Amended December 3, 2014 State of Iowa v. Patrick Edouard ( 2014 )


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  •                IN THE SUPREME COURT OF IOWA
    No. 12–1899
    Filed July 18, 2014
    Amended December 3, 2014
    STATE OF IOWA,
    Appellee,
    vs.
    PATRICK EDOUARD,
    Appellant.
    On review from the Iowa Court of Appeals.
    Appeal from the Iowa District Court for Marion County, Paul R.
    Huscher, Judge.
    The State seeks further review of a decision by the court of appeals
    reversing a pastor’s convictions for sexual exploitation by a counselor or
    therapist under Iowa Code section 709.15 and remanding for a new trial.
    DECISION OF COURT OF APPEALS VACATED; DISTRICT COURT
    JUDGMENT AFFIRMED IN PART AND REVERSED IN PART; CASE
    REMANDED WITH INSTRUCTIONS.
    Gary D. Dickey Jr. and Angela L. Campbell of Dickey & Campbell
    Law Firm P.L.C., Des Moines, for appellant.
    Thomas J. Miller, Attorney General, Sheryl A. Soich, Scott K.
    Brown, and Laura M. Roan, Assistant Attorneys General, and Edward W.
    Bull, County Attorney, for appellee.
    2
    MANSFIELD, Justice.
    A pastor who had sexual relations with four women in his
    congregation was convicted of four counts of sexual exploitation by a
    counselor or therapist and one count of a pattern or practice to engage in
    sexual exploitation by a counselor or therapist.                    See Iowa Code
    § 709.15(2)(a), (c) (2013). 1      The pastor appealed, contending: (1) the
    district court failed to properly instruct the jury on the sexual
    exploitation statute; (2) the district court abused its discretion in
    excluding expert testimony concerning differences between pastoral care
    and pastoral counseling; (3) the evidence was insufficient to support the
    pastor’s convictions; (4) the district court erred in denying the pastor’s
    discovery request for one of the victim’s counseling records; (5) the
    sexual exploitation statute is unconstitutional as applied to the pastor;
    (6) the district court wrongly excluded certain fact evidence; and (7) the
    district court erred in the amount of restitution awarded against the
    pastor.
    On appeal, the court of appeals reversed and remanded for a new
    trial. It found that the jury instructions were improper and the district
    court had abused its discretion in excluding the proffered expert
    testimony. Upon further review, we respectfully disagree with the court
    of appeals and find no error on these points. We therefore vacate the
    court of appeals decision.
    We also reject the pastor’s remaining claims of error, with two
    exceptions.     We find the district court should have conducted an in
    1For the sake of convenience, we cite to the current version of Iowa Code section
    709.15 (2013). The general assembly made nonsubstantive changes to the relevant
    provisions of section 709.15 in 2013, which do not affect our analysis here. See 2013
    Iowa Acts ch. 90, § 230. Prior to those 2013 changes, the legislature had last amended
    section 709.15 in 2004. See Iowa Code § 709.15.
    3
    camera review of the counseling records. We therefore remand so this
    review may occur, along with further proceedings if necessary. We also
    reverse the restitution award and remand for further proceedings
    thereon.      In all other respects, we affirm the pastor’s convictions and
    sentence.
    I. Background Facts and Proceedings.
    We recite the facts in the manner most favorable to the jury
    verdicts. 2
    Patrick Edouard served as the pastor of the Covenant Reformed
    Church in Pella from 2003 to 2010. Witnesses testified that his sermons
    were “amazing,” “great,” and “dynamic.”                 He was a “very talented
    speaker.” “He definitely could preach the word of God.”
    V.B. and her husband were members of the church from the time
    Edouard arrived in 2003. In 2005, Edouard began making unsolicited
    calls to V.B. on her cellphone. V.B. was undergoing fertility treatments
    unsuccessfully and was struggling with her infertility. Edouard began
    asking questions about V.B.’s personal life, and she began to confide in
    him.
    V.B. and her husband decided to look at international adoption. A
    potential opportunity arose to adopt four siblings from abroad as a
    group.     V.B. was personally struggling with this adoption, and at the
    recommendation of her husband and her mother she decided to see
    Edouard. As V.B. related,
    I think it was in January or February of 2006, and we were
    getting ready to adopt the sibling group . . . , and I called
    2Three of the victims testified that the first time they had sexual relations with
    Edouard he forced them to do so. Because Edouard was acquitted of the sexual abuse
    charges, we will not include further discussion of that testimony herein.
    4
    him from my office and told him that I wanted to come see
    him.
    And he said, ‘Great. I’ve been encouraging you to do that, to
    come see me. You know I’ve told you you can talk to me
    anytime.’ And so he said, ‘Just come tonight. We can just
    meet here at my study.’
    When V.B. arrived at Edouard’s house, Edouard’s wife and family
    were present. Edouard told his wife, “We could be a while,” and he and
    V.B. headed down to the study in the basement. Edouard then locked
    the door to the study so, as he explained, the children would not
    interrupt them.     The study served as Edouard’s office, and had
    bookshelves, a desk, and two couches.
    Edouard asked V.B. how she was doing, and she explained she
    was really struggling with this adoption. “I wasn’t sure if it was what
    God wanted for me in my life,” she said. Edouard asked V.B. about her
    marriage and whether her husband was “meeting [her] needs.”            V.B.
    started to cry and said that things were difficult. At that point, Edouard
    made advances toward her and had sexual relations with her.
    Edouard continued to call V.B. on her cellphone thereafter.        He
    repeatedly told V.B. that her husband was not meeting her needs. He
    also told V.B. he was attracted to her.     They would talk two or three
    hours a day. V.B. would call Edouard, in addition to Edouard calling
    V.B. This lasted for months. Edouard also arranged liaisons with V.B.
    during the workday at hotel rooms and other buildings near V.B.’s office.
    Edouard would appear at V.B.’s workplace uninvited.
    Edouard insisted to V.B. that she did not really want to adopt, that
    she was doing it to please her husband.        He told V.B. that her real
    struggles resulted from her unhappiness in her marriage—“the sexual
    frustration.” V.B. testified, “His role was to protect me, because I had all
    5
    of this sexual energy that needed to be released, and he had to be there
    to protect me.”
    Edouard asked V.B. for money. As V.B. explained,
    he would make references to . . . it’s possible that . . . God
    brought us together so that . . . I can provide for him out of
    the excess of my abundance, what I had, I could in turn
    bless him with that.
    Edouard made it clear he did not want a loan, because he could get a
    loan elsewhere and did not want to be burdened with a repayment
    obligation. V.B. gave Edouard a total of $70,000.
    Eventually, after V.B. adopted a child, the relationship cooled. In
    approximately November 2009, V.B. called Edouard and told him she
    knew what he was doing, “that he’s trying to get women into counseling
    for the purpose of trying to have sexual contact with them.” Edouard
    panicked and tried to call or see V.B. at her office, but V.B. refused to
    have any communication with him for several months.          Their sexual
    relationship ended. V.B. did not report anything to the church elders or
    the police at the time, because she did not think she would be believed.
    S.K. and her husband were also active members of the Covenant
    Reformed Church when Edouard arrived in 2003. Four years later, when
    S.K.’s husband happened to be out of the country, Edouard began
    calling S.K. to check up on her.
    S.K.’s father was going through a severe illness at that time and
    later in 2007 passed away.         S.K.’s husband was depressed.       S.K.’s
    daughter was having problems in her marriage. S.K. was feeling down
    because of her father’s death and the troubles in her daughter’s
    marriage. S.K. also learned that her husband had had two affairs. In
    addition, S.K.’s best friend passed away.
    6
    Edouard called S.K. on her cellphone while S.K. was driving and
    wanted to know how she was doing. S.K. responded that she was not
    doing very well. S.K. started shaking; she pulled her car over. At this
    point Edouard made a comment to S.K. that “he would like it if we could
    be together under the cool, crisp sheets.” He added, “You know, if you
    ever need anybody to talk to, you know, call me. I’ll always be there for
    you.” S.K. was shocked by Edouard’s comment.
    However, some months later, in early 2008, S.K. called Edouard
    because she “just had absolutely nobody to talk to.”      Her relationship
    with her husband was rocky. Edouard sensed something was going on
    and said, “You can tell me . . . things, and I’ll listen.” S.K. asked him to
    come see her, because she wanted to discuss her problems in her
    marriage with him. At the meeting, she disclosed her husband’s affairs
    to Edouard. After about thirty minutes of conversation, Edouard asked
    S.K. if he could kiss her.     Thereafter, Edouard and S.K. had many
    meetings where they kissed. They began having sex.
    In the spring of 2008, Edouard took S.K. down to the study in the
    basement of his house. He locked the door, and S.K. thought they would
    talk. Instead, they had sex. Afterward Edouard told her:
    You will never tell anybody. The elders will never believe
    you. They will only believe me. I’ll make sure everybody
    knows you’re crazy. You’ll kill your husband . . . . You’ll
    destroy the church. You’ll hurt your family and you will hurt
    [my family].
    S.K. had sexual relations with Edouard a total of six to eight times.
    S.K. felt that Edouard “had power” over her.      “He made me feel like I
    depended on him,” she said.
