The author examines the legal and professional sanctions against sex between therapist and patient. The relevant literature of criminal law suggests that charges of rape or related sexual offenses against psychotherapists who exploit their patients are a remote possibility. Although sexual activity between therapist and patient may form the basis of a malpractice claim, the existing case law is complicated, and the legal distinctions are not always consistent with good psychiatric practice. Professional associations lack the legal expertise and indemnification to act in these situations, but medical boards in some states have the power to revoke licenses. In the end, patients must depend on the decent moral character of their therapists.