liability, if proven. ² St. Paul has limited its coverage to claims "resulting from [p]rofessional services provided or which should have been provided." ³

We must, therefore, look to the conduct which results in the patient's claim. If, in Mary's case, we look no further than the therapist's sexual acts (as the insurer argues), obviously there is no coverage, but we are then ignoring the professional treatment that preceded and accompanied the sexual conduct. On the other hand, if we look only at the treatment which should have been given and was not (as the patient proposes), we ignore the sexual acts. Either focus puts on blinders. In determining whether the patient's claim results from professional services provided or which should have been provided, we believe the focus must be on the therapist's entire conduct. The question then becomes whether the sexual aspect of that conduct is inextricably related to the professional services provided or withheld. If the linkage is absent or slight, the patient's claim cannot be said to result from professional services provided or withheld. On the other hand, if there is a substantial connection, the claim results from the professional services, and the sexual conduct is seen as a consequence of those services provided or withheld. In applying this test, the factors to be considered include the patient's health problem, the nature of the professional services involved, and how the sexual conduct arises within the context of the patient's problem and the prescribed treatment.

In Smith, for example, the patients' problems were, respectively, a heart condition, a groin injury, and a knee injury. The professional services involved consisted of the "medical treatment of a physical ailment by the insured [medical] doctor." Id., 353 N.W.2d at 132. Except in the remote sense that the doctor used his professional role and authority status as an occasion and pretext to take advantage of his patients, his sexual acts had absolutely nothing to do with either the patients' problems or the prescribed medical treatment. The doctor indulged in sex for personal reasons undiluted by any treatment considerations. Consequently, this court held that the damages from the sexual conduct did not result from treatment provided or withheld.

While Mary's case now before us also involves sexual exploitation, we think it differs greatly from Smith. Here the patient has an emotional and sexual problem and the professional services were to treat that very problem. The harm for which the patient claims damages, moreover, was related to the problem for which treatment was sought and provided. Ordinarily, if a medical doctor, such as in Smith, engages in sexual conduct with the patient, the patient's physical injuries and condition are not made worse; despite the personal relationship, the medical doctor can still properly treat the physical condition. Here, however, the claim is that the therapist's sexual acts worsened the patient's condition for which treatment was sought. This suggests, we think, a "failure on the part of the insured doctor [therapist] to discover or treat an ailment that should have been...