    7
    Eventually Edouard terminated the relationship.      But he said to
    S.K., “Call me if you ever need me or need somebody to talk to, I’ll always
    be there for you night or day.”
    W.B. and her husband also belonged to Covenant Reformed
    Church when Edouard became the pastor in 2003.           W.B.’s father had
    been a pastor himself.
    In August 2007, W.B. attended a church service alone. Edouard
    approached her after the service and asked how she was doing. As the
    conversation progressed, W.B. felt Edouard was flirting with her. During
    the course of the week, Edouard called again. The discussion was again
    flirtatious. W.B. could not sleep or eat. She prayed.
    On the following Thursday, W.B. asked Edouard for a meeting.
    She intended to “let him down.” It was arranged for the meeting to occur
    in the office in Edouard’s home. Edouard assured W.B. it was fine to
    come to his home during an evening, as he “counsels women” in his
    home.
    When W.B. arrived, Edouard and his family were there. Edouard
    took W.B. down to the basement office and locked the door. Edouard
    asked W.B. very personal questions. Edouard posed “a lot of questions—
    very concerned about how I was doing, how my father is doing.” W.B.’s
    father had recently been diagnosed with Alzheimer’s. W.B. disclosed to
    Edouard that she had been sexually abused as a child. The conversation
    lasted a couple of hours. There was no sexual contact.
    Edouard and W.B. continued to meet. They had sexually charged
    conversations. Soon they began to have sex. Edouard told W.B. not to
    tell anyone because “nobody would understand this.        Even if you feel
    close to your husband some night, never tell him. Never think he’s going
    to understand this.” Edouard and W.B. engaged in sexual activity over a
    8
    period of years.    During the course of her sexual relationship with
    Edouard, W.B. went to marital counseling with her husband. Edouard
    asked W.B. to recite what she had been told at the marital counseling
    sessions and then indicated to W.B. whether or not to follow that advice.
    A.B. and her husband were also members of the church when
    Edouard was appointed pastor. In the spring of 2008, A.B. had a young
    child with special needs, her mother-in-law had passed away, and she
    had an overworked husband. As A.B. put it, “My plate was very full.”
    A.B. had seen a physician and had been prescribed an anti-depressant
    and anxiety medication, which she was taking.
    At that time, Edouard called A.B. and asked to set up a meeting.
    She recounted, “He just wanted to make sure that I was doing okay . . . .”
    Eventually a meeting was set for a school day in April in Edouard’s
    basement study. Edouard locked the door from the inside. They began
    with conversation. Edouard probed A.B. on whether she felt stressed.
    He asked her about her family issues. He asked A.B. whether she had
    had premarital sex. After a while, Edouard told A.B. that he was very
    fond of her and “would like to get to know [her] better.” Edouard added,
    “[S]omebody needs to take care of you. You have your hands full.” A.B.
    became uncomfortable. Her feet were trembling.
    The encounter ended because A.B. had to leave to pick up her son.
    But other conversations followed. Edouard told A.B., “I just want you to
    sit and tell me everything about you.” Edouard asked A.B. about her sex
    life, telling her she could trust him. He frequently asked whether A.B.
    had been sexually abused as a child.      As A.B. put it, “[T]he questions
    were getting deeper and [he was] getting to know me more and more, I
    guess knowing my vulnerabilities, . . . where the voids were in my life.”
    9
    Soon Edouard asked to meet A.B. at her home. After he arrived,
    he kissed her. Subsequently, Edouard and A.B. called each other many
    times a day. They kissed and made out. A.B. shared with Edouard that
    she longed for someone to take care of her. By May 2008 Edouard and
    A.B. were having sex. This continued at least once a week for the next
    two-and-a-half years.    Edouard advised A.B. that this was a “secret
    relationship, and we need to keep [it] a secret.”
    In May 2010, Edouard told A.B. he had something he needed to get
    off his chest. He disclosed to her that he had had sexual relationships in
    the past with V.B. and S.K.       V.B. is A.B.’s sister-in-law.    A.B. was
    “devastated and shocked.” She “had a very difficult time.” Yet Edouard
    and A.B. continued their sexual relationship.       According to A.B., “[H]e
    was just constantly always evaluating me.”
    In December 2010, A.B.’s husband arrived at home as Edouard
    and A.B. were having sexual relations. He saw Edouard’s vehicle and
    became suspicious. He spoke to his own brother (V.B.’s spouse) and the
    two of them put the stories together. Then A.B.’s husband went to the
    elders of the church.
    Edouard resigned immediately. He called S.K. and informed her he
    had resigned because he had been caught kissing the hand of another
    woman. He reminded her not to disclose their sexual relationship. He
    also called W.B. and told her he had resigned because two affairs had
    come to light. He told W.B., “If anybody says you’re one of them, just
    deny it. I will never tell anybody, and this will all blow over. I love you.”
    He made W.B. role-play and rehearse her denials.
    Edouard was charged with three counts of sexual abuse in the
    third degree in violation of Iowa Code section 709.4(1), four counts of
    sexual exploitation by a counselor or therapist in violation of section
    10
    709.15(2)(c), and one count of engaging in a pattern or practice of sexual
    exploitation by a counselor or therapist in violation of section
    709.15(2)(a).
    Following a change of venue, the case went to trial in Dallas
    County, commencing August 13, 2012. Each of the four victims testified.
    Edouard and his wife testified for the defense. Edouard acknowledged
    having sexual relations with all four women, but maintained that it was
    consensual. Edouard denied having provided mental health services to
    any of the women.
    The jury found Edouard not guilty on the three sexual abuse
    charges, but guilty on the five sexual exploitation charges.          He was
    sentenced to one year imprisonment on each of the Iowa Code section
    709.15(2)(c) counts, with the sentences to run consecutively.         He was
    sentenced to five years imprisonment on the section 709.15(2)(a) count,
    with the sentence to run concurrently with the section 709.15(2)(c)
    sentences. Edouard timely appealed.
    On appeal, Edouard argues: (1) the evidence was insufficient to
    prove that he provided mental health services to V.B., S.K., W.B., or A.B.;
    (2) the district court erred in denying his discovery request for W.B.’s
    counseling records; (3) the sexual exploitation statute is unconstitutional
    as applied to him; (4) the district court abused its discretion in excluding
    expert testimony relating to the differences between pastoral counseling
    and pastoral care; (5) the district court erred in excluding certain fact
    evidence; (6) the district court erred in omitting certain jury instructions;
    and (7) the district court erred in the computation of restitution.
    We transferred the case to the court of appeals, which reversed
    and remanded for a new trial. The court of appeals found the district
    court had failed to properly instruct the jury on the “mental health
    11
    services” element of the sexual exploitation counts and had wrongfully
    excluded Edouard’s proposed expert testimony.        The State applied for
    further review, and we granted the application.
    II. Standard of Review.
    “We review challenges to jury instructions for correction of errors
    at law.” State v. Frei, 
    831 N.W.2d 70
    , 73 (Iowa 2013). The related claim
    that the district court should have given a requested instruction is
    reviewed for abuse of discretion. Id.
    Constitutional challenges to the district court’s discovery rulings
    are reviewed de novo. State v. Thompson, 
    836 N.W.2d 470
    , 476 (Iowa
    2013); State v. Cashen, 
    789 N.W.2d 400
    , 405 (Iowa 2010), superseded by
    statute, 2011 Iowa Acts ch. 8 § 2. We likewise review de novo challenges
    to a statute’s constitutionality. Thompson, 836 N.W.2d at 483. Statutes
    are presumed to be constitutional. Id.
    The district court’s rulings on the admissibility of evidence are
    reviewed for abuse of discretion. State v. Huston, 
    825 N.W.2d 531
    , 536
    (Iowa 2013). Additionally, “[w]e review challenges to the sufficiency of the
    evidence for correction of errors at law.” State v. Neiderbach, 
    837 N.W.2d 180
    , 190 (Iowa 2013).       Finally, restitution orders are reviewed for
    correction of errors at law. State v. Hagen, 
    840 N.W.2d 140
    , 144 (Iowa
    2013).
    III. Analysis.
    We begin our consideration of Edouard’s appeal with the
    instructional and evidentiary issues that were the basis of the court of
    appeals’ reversal and remand.
    A. Jury Instructions. According to the Iowa Code:
    2. Sexual exploitation by a counselor or therapist
    occurs when any of the following are found:
    12
    ....
    (c) Any sexual conduct with a patient or client or
    former patient or client within one year of the termination of
    the provision of mental health services by the counselor or
    therapist for the purpose of arousing or satisfying the sexual
    desires of the counselor or therapist or the patient or client
    or former patient or client . . . .
    Iowa Code § 709.15(2)(c). Sexual exploitation by a counselor or therapist
    within the meaning of section 709.15(2)(c) is considered a serious
    misdemeanor. See id. § 709.15(4)(c). Additionally, it is a class “D” felony
    for a counselor or therapist to engage in a “pattern or practice or scheme
    of conduct” of sexual exploitation. See id. § 709.15(2)(a), (4)(a).
