Criminalization of Sexual Abuse in the Therapist–Patient Relationship: A Public Policy Proposal for Romania Based on European and International Legal Frameworks

This policy paper presents a comprehensive legal analysis and legislative proposal for the explicit criminalization of sexual acts committed by psychologists, psychotherapists, counselors, and psychiatrists against their patients or clients in Romania. The paper was developed in response to a significant normative gap in Romanian criminal law, brought into sharp public focus by two cases in early 2026: psychiatrist Cristian Andrei, investigated for rape and sexual assault after practicing psychotherapy for over two decades without a psychology license, and psychologist Ion Duvac, a member of the Ethics and Discipline Commission of the Romanian College of Psychologists, exposed by investigative journalists for requesting intimate photographs from patients during therapy sessions.

The analysis is structured around five pillars.

First, a comparative legislative map of all 27 EU member states demonstrates that Romania remains among the last EU countries without specific criminal provisions addressing sexual exploitation in the therapeutic relationship. Germany stands as the primary reference model, having explicitly criminalized this conduct since 1998 through §174c of the Criminal Code (StGB), which does not require proof of physical coercion — the exploitation of the therapeutic relationship itself constitutes the offense. The Netherlands (Art. 249 Sr), Sweden, France, Belgium, Denmark, and Finland have each adopted adapted legal solutions, while Romania, Ireland, Bulgaria, Estonia, Latvia, and Cyprus rely predominantly on disciplinary mechanisms.

Second, the paper provides a detailed examination of psychological vulnerability and vitiated consent in the therapeutic relationship, drawing on four decades of international research. The therapeutic relationship generates a structural vulnerability unparalleled in other professional contexts: the therapist possesses complete knowledge of the patient's emotional architecture — traumas, fears, attachment mechanisms, points of vulnerability — and has been professionally trained to influence cognitive and emotional processes. The paper introduces the concept of frame of reference (Rogers, 1951; Beck, 1976) and demonstrates how therapists who commit abuse systematically alter the patient's internal evaluative framework through boundary erosion (Simon, 1995; Gabbard & Lester, 1995), relational isolation (Herman, 1992), and guilt inversion (Festinger, 1957; Stark, 2007), rendering the patient incapable of recognizing the exploitation as it occurs. Research by Pope and Vetter (1991), conducted on a sample of 958 patients, found that 90% of patients sexually abused by therapists experienced severe negative effects, 11% required hospitalization, and 14% reported suicide attempts — even when the patient had ostensibly "consented." The paper argues that such consent, formed within a frame of reference professionally altered by the therapist, cannot be considered free and valid under criminal law.

Third, the proposal is grounded in European and international legal obligations. The European Court of Human Rights, in M.C. v. Bulgaria (2003), established that states have a positive obligation to criminalize all non-consensual sexual acts, including in the absence of physical resistance. The Istanbul Convention (ratified by Romania in 2016) requires that abuse of a recognized position of trust, authority, or influence be treated as an aggravating circumstance (Art. 46(d)). Additional obligations derive from CEDAW General Recommendations 19 and 35, CRPD Article 16, and EU Directive 2012/29/EU on victims' rights.

Fourth, the paper identifies the specific normative gap in Romanian law: Articles 218–219 of the Criminal Code condition criminal liability on proof of physical coercion or the victim's inability to defend themselves — conditions that are impossible to meet when manipulation is psychological, gradual, and exercised through professional instruments. Article 299 (abuse of office for sexual purposes) applies exclusively to public officials. Disciplinary sanctions under Law 213/2004 are insufficient and inapplicable when the perpetrator practices without a license.

Fifth, the paper presents concrete legislative drafts for simultaneous adoption. It proposes a new Article 219² in the Criminal Code, establishing that sexual acts committed by a therapist through exploitation of the care relationship, psychological dependency, or professional influence constitute a criminal offense punishable by 2 to 7 years imprisonment, without requiring proof of physical coercion. The patient's consent does not exclude criminal liability when the act was committed during the therapeutic relationship or within 2 years of its termination, if the perpetrator exploited psychological dependency, therapeutic transference, or structural vulnerability. Aggravating circumstances (3 to 10 years) include minor victims, victims with mental disorders or in crisis situations, perpetrators practicing without qualification, and multiple victims. As well, it proposes amendments to Law 213/2004, introducing a mandatory prohibition of sexual relations for 2 years post-therapy, mandatory reporting obligations to criminal authorities, and enhanced disciplinary sanctions including permanent license revocation.

The paper concludes with an evidentiary analysis demonstrating that the proposed new constitutive element - exploitation of the therapeutic relationship - can be proven through documentary, behavioral, and testimonial evidence that is typically more abundant and verifiable than traditional evidence of physical coercion: therapeutic files, electronic communications, audio recordings, forensic psychological expertise, witness statements, pattern evidence from multiple victims, and financial records.

Keywords: therapist-patient sexual abuse, criminalization, vitiated consent, psychological vulnerability, frame of reference, comparative criminal law, European Union, Romania, Istanbul Convention, ECHR, legislative reform

Citation: Radu (Turza), M.M. (2026). Criminalization and sanctioning of sexual/abusive relationships between psychologist/psychotherapist and patient/client: Public policy proposal — European and international legal foundations for amending Romania's national legislation. March 2026. Available at: https://www.madalinaradu.com

License: CC BY-NC

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