    The statute defines “counselor or therapist” as follows:
    “Counselor or therapist” means a physician, psychologist,
    nurse, professional counselor, social worker, marriage or
    family therapist, alcohol or drug counselor, member of the
    clergy, or any other person, whether or not licensed or
    registered by the state, who provides or purports to provide
    mental health services.
    Id. § 709.15(1)(a).
    Thus, Iowa law makes it a crime for anyone who provides “mental
    health services” to another person to engage in sexual conduct with that
    person while the mental health services are being provided or within one
    year thereafter. Id. § 709.15(1)(a), (2)(c). The law does not require the
    defendant to have any particular status.            Id. § 709.15(1)(a).   The
    defendant, for example, need not be a professional or a clergyperson. Id.
    All that is required is that the defendant (1) provided “mental health
    services” to a person and (2) engaged in sexual conduct with that person
    less than one year later. Id. § 709.15(1)(a), (2)(c).
    The statute in turn defines “mental health services” to mean “the
    treatment, assessment, or counseling of another person for a cognitive,
    13
    behavioral, emotional, mental, or social dysfunction, including an
    intrapersonal or interpersonal dysfunction.” Id. § 709.15(1)(d).
    We have considered and rejected vagueness and overbreadth
    challenges to this law in the past.          In State v. Allen, we affirmed the
    conviction of a hypnotherapist who engaged in sexual conduct with a
    patient, while rejecting a vagueness and overbreadth challenge to the
    statute. 
    565 N.W.2d 333
    , 337–38 (Iowa 1997). The defendant there had
    fondled the victim and attempted sexual intercourse with her during
    hypnotherapy sessions, which also involved the provision of alcoholic
    beverages and readings of Tarot cards. Id. at 335. We reasoned that the
    statute did not reach a substantial amount of protected conduct because
    “[a] person of ordinary intelligence could understand that the term
    ‘mental health services’ . . . does not encompass strictly personal
    relationships involving the informal exchange of advice” and would rarely
    if ever “apply to a marriage relationship.” Id. at 337–38.
    In State v. Gonzalez, we reversed the dismissal of a trial
    information charging a psychiatric nursing assistant with violating the
    statute.      
    718 N.W.2d 304
    , 305 (Iowa 2006).               According to the
    information, the defendant had inappropriately touched a female
    patient’s genital area. Id. Accepting the facts in the information as true,
    we found it sufficient to allege criminal conduct.         Id. at 308–09.     The
    defendant had provided “treatment” because he “performed nursing
    tasks    to   assist   in   providing   care   of   psychiatric   patients”   and
    “assessment” because he “performed nursing tasks to assist in
    monitoring psychiatric patients.” Id. at 308. In dicta we also quoted a
    definition of “counseling” from Webster’s dictionary, stating that the term
    means:
    14
    “a practice or professional service designed to guide an
    individual to a better understanding of his problems and
    potentialities by utilizing modern psychological principles
    and methods esp. in collecting case history data, using
    various techniques of the personal interview, and testing
    interests and aptitudes.”
    Id. at 308 (quoting Webster’s Third New Int’l Dictionary 518 (unabr. ed.
    2002)).   Our opinion, however, did not address whether the defendant
    had provided counseling.
    We also rejected vagueness and overbreadth challenges in
    Gonzalez. Regarding vagueness, we explained:
    Any person who renders “treatment, assessment, or
    counseling of another person for a cognitive, behavioral,
    emotional, mental, or social dysfunction, including an
    intrapersonal or interpersonal dysfunction” provides
    “ ‘[m]ental health service.’ ” Id. § 709.15(1)(d). There is no
    doubt the language of section 709.15 applies to the services
    Gonzalez is alleged to have provided to the female patient
    under the facts in the trial information and attached
    minutes. Therefore, we conclude Gonzalez’s vagueness claim
    is without merit.
    Id. at 310.   We then refused to find the statute overbroad because
    Gonzalez had not identified any protected conduct. Id.
    Edouard does not ask us to reexamine Allen or Gonzalez. He does
    not argue on appeal that the statute is void for vagueness or overbroad.
    Instead, we are asked to decide whether the district court’s sexual
    exploitation jury instructions were proper.
    Here, for each alleged victim, the district court instructed the jury
    as follows:
    The State must prove each of the following elements of
    Sexual Exploitation by a Counselor or Therapist as to
    [alleged victim]:
    1. On or about [relevant time period], the defendant engaged
    in sexual conduct with [alleged victim].
    15
    2. The defendant did so with the specific intent to arouse or
    satisfy the sexual desires of either the defendant or [alleged
    victim].
    3. The defendant was then a counselor or therapist.
    4. [Alleged victim] was then receiving mental health services
    from the defendant, or had received mental health services
    from the defendant within one year prior to the conduct.
    Additionally, the court instructed the jury that “a ‘counselor or therapist’
    includes a member of the clergy, or any other person, whether or not
    licensed or registered by the State, who provides or purports to provide
    mental health services.”
    Finally, in Instruction 25, the court provided the jury with the
    following definition of “mental health services”:
    As used in element number 4 of Instructions No. 18, 19, 20,
    and 21, ‘mental health services’ is the providing of
    treatment, assessment, or counseling to another person for a
    cognitive,   behavioral,   emotional,   mental    or  social
    dysfunction, including an intrapersonal or interpersonal
    dysfunction.     It does not include strictly personal
    relationships involving the informal exchange of advice, nor
    does it include the giving of general spiritual advice or
    guidance from a clergy member to congregants.              It
    contemplates a counseling relationship with the clergy
    member established for the purpose of addressing particular
    mental, intrapersonal or interpersonal dysfunctions.
    Thus, the jury was not only given the statutory definition of mental
    health services, see Iowa Code § 709.15(1)(d), the jury was also told—
    consistent with Allen—that mental health services do not involve
    informal advice.    Additionally, in Instruction 25, the district court
    excluded general spiritual advice or guidance from the definition of
    mental health services. And Instruction 25 required the State to prove a
    counseling relationship, not merely some counseling.
    In crafting this instruction, the district court went beyond the Iowa
    State Bar Association Criminal Jury Instruction, which simply restates
    16
    the statutory definition of mental health services.     See Iowa State Bar
    Ass’n, Iowa Crim. Jury Instruction 920.5 (2013). Essentially, the district
    court adopted a middle position between the parties.         The State had
    asked that only the ISBA instruction be given.         The defendant had
    requested the following additions to the ISBA instruction:
    Counseling means a practice or professional service designed
    to guide an individual to a better understanding of his or her
    problems and potentialities by utilizing modern psychological
    principles and methods especially in collecting case history
    data, using various techniques of personal interview, and
    testing interests and aptitudes.
    Mental health services does not mean mere spiritual advice
    or guidance provided by a member of the clergy. Nor does it
    encompass strictly personal relationships involving the
    informal exchange of advice.
    The district court, as can be seen, incorporated some of the defendant’s
    proposals (i.e., the second paragraph) but not all of them (i.e., the first
    paragraph).
    Edouard argues that his definition of counseling, drawn from
    certain language in Gonzalez, should have been included in the court’s
    jury instructions.   “[T]he court is required to give a party’s requested
    instruction so long as it states a correct rule of law having application to
    the facts of the case and when the concept is not otherwise embodied in
    other instructions.” State v. Becker, 
    818 N.W.2d 135
    , 141 (Iowa 2012)
    (internal quotation marks omitted). However, “the court is not required
    to give any particular form of an instruction; rather, the court must
    merely give instructions that fairly state the law as applied to the facts of
    the case.” Id. (internal quotation marks omitted).
    There is no dispute the district court provided the jury with Iowa
    Code section 709.15(1)(d)’s complete definition of “mental health
    services.” What the court did not do is go a step further. That is, the
    17
    district court did not tell the jury what the word “counseling,” as used in
    that statutory definition, meant.         “Counseling” is not defined in the
    statute. Edouard contends the jury should have been told counseling is
    limited to “modern psychological principles and methods especially in
    collecting case history data, using various techniques of personal
    interview, and testing interests and aptitudes.” 3            Edouard, in other
    words, wanted the jury to be told that in order for him to be convicted,
    any “counseling” he provided had to have been based upon a modern
    psychological approach.
    We have said:
    In criminal cases, the court is required to instruct the jury
    on the definition of the crime. Generally understood words
    of ordinary usage need not be defined; however, technical
    terms or legal terms of art must be explained.
    State v. Kellogg, 
    542 N.W.2d 514
    , 516 (Iowa 1996) (citation omitted).
    “Counseling” is certainly a word of ordinary usage. Thus, it did not need
    to be specially defined for the jury unless the legislature meant to use it
    in a technical way in section 709.15 or viewed it as a “legal term of art.”
    We do not believe the legislature had such a view of “counseling.”
    “[S]tatutes must be read in their entirety.” State v. DeSimone, 
    839 N.W.2d 660
    , 666 (Iowa 2013).           Read as a whole, Iowa Code section
    709.15 does not appear to use the term “counseling” in a technical or
    specialized way. To the contrary, the statute expressly covers members
    of the clergy. See Iowa Code § 709.15(1)(a). These individuals typically
    do not perform psychotherapy or use “modern psychological principles
    3In his brief, Edouard concedes this is not the only dictionary definition of
    “counseling.”
    18
    and methods especially in collecting case history data, using various
    techniques of personal interview, and testing interests and aptitudes.”
    Additionally, the statute by its terms does not require that the
    defendant be “licensed or registered by the state,” and it covers even
    persons who merely “purport[] to provide mental health services.”         Id.
    This again suggests that the legislature did not intend a strict definition
    of counseling limited to modern psychological principles and methods, so
    long as the individual was addressing “a cognitive, behavioral, emotional,
    mental, or social dysfunction, including an intrapersonal or interpersonal
    dysfunction.” See id. § 709.15(1)(d).
    Furthermore, we do not believe our prior section 709.15 caselaw
    supports Edouard’s requested jury instruction. In Allen we affirmed the
    conviction of a hypnotherapist who plied his victim with alcohol and
    Tarot cards. See 565 N.W.2d at 335. While we excluded mere informal
    advice from the coverage of the statute, we did not say that the use of
    “modern psychological principles and methods” was required. See id. at
    337. To the contrary, the defendant there was a charlatan who used (or
    purported to use) some of the oldest methods in the book—hypnotism,
    adult beverages, and fortune telling. See id. at 335.
    Gonzalez, as noted, did not involve “counseling.”     See Gonzalez,
    718 N.W.2d at 308.     In addition, although we quoted some dictionary
    definitions of statutory terms, we did so to demonstrate the defendant’s
    conduct was covered by the statute, not to indicate those definitions set
    forth the outermost limits of the law. See id.
    Notably, when we rejected the argument later in Gonzalez that the
    statute was unconstitutionally vague, we reverted to the statutory
    definition of “mental health services,” not to any of the dictionary
    definitions we had previously quoted. See id. at 310. Had we intended
    19
    the dictionary definitions to be a required gloss on the statute, we
    logically would have repeated them and relied on them in discussing the
    vagueness question.    Thus, we do not read Gonzalez as endorsing a
    definition of “counseling” limited to “modern psychological principles and
    methods.”
    For these reasons, we reject Edouard’s challenge to Instruction 25.
    Edouard’s other challenges to the jury instructions are less substantial.
    He contends the jury should have been told that each alleged victim had
    to have been his “patient or client” in order to sustain a guilty verdict.
    This argument is purely form over substance, because the statute defines
    a “patient or client” as “a person who receives mental health services
    from the counselor or therapist,” see Iowa Code § 709.15(1)(e), and the
    jury was told that each of the alleged victims had to have “receiv[ed]
    mental health services” from Edouard.
    Edouard also urges that the jury should have been given a list of
    “all the enumerated professions” referenced in section 709.15(1)(a),
    including those which had no applicability to the case, such as
    physicians,   psychologists,   nurses,   professional   counselors,   social
    workers, marriage or family therapists, and alcohol or drug counselors.
    See id. § 709.15(1)(a). Instead, the jury was just told that “a ‘counselor
    or therapist’ includes a member of the clergy, or any other person,
    whether or not licensed or registered by the State, who provides or
    purports to provide mental health services.”      We see no error.      The
    district court’s instruction was an accurate statement of the law; it left
    out only those portions of the statute that had no bearing on the case.
    B. Expert Testimony. At trial, Edouard tried to offer testimony
    from a forensic psychiatrist, Dr. Hollida Wakefield, describing differences
    between “pastoral care” and “pastoral counseling.” In an offer of proof,
    20
    Dr. Wakefield testified there is a difference between pastoral care and
    pastoral counseling that is “recognized and accepted generally in the . . .
    theological community.” Dr. Wakefield testified that pastoral care occurs
    when
    somebody comes with a specific problem, you get an idea of
    what the problem is, you formulate a treatment plan, you
    meet with the person in a structured way. It is usually time
    limited. It doesn’t go on for months and years.
    Based on her review of the depositions given by the four women,
    Dr. Wakefield concluded Edouard’s interactions with them did not “fit the
    definition of pastoral counseling.”
    The district court refused to allow the testimony.     It reasoned it
    was the court’s duty
    to instruct the jury on what the law is regarding mental
    health services and counseling . . . and that it is the function
    of the jury to determine whether the defendant’s conduct did
    or did not constitute the provision of mental health services
    by a counselor or therapist.
    It excluded Dr. Wakefield’s testimony “regarding pastoral care or pastoral
    counseling” because “neither . . . are a part of the elements of this case.”
    The admissibility of expert testimony in a criminal case “falls
    squarely within the trial court’s sound discretion.” State v. Hulbert, 
    481 N.W.2d 329
    , 332 (Iowa 1992). Upon our review, we do not believe the
    court abused its discretion. Here, in effect, the defendant wanted to call
    an expert to provide the defendant’s own definition of the crime, and then
    to explain the defendant had not committed it.
    Even if the theological community were in agreement that
    Edouard’s actions did not amount to pastoral counseling, that would not
    resolve whether Edouard’s actions fit within the statutory definition of
    mental health services. See, e.g., People v. Littlejohn, 
    494 N.E.2d 677
    ,
    21
    686 (Ill. App. Ct. 1986) (noting the district court improperly allowed
    evidence by a doctor that confused the jury as to the legal definition of
    insanity by testifying to a “definition [that] may have medical meaning to
    clinicians,” but “clearly [did] not comport with Illinois definition of
    insanity for legal purposes”); State v. Williams, 
    431 So. 2d 885
    , 888–89
    (La. Ct. App. 1983) (upholding the convictions of the defendant, a prison
    inmate, on one count of forcible rape and one count of attempted forcible
    rape against a fellow inmate and rejecting the defendant’s argument that
    the trial judge had erred in excluding the defendant’s expert witness
    testimony   about   “the   relationship   between   prison   security   and
    consensual versus nonconsensual sex”); State v. Spano, 
    745 A.2d 598
    ,
    601–02 (N.J. Super. Ct. App. Div. 2000) (upholding the exclusion of
    expert testimony on the meaning of “worrying” in a statute which allowed
    a person to kill a dog if it was “worrying” a domestic animal and affirming
    the defendant’s conviction).
    In 1925, we considered the appeal of an osteopath who, under the
    statutes of that time, had been convicted of practicing medicine without
    a license. See State v. Gibson, 
    199 Iowa 177
    , 178, 
    201 N.W. 590
    , 590
    (1925).   The defendant argued on appeal the trial court had erred in
    excluding expert testimony as to the technical meaning of “internal
    curative medicine.” Id. We rejected the appeal, reasoning the words “do
    not import a technical meaning,” and therefore the expert testimony was
    properly excluded. Id. at 178, 180, 201 N.W. at 590, 591. The same
    basic principles concerning admissibility of expert testimony apply today.
    In order for the expert testimony to be admissible, it must “assist
    the trier of fact to understand the evidence or to determine a fact in
    issue.” Iowa R. Evid. 5.702. In other words, it must add something to
    the jury’s determination of whether Edouard’s actions fell within the legal
    22
    definition of mental health services. The specialized meaning given to a
    term by the theological community is ultimately beside the point in
    determining whether Edouard’s actions met the legislature’s definition of
    the crime. Notably, Dr. Wakefield’s indicia of pastoral counseling—i.e.,
    the existence of a “treatment plan,” the “structured” meetings, and
    presence of time limitations—do not appear anywhere in section 709.15.
    Hence, the district court did not abuse its discretion in excluding
    Dr. Wakefield’s proposed testimony.
    C. Sufficiency of the Evidence. Edouard also contends there is
    insufficient evidence to sustain a guilty verdict on any of the charges. In
    particular, he disputes the sufficiency of the evidence that he provided
    mental health services as defined in Iowa Code section 709.15(1)(d) to
    any of the four women.
    In reviewing challenges to the sufficiency of evidence
    supporting a guilty verdict, courts consider all of the record
    evidence viewed in the light most favorable to the State,
    including all reasonable inferences that may be fairly drawn
    from the evidence. [W]e will uphold a verdict if substantial
    record evidence supports it.        We will consider all the
    evidence presented, not just the inculpatory evidence.
    Evidence is considered substantial if, when viewed in the
    light most favorable to the State, it can convince a rational
    jury that the defendant is guilty beyond a reasonable doubt.
    Inherent in our standard of review of jury verdicts in
    criminal cases is the recognition that the jury [is] free to
    reject certain evidence, and credit other evidence.
    State v. Sanford, 
    814 N.W.2d 611
    , 615 (Iowa 2012) (citations omitted)
    (internal quotation marks omitted).
    We begin by noting a few common facts.         All four women were
    members of Covenant Reformed Church; Edouard had been their pastor
    for several years. Three of the four had preexisting marital problems in
    addition to other difficulties in their personal lives. The fourth developed
    such problems after getting involved with Edouard, who claimed to be
    23
    resolving them. Two of the four went to Edouard’s office initially thinking
    they would receive help from him, and Edouard quickly ended up having
    sex with both of them (one of them in the office that day). Before and
    during his sexual encounters with each of the four women, Edouard
    asked each of them deeply personal and probing questions, purporting to
    guide them through their personal difficulties.
    We now review the evidence specifically relating to V.B. She was
    “really struggling with going through” with an international adoption of
    four siblings. She decided to see her pastor, Edouard, to discuss these
    issues and her own infertility.
    Edouard was immediately receptive. He responded, “I’ve told you,
    you can talk to me anytime.” He invited her to his office, where he asked
    her how she was doing. V.B. explained that she was “really struggling”
    and that it was a “horrible, painful time” for her. After that, Edouard
    moved into questioning about V.B.’s marriage and whether her husband
    was “meeting her needs.” V.B. began to cry. Regarding her relationship
    with her husband, V.B. told Edouard that “[i]t was hard that we were
    both hurting and not able to hurt together, to connect together and hurt
    through it; that we just seemed like we were separate. It was hard.” By
    the end of the meeting, Edouard was having sexual relations with V.B.
    V.B. added that in her faith and the way she was raised, “[w]e just
    didn’t go to outside counselors . . . . [Y]ou would go to the elder or the
    pastor and that was it.”
    S.K., like V.B., was experiencing marital problems when she
    decided to call Edouard as a result of “all the stresses in [her] life.” She
    had previously sought counseling from Edouard after her daughter had
    been sexually abused by another member of the congregation.             Her
    husband had recently confessed infidelities to her.         S.K. felt their
    24
    “relationship was rocky,” and that she “had absolutely nobody to talk to.”
    In addition to the marital problems S.K. was suffering, she was also
    coping with the recent death of her best friend.         Edouard “sensed
    something was going on,” and Edouard explained to S.K. she could tell
    him “things, and [he would] listen.” They set up a meeting at her house
    to discuss these stressors in her life.    S.K. revealed to Edouard her
    husband’s infidelities in that meeting. S.K. “was relieved that [she] could
    tell somebody, that he’s the pastor; that [she] could confidentially talk to
    him about what was going on.” They continued to meet at her house. At
    these ensuing meetings, they were physically intimate, and, S.K.
    testified, they would talk, because she “would want to talk,” and felt she
    “needed somebody to talk to.”
    Edouard’s relationship with W.B. began in a different fashion.
    Some flirtatious conversation between the two of them had occurred.
    W.B. telephoned Edouard to set up a meeting to put an end to things.
    When she asked in the course of that telephone conversation whether it
    was “normal and acceptable” for Edouard to meet with women in his
    office, “he said yes, he counsels women at his home, and . . . it was just
    fine” for her to meet there.
    At the office meeting, Edouard asked “a lot of questions—very
    concerned about how I was doing, how my father is doing.” Her father
    had recently been diagnosed with Alzheimer’s.       The questions quickly
    became more personal, and W.B. eventually revealed in the meeting that
    she had been abused physically and sexually as a child.            Edouard
    probed that topic more deeply, she explained, as “[h]e was interested in
    it. He wanted to know the dynamics.” Soon thereafter, Edouard began
    to have a sexual relationship with W.B. This led W.B. to seek marital
    25
    counseling. Edouard would ask W.B. about what the marital counselor
    had said, and then tell W.B. whether to follow that advice or not.
    We turn finally to A.B. Edouard inquired as to how she was doing
    and how she was “juggling everything.” He asked if she “would like to set
    up a meeting with him.” Even though she testified she was not suffering
    from a mental disease or dysfunction at the time of their initial meeting,
    A.B. also testified she was taking depression and anxiety medication at
    the time and had various stressors in her life. She agreed to meet with
    Edouard in his home office.       She perceived this meeting to be a
    “counseling session, something [she] could go to that he was . . . a
    pastor[.]” The conversation in that initial meeting, she testified, started
    out with “typical conversation.” Edouard asked gradually more probing
    questions, such as, “Do you feel stressed?        Do you feel upset?”   A.B.
    testified she was “very open with him” because “it [was] all supposed to
    be confidential,” so she “definitely shared with him the ins and outs of
    how it felt to be a mom and taking care of everyone.” As the conversation
    progressed, Edouard began to ask even more “dig-deep kind of
    questions,” inquiring, for example, about her relationship with her
    husband. Many of the questions made her feel uncomfortable, and she
    left the meeting “[c]onfused and very nervous.”
    A.B. immediately called her sister, and reported, “I just got done
    with a counseling session with Pastor Edouard, and I—it went fine, but
    at the end, it was just odd.” Edouard continued to have meetings with
    A.B., and Edouard continued to ask her probing questions, often of a
    kind that made her feel uncomfortable. She described these questions as
    “intellectual” and “constantly-thinking questions that no one has ever
    asked me before.” A.B. characterized Edouard’s inquiries as “digging and
    26
    finding out [her] vulnerabilities.” By this time, they were having sexual
    relations.
    We find sufficient evidence to sustain Edouard’s convictions on all
    of the sexual exploitation counts. There is substantial evidence that he
    counseled each of the four women for an “emotional . . . or social
    dysfunction, including an intrapersonal or interpersonal dysfunction.”
    See Iowa Code § 709.15(1)(d).          As required by the district court’s jury
    instructions, this went beyond an “informal exchange of advice,” or “the
    giving of general spiritual advice or guidance from a clergy member to
    congregants.” 4     There is substantial evidence that a relationship was
    established between Edouard and each victim, at least initially, “for the
    purpose of addressing particular mental, intrapersonal or interpersonal
    dysfunctions.” To some extent, as in Allen, it appears sexual contact was
    part of Edouard’s program of pseudotherapy and treatment for his
    victims. 5
    D. Production of Mental Health Records.                  The four victims in
    this case participated in group therapy sessions after Edouard’s conduct
    came to light and he resigned from the church.                V.B., S.K., and A.B.
    voluntarily agreed to waive any privilege with respect to the records of
    these sessions.     W.B. did not.       Nonetheless, the district court ordered
    their production and they are not at issue on appeal.
    W.B. also went through marital counseling while she was still
    seeing Edouard. She underwent additional counseling thereafter. She
    declined to waive the privilege as to those records. Edouard argues the
    4Instruction 25, which we have upheld, is the law of the case for sufficiency-of-
    evidence purposes. See, e.g., State v. Merrett, 
    842 N.W.2d 266
    , 275 (Iowa 2014).
    5According to V.B., Edouard advised her that she had “all this sexual energy
    that needed to be released, and he had to be there to protect me.”
    27
    records were relevant to show that W.B. was not suffering from “a
    cognitive, behavioral, emotional, mental, or social dysfunction, including
    an intrapersonal or interpersonal dysfunction,” Iowa Code § 709.15(1)(d),
    and therefore Edouard could not have been providing mental health
    services to her. See id.
    The district court denied Edouard’s motion for access to the
    records and found he had not met the burden under Cashen or Iowa
    Code section 622.10 to show at least a reasonable probability that these
    records “contain something that may be exculpatory.”      See Iowa Code
    § 622.10; Cashen, 789 N.W.2d at 405. Edouard argues the district court
    improperly applied Cashen, and as a result, prejudice is presumed. He
    insists the denial of the access to the records violated his right to due
    process.
    This court developed the Cashen protocol to determine whether a
    criminal defendant should have access to the mental health records of a
    victim.    See Cashen, 789 N.W.2d at 408–10 (requiring a defendant to
    make a good faith showing that there is a “reasonable basis to believe the
    records are likely to contain exculpatory evidence tending to create a
    reasonable doubt as to the defendant’s guilt”); see also Thompson, 836
    N.W.2d at 479–80 (discussing the Cashen protocol).      However, a 2011
    change in the Iowa Code superseded Cashen by providing a defendant
    seeking to obtain privileged records must:
    demonstrat[e] in good faith a reasonable probability that the
    information sought is likely to contain exculpatory
    information that is not available from any other source and
    for which there is a compelling need for the defendant to
    present a defense in the case.
    Iowa Code § 622.10(4)(a)(2)(a); see 2011 Iowa Acts ch. 8, § 2 (amending
    the statute); Thompson, 836 N.W.2d at 481, 490 (recognizing the
    28
    amendment as a “reaction to Cashen” and upholding the amended
    statute as constitutional on its face). This amendment was in effect at
    the time of the hearing on the motion for subpoena, and thus controls in
    this case.
    We discussed section 622.10(4)(a)(2)(a) in length in Neiderbach,
    837 N.W.2d at 195–98. In Neiderbach, the defendant and codefendant
    were charged with child endangerment after the victim, their son,
    suffered a number of injuries, including permanent brain damage, over a
    three-week period shortly after his birth. Id. at 187–89. We concluded
    the district court erred by failing to conduct an in camera inspection of
    the codefendant’s medical records sought by Neiderbach under section
    622.10(4)(a)(2)(a). Id. at 197. We noted the codefendant’s credibility was
    “a central issue” in the case and Neiderbach’s “defense strategy included
    raising reasonable doubt whether certain injuries may have been
    inflicted by [the codefendant] instead of him.”          Id.      Because the
    codefendant gave inconsistent statements, concocted a false story with
    Neiderbach to present to hospital staff, and behaved strangely in jail, we
    concluded the defendant “ ‘demonstrate[d] in good faith a reasonable
    probability that the information sought . . . is likely to contain
    exculpatory evidence . . . and for which there is a compelling need for
    [the defendant] to present a defense’ within the meaning of section
    622.10(4)(a)(2)(a).”   Id. at 197 (quoting Iowa Code § 622.10(4)(a)(2)(a)).
    We observed that the records of her mental health counselor “may very
    well have enabled defense counsel to more effectively cross-examine her
    at trial or assisted counsel’s preparation for her deposition.” Id. at 198.
    However,   despite   our   conclusion,   we   declined    to   reverse
    Neiderbach’s conviction outright. Id. Rather, we entered the following
    order:
    29
    Accordingly, we reverse the district court’s ruling
    denying [Neiderbach]’s motion for an in camera review of [the
    codefendant]’s mental health records and remand the case
    for the district court to conduct that review pursuant to
    section 622.10(4)(a)(2).      If the district court finds no
    exculpatory evidence on that review, [Neiderbach]’s
    remaining convictions shall remain affirmed. If exculpatory
    evidence is found, the district court shall proceed as directed
    in section 622.10(4)(a)(2)(c) and (d) and determine whether
    [Neiderbach] is entitled to a new trial.
    Id.
    We recognize that this case presents a different set of facts than
    Neiderbach. Rather than seeking the records of a testifying codefendant,
    here Edouard seeks the counseling records of one of his alleged victims.
    Even after the legislature’s adoption of section 622.10, we reiterated our
    recognition of the “importance of maintaining confidentiality in mental
    health treatment.”   Thompson, 836 N.W.2d at 483.         In reviewing the
    constitutionality of the legislature’s policy choices contained in section
    622.10(4), we stressed a “victim–patient’s constitutional right to privacy
    in her mental health records” was protected, in part, by the legislature’s
    choice “to have a neutral judge review the victim’s private records, rather
    than the advocate for the alleged abuser.” Id. at 487. We determined
    this protection, along with others contained in the statute, was a
    constitutional way “to balance the competing rights of criminal
    defendants and their victims.” Id. at 490.
    Having said that, we believe a similar approach to the one we took
    in Neiderbach is warranted in this case. W.B. testified that during her
    sexual relationship with Edouard, she was also going through marital
    counseling at a counseling center. Edouard’s counsel used this fact to
    close her cross-examination of W.B. with a flourish:
    Q. You and your husband don’t               go to marital
    counseling with [Edouard]? A. Correct.
    30
    Q. You go to Pine Rest? A. Right.
    Q. And Pine Rest is a counseling center? A. Yes.
    Q. And that’s what they do there, is they have
    Christian counselors, right? A. Yes.
    Q. So you never do actually go to Mr. Edouard for
    your counseling? A. Right.
    The defense did not ask W.B. about the content of her marital
    counseling sessions.   However, needing to rehabilitate W.B., the State
    then got her to testify on redirect that Edouard went over the same
    matters with her that her marital counselor had covered with her:
    Q. After you would have a session at Pine Rest with
    the marriage counselor, would you tell Pastor Edouard what
    the counseling session was about? A. Yes.
    Q. Would he ask you? A. Yes.
    Q. Would he ask you lots of questions about the
    counseling session? A. Yes.
    Q. And would you answer his questions? A. Yes.
    Q. What kind of questions would he ask about a
    counseling session at Pine Rest that you attended with your
    husband? A. He wanted to know all the dynamics. He
    wanted to know what we said, what she said.
    Q. Who is “she”? A. The counselor.
    Q. And would you tell him specifics about what she
    said and what the two of you talked about with her? A. Yes.
    Q. Would you share with him—you said “the
    dynamics.” What do you mean by that? A. What did I say?
    Q. You said something about “the dynamics” of the
    session, he would ask about the dynamics. A. What was
    said.
    Q. And would you—if the counselor gave you and your
    husband a piece of advice that was supposed to help you,
    did he ask you whether the counselor gave you advice?
    A. Yes.
    Q. And would you tell him? A. Yes.
    31
    Q. Would he express an opinion on whether he agreed
    with that? A. Yes.
    Q. Would he advise you whether to follow the advice of
    that counselor at Pine Rest or not? A. Yes.
    Q. Could you explain that? Give us an example.
    A. There was oftentimes he did not like the advice that she
    gave, and he would tell me a different way to do it or “Just
    don’t listen to her.”
    Q. And then would you do it her way or his way?
    A. His way.
    This sequence involving two talented trial lawyers demonstrates
    that Edouard’s quest for W.B.’s mental health records was clearly more
    than a fishing expedition. Cf. Thompson, 836 N.W.2d at 490 (noting the
    absence of “a nexus between the issues at trial and the mental health
    treatment received by [the victim]”). Nevertheless, the State argues the
    records were not likely to contain exculpatory information for two
    reasons. First, the State points out that W.B. consistently admitted her
    mental health was fine in 2007 before she started seeing Edouard. Thus,
    it contends Edouard did not need those records to establish the absence
    of a dysfunction. Second, the State urges that the existence or lack of a
    diagnosis is irrelevant to whether Edouard provided “mental health
    services.”
    We disagree with the State. Although W.B. admitted her mental
    health was fine before her sexual relationship with Edouard began, she
    described having personal difficulties thereafter. Counseling records for
    the time period when W.B. was seeing Edouard and shortly thereafter
    would be potentially relevant to the extent they touch upon the nature
    and extent of those problems.      And while the State insists that a
    diagnosed dysfunction is not a required element of the crime, the lack of
    diagnosis for such a dysfunction would seem to us an appropriate
    32
    subject for jury argument. In its closing, the State argued with respect to
    W.B.:
    What is a mental health service? “. . . . The providing
    of treatment, assessment, or counseling to another person
    for a cognitive, behavioral, emotional, mental or social
    dysfunction, including an intrapersonal or interpersonal
    dysfunction.”
    In other words, she’s having personal problems, and
    [Edouard’s] counseling her for those problems. That’s what
    all that fancy language is.
    In short, the State argued to the jury that dysfunction means
    nothing more than “personal problems.” But a defendant should have
    latitude to argue it means something more than that.       Perhaps W.B.’s
    counseling records would have assisted Edouard in fashioning an
    argument that W.B. was not suffering from a dysfunction during any
    relevant time period.
    In addition to showing a reasonable probability the records might
    likely contain exculpatory information necessary to his defense, Edouard
    also had to show the information “is not available from any other
    source.” See Iowa Code § 622.10(4)(a)(2)(a). We previously pointed out
    in Neiderbach that, under certain circumstances, information is not
    “available” from another source just because testimony can be obtained
    from the patient or client.   837 N.W.2d at 197–98.     We believe this is
    another one of those situations. Information in the counseling records
    could have significantly undermined W.B.’s testimony. We do not know.
    Therefore, we reverse the district court’s ruling that denied
    Edouard’s request for in camera review of W.B.’s counseling records. We
    emphasize the limits of this decision.    The crime charged requires the
    State to show the defendant counseled W.B. for a dysfunction, and the
    record shows W.B. was receiving outside counseling at the same time
    33
    and shortly thereafter. Also, as in Neiderbach, if the district court finds
    no exculpatory evidence, Edouard’s convictions will stand affirmed. See
    837 N.W.2d at 198 & n.3. If exculpatory evidence is found, the district
    court would then determine if a new trial is required on the Iowa Code
    section 709.15(2)(c) count relating to W.B. and the section 709.15(2)(a)
    pattern or practice count.
    E. Constitutional Challenges. Edouard raises two constitutional
    challenges as a part of his appeal.         First, he contends that section
    709.15(2),   as   applied     to   him,    unconstitutionally      burdens     his
    fundamental right to enter into sexual relationships. He maintains that
    section 709.15(2) “creates a per se ban on all sexual relations between
    certain   categories   of   individuals    regardless   of   the   existence   or
    nonexistence of consent,” and that “[i]mplicit in the jury’s verdict finding
    Edouard not guilty of sexual abuse in the third degree is the conclusion
    that his sexual relationships with all four women were consensual.” In
    Edouard’s view, section 709.15(2) is not narrowly tailored to address a
    compelling interest using the least restrictive means possible.
    Edouard refers to the Due Process Clauses of both the United
    States Constitution and the Iowa Constitution in his brief. However, he
    does not advance a separate analysis under the Iowa Constitution. For
    this reason, we will undertake the same analysis for both claims. See
    State v. Kennedy, 
    846 N.W.2d 517
    , 522 (Iowa 2014) (stating that “[w]e
    jealously protect this court’s authority to follow an independent approach
    under our state constitution for provisions of the Iowa Constitution that
    are the same or nearly identical to provisions in the United States
    Constitution” but choosing not to interpret the Iowa Constitution any
    differently from the United States Constitution where the defendant had
    34
    not proposed a specific test under the Iowa Constitution (internal
    quotation marks omitted)).
    In Lawrence v. Texas, 
    539 U.S. 558
    , 
    123 S. Ct. 2472
    , 
    156 L. Ed. 2d 508
     (2003), the United States Supreme Court overturned the convictions
    of two male adults for engaging in consensual sexual conduct.          The
    Court found the defendants were “free as adults to engage in the private
    conduct in the exercise of their liberty under the Due Process Clause of
    the Fourteenth Amendment to the Constitution.” Id. at 564, 123 S. Ct.
    at 2476, 156 L. Ed. 2d at 516. Edouard cites us to Lawrence, but it is
    important to note that Lawrence “does not involve persons who might be
    injured or coerced or who are situated in relationships where consent
    might not easily be refused.”     Id. at 578, 123 S. Ct. at 2484, 156
    L. Ed. 2d at 525. By contrast, Lawrence involved “two adults who, with
    full and mutual consent from each other, engaged in sexual practices
    common to a homosexual lifestyle.” Id.
    In State v. Musser, we rejected a constitutional privacy challenge to
    Iowa’s statute making it a felony for a person knowing he or she was HIV
    positive to engage in intimate conduct with another person who was not
    aware of that status. See 
    721 N.W.2d 734
    , 748 (Iowa 2006). We found
    that Lawrence was “readily distinguishable” because there was “not ‘full
    and mutual consent’ ” where one sexual partner was unaware of the
    other’s infected status.   Id. (quoting Lawrence, 539 U.S. at 578, 123
    S. Ct. at 2484, 156 L. Ed. 2d at 525). “Consent in the absence of such
    knowledge is certainly not a full and knowing consent as was present in
    Lawrence.” Id. We also observed that “the sexual partner of an infected
    person is at serious risk of injury and even death from the prohibited
    sexual contact.” Id.
    35
    To some extent, the distinctions we recognized in Musser also exist
    here.   Based upon their testimony, the relationships between Edouard
    and each of the four women did not involve full and mutual consent. In
    each case, Edouard used—misused—his position of authority as a
    counselor to exploit the vulnerabilities of his victim. The relationships
    were of a kind where “consent might not easily be refused.” Lawrence,
    539 U.S. at 578, 123 S. Ct. at 2484, 156 L. Ed. 2d at 525.
    And the women suffered harm.       Following her experience with
    Edouard, A.B. was “scared” and “struggling.” She later wrote the word
    “Freedom” in her husband’s notebook because “[t]he longer you’re out of
    [Edouard’s] grip, the more freedom you get.”     V.B. felt it “was hard to
    keep going” after her experience with Edouard and was afraid of “[l]osing
    everything” because she felt no one would believe her over him due to his
    reputation in the congregation.       S.K. was “trapped,” and felt that
    Edouard was “a ball and chain.”        After Edouard was exposed, W.B.
    “couldn’t eat” and was “losing weight.”
    Edouard is not the first person to assert that any sexual
    exploitation laws that criminalize consensual sexual relations between
    adults are unconstitutional.      Similar arguments have been raised,
    generally without success, in other jurisdictions. For the most part, the
    courts have reasoned that the statutes do not implicate fundamental
    rights and are not controlled by Lawrence because the relationship is
    imbalanced and not fully consensual. See, e.g., State v. Freitag, 
    130 P.3d 544
    , 545–46 (Ariz. Ct. App. 2006) (rejecting an argument that
    prostitution was protected by a “fundamental constitutional right to
    engage in adult consensual sexual conduct” as recognized in Lawrence);
    Talbert v. State, 
    239 S.W.3d 504
    , 511–13 (Ark. 2006) (upholding a
    statute that prohibits a member of the clergy from using his or her
    36
    position of trust and authority to engage in sexual activity with a victim
    and finding Lawrence distinguishable); State v. Edwards, 
    288 P.3d 494
    ,
    498–503 (Kan. Ct. App. 2012) (finding a statute that prohibited a teacher
    from engaging in sexual activity with an eighteen-year-old student was
    subject to a rational basis review, noting, “[w]hen read in its entirety, it is
    clear that the intent of this statute is to prohibit sexual conduct of
    certain persons who have authority over other persons where the ability
    to freely consent is questionable”); State v. Lowe, 
    861 N.E.2d 512
    , 515–
    18 (Ohio 2007) (determining that Lawrence did not apply and the
    defendant did not have a fundamental right to engage in sexual
    intercourse with his consenting adult stepdaughter); State v. Green, 
    989 N.E.2d 1088
    , 1089–90 (Ohio Ct. App. 2013) (finding no fundamental
    right to engage in consensual sexual activity for hire); Ex parte Morales,
    
    212 S.W.3d 483
    , 490–98 (Tex. Ct. App. 2006) (finding a statute that
    criminalized sexual conduct between a dormitory residential advisor and
    a student over the age of majority should be reviewed under a rational
    basis standard, which it met); see also Flaskamp v. Dearborn Pub. Schs.,
    
    385 F.3d 935
    , 943 (6th Cir. 2004) (indicating that a ban on relationships
    between teachers and their students for one year after graduation would
    not be a direct and substantial burden on the right to intimate
    association and would be subject to a rational basis review).         But see
    Paschal v. State, 
    388 S.W.3d 429
    , 434–37 (Ark. 2012) (finding a statute
    that criminalized sexual conduct between a teacher and an eighteen-
    year-old student infringed upon a fundamental right to privacy under the
    Arkansas Constitution).
    In State v. Hollenbeck, the New Hampshire Supreme Court
    confronted a psychologist’s constitutional challenge to a New Hampshire
    law that made it a crime for a therapist to have sexual relations with a
    37
    patient within one year of the termination of the therapeutic relationship
    in a manner which is not professionally recognized as ethical. 
    53 A.3d 591
    , 593 (N.H. 2012).      The court found that “the kind of sexual
    relationship alleged here is not included in the constitutional right
    Lawrence recognized.”    Id. at 598.   Rather, the relationship between a
    therapist and a former client is the kind of relationship “ ‘where consent
    might not easily be refused.’ ” Id. (quoting Lawrence, 539 U.S. at 578,
    123 S. Ct. at 2484, 156 L. Ed. 2d at 525). Accordingly, the court applied
    a rational basis standard of review and upheld the statute as serving
    “legitimate governmental interests in protecting those who are vulnerable
    to exploitation from being exploited . . . and in maintaining the integrity
    of the mental health profession.” Id. at 598–99.
    We find Hollenbeck persuasive here. The statute as applied to this
    case does not invade a fundamental right. There is no fundamental right
    to engage in sexual relations in circumstances where one partner is in a
    position of power or authority over another. There was ample evidence
    that Edouard occupied a position of power and authority over each of his
    four victims. We would leave open the question whether a substantive
    due process challenge to Iowa Code section 709.15 could be successfully
    brought in other factual contexts.       We also emphasize, as we stated
    earlier, that Edouard has not raised a vagueness or overbreadth
    challenge to section 709.15 in this case.
    Edouard’s other argument is that section 709.15, as applied to
    members of the clergy, violates the Establishment Clause of the United
    States and Iowa Constitutions. See U.S. Const. amend. I; Iowa Const.
    art. I, § 3; Kliebenstein v. Iowa Conference of United Methodist Church,
    
    663 N.W.2d 404
    , 406 (Iowa 2003) (noting that “ordinarily the courts have
    no jurisdiction over, and no concern with, purely ecclesiastical questions
    38
    and controversies,” but “do have jurisdiction as to civil, contract, and
    property rights which are involved in or arise from a church controversy”
    (internal quotation marks omitted)).
    In State v. Bussmann, the Minnesota Supreme Court divided
    equally on the question whether Minnesota’s clergy sexual conduct
    statute—which applies only to members of the clergy—facially violated
    the   Establishment      Clause      of    the   United   States   and    Minnesota
    Constitutions. See generally 
    741 N.W.2d 79
     (Minn. 2007).6 A majority of
    the court found an Establishment Clause violation as applied to the facts
    of the defendant’s trial because “[t]he state relied heavily on religious
    expert testimony to prove its case and the court allowed the jury to hear
    discussion that intertwined religious doctrine with state law.” Id. at 92.
    The court elaborated, “Virtually all of this testimony lacked foundation to
    connect it to any secular standard, was irrelevant to any secular
    standard,     was     inadmissible        hearsay   evidence,    and     was   highly
    prejudicial.” Id. at 93. The court concluded:
    [T]he district court allowed the state to introduce extensive
    evidence regarding the Catholic Church’s doctrine on the
    religious power of priests over parishioners; the Church’s
    official policy on counseling and pastoral care; the Church’s
    concerns about priest sexual misconduct; and the Church’s
    official investigation and findings regarding Bussmann’s
    behavior. Through the admission of this evidence, the court
    allowed the religious doctrine of the Catholic Church to
    become entangled with the criteria set out in the clergy
    sexual conduct statute for determining the criminality of
    Bussmann’s conduct. The jury’s verdict was based on this
    evidence, and was unavoidably entangled with the religious
    doctrine introduced into evidence by the state.
    6Minnesota’s   statute makes it a crime for anyone who “is or purports to be a
    member of the clergy” to have sexual intercourse with another person “during a period
    of time in which the complainant was meeting on an ongoing basis with the actor to
    seek or receive religious or spiritual advice, aid, or comfort in private.” Minn. Stat.
    § 609.344 subd. 1(l)(ii) (West, Westlaw current through 2014 Reg. Sess.).
    39
    Id. at 94.
    Subsequently, in State v. Wenthe, the Minnesota Supreme Court
    held that Minnesota’s clergy sexual conduct statute did not facially
    violate the Establishment Clause, because it was “part of a larger
    statutory scheme that regulates the behavior of those involved in . . .
    relationships for which the Legislature has determined there is a power
    imbalance between the parties” and “applies neutral principles of law
    and regulates only secular aspects of clergy–parishioner relationships.”
    
    839 N.W.2d 83
    , 88–91 (Minn. 2013).
    The court also upheld the constitutionality statute as applied to
    the facts of the case because “the State did not attempt to shift the jury’s
    focus away from the secular elements in the clergy-sexual-conduct
    statute and onto religious doctrine.”     Id. at 92.    In Wenthe, unlike
    Bussmann, there was no testimony by a Catholic priest and a Catholic
    counselor about the religious power of priests, only a minimal amount of
    evidence admitted by the state related to the policies of the Catholic
    Church on pastoral care, and the state’s evidence about the church’s
    response to the sexual relationship was factually relevant to the case.
    Wenthe, 839 N.W.2d at 93–95.
    We do not find section 709.15 violates the Establishment Clause
    as applied to clergy.     As the State points out, the statute, unlike
    Minnesota’s, is essentially neutral. It applies to all persons who provide
    or purport to provide mental health services. Iowa Code § 709.15(1)(a).
    Edouard notes the State’s emphasis during trial on the victims’ faith and
    on Edouard’s status as the victims’ pastor.      But these were relevant
    evidentiary considerations because they showed why the victims would
    allow Edouard to have sex with them even as they were receiving mental
    health services from him. Edouard also overlooks the fact the case, as
    40
    tried, included three counts of sexual abuse.                Evidence regarding
    Edouard’s status and the victims’ faith was particularly relevant to the
    sexual abuse counts, because it tended to explain why three of the four
    victims would later be willing to have sex with a person who had initially
    forced them to have sex with him. 7 Edouard, of course, does not contend
    that Iowa’s sexual abuse statute violates the Establishment Clause. See
    Iowa Code § 709.1.
    As in Wenthe, while the trial certainly did not veer away from the
    religious setting in which the defendant’s conduct took place, it did not
    dwell on religious doctrine either. The defendant, not the State, sought
    to introduce evidence on standards of pastoral care. In addition to the
    victims themselves, the only witnesses called by the State were a
    psychologist as a rebuttal witness and two church elders.              The elders
    testified primarily as fact witnesses to admissions and statements made
    in meetings after Edouard’s conduct began to come to light.                 In the
    course of cross-examining the first elder, Edouard’s counsel delved to
    some extent into the Covenant Reformed Church’s mission. By doing so,
    Edouard’s counsel was able to get this elder to admit, helpfully, that
    Edouard was expected to provide spiritual guidance—but not mental
    health services—to parishioners.
    Notably, when the second elder was asked about his concerns
    regarding his congregation and its members, and Edouard objected on
    the basis of relevance, the district court sustained the objection.            The
    court explained:
    Counsel, it seems to me that the discussions which
    took place between Mr. Edouard and members of the church
    7Edouard’s counsel attacked the sexual abuse charges during closing argument
    on this very ground.
    41
    are certainly relevant to the extent that they are his
    statements, but I’m concerned that the actions of the church
    and the positions of the church really don’t have a bearing
    on the legal issues that are before the court.
    Whether the church in its hierarchy and its
    functioning made a determination that Pastor Edouard had
    sinned, that he should be removed in some manner from his
    duties with the church, or that the church should in some
    manner sanction him, I have trouble believing that that is
    relevant to the issues in this case for this jury; and that the
    inclination would be for the jury to in some manner,
    essentially, be assisted by the findings of the church, which
    would be inappropriate in this case.
    This incident illustrates the district court’s sensitivity to the
    potential crossover between church canons and secular laws.             It
    demonstrates the court enforced proper boundaries. While we would not
    foreclose an as-applied challenge in a future case, we are not persuaded
    by Edouard’s Establishment Clause arguments here.
    F. Other Evidentiary Rulings.       Before trial, the State filed a
    motion in limine seeking to exclude any reference to evidence that
    Edouard’s home in Pella was vandalized or that his family had been
    harassed after his sexual encounters with his parishioners came to light.
    This included evidence of a brick being thrown through his window and
    that his home and personal belongings were posted for sale on Craigslist,
    along with other evidence of harassment and vandalism.
    In response to the motion, Edouard argued the evidence was
    relevant to explain why he left the Pella community after his conduct
    came to light. The court concluded:
    In a general sense, the court believes that the evidence
    regarding allegations of a brick being thrown through a
    window, postings on Craigslist regarding the defendant’s
    property, or reports of vandalism or harassment at the
    defendant’s home in 2010 and 2011 is not relevant, at least
    of any apparent nature at this point.
    It appears to the court that such evidence, if admitted,
    would merely confuse the jury, would distract the jurors
    42
    from the issues in the case which they must decide, and that
    it has little, if any, probative value in this case. If, in fact, it
    becomes apparent that there is a basis for admitting the
    evidence, the court certainly is willing to take another look at
    that, if raised by the defendant prior to the admission of the
    evidence.
    The defendant presented his evidence in an offer of proof at trial.
    Edouard testified that, before the four women actually went to the police,
    a rock was thrown through his sons’ bedroom window while they were
    sleeping.   Additionally, spikes were placed behind the wheels of his
    vehicles in his driveway, his home and personal belongings were listed
    for sale on Craigslist along with his home telephone number, pizzas he
    had not ordered were delivered to his home, and the husband of one of
    the victims followed him “on a couple of occasions.”
    The questioning in the offer of proof ended as follows:
    Q. Did all of these acts influence your decision to
    move to Michigan when you did? A. Yes. Absolutely.
    Q. Why? A. Well, evidently we were not safe there.
    But also, it became clear to me that my presence probably
    was a lightning rod. I didn’t want my children to be
    subjected to that kind of harassment. I wanted for there to
    be healing as soon as possible, and I thought my absence
    would be the first building block toward that.
    Edouard maintains this information is relevant as the “threats and
    fear explain Edouard’s hesitancy in answering questions about the
    allegations to the church elders, his general withdrawal from his
    friendships within the church, and his abrupt move out of Iowa.” The
    State, however, argues the jury did not need this explanation.
    We agree with the State.        Edouard had admittedly engaged in
    sexual relations with four married women from his congregation. As he
    explained to the jury, “[T]he sins for which I resigned warranted my
    deposition as a minister.” He testified that he was “censured” and “did
    not contest it.”     All this was scandalous enough for the jury to
    43
    understand why he left town. A jury would not conclude that Edouard
    believed he was guilty of a crime just because he moved to Michigan. We
    see no abuse of discretion.
    Edouard also attempted to offer evidence that one of the victims,
    V.B., had an extramarital affair with another man, R.M., after having
    sexual relations with Edouard and before making any allegations against
    Edouard. Edouard indicated that V.B. told him about the details of this
    sexual relationship with R.M. and asked him to lie about it to her
    husband.    Edouard argued the information was relevant for three
    reasons: (1) the fact she shared this type of information with Edouard
    about the second affair shows their relationship was one of friendship,
    not counseling; (2) the nature of the relationship V.B. had with R.M. was
    very similar to the relationship she had with Edouard, and she later lied
    to her husband about R.M. so it “is exactly the same kind of lie we
    believe she would be telling about Mr. Edouard”; and (3) the fact she gave
    $2000 to R.M. undermines the suggestion that the monetary gifts she
    gave to Edouard were as a result of any type of power relationship
    between the two.
    The court determined the evidence of the affair was “squarely
    within the provisions of the rape shield law.” It concluded evidence of
    the affair or money gift amounted to an argument that V.B. had “the
    same type of relationship the defendant claims” and “would be no
    different than a defendant claiming that the alleged victim had engaged
    in consensual sex with 15 other individuals and that that should be
    admitted as proof that the relationship with the defendant was
    consensual, which is precisely what is precluded by the rule.”
    Iowa Rule of Evidence 5.412(a) states, “[I]n a criminal case in
    which a person is accused of sexual abuse, reputation or opinion
    44
    evidence of the past sexual behavior of an alleged victim of such sexual
    abuse is not admissible.”     The purpose of this rule “is to protect the
    victim’s privacy, encourage the reporting and prosecution of sex offenses,
    and prevent the parties from delving into distractive, irrelevant matters.”
    State v. Alberts, 
    722 N.W.2d 402
    , 409 (Iowa 2006). However, “evidence of
    a victim’s past sexual behavior other than reputation or opinion
    evidence” is admissible if it is “constitutionally required to be admitted.”
    Iowa R. Evid. 5.412(b)(1).    Additionally, the rule contains a balancing
    test, identical to that contained in rule 5.403, for the admission of
    evidence under 5.412(b).     Id. r. 5.412(c)(3) (“If the court determines on
    the basis of the hearing described in rule 5.412(c)(2) that the evidence
    which the accused seeks to offer is relevant and the probative value of
    such evidence outweighs the danger of unfair prejudice, such evidence
    shall be admissible in the trial to the extent an order made by the court
    specifies evidence which may be offered and areas with respect to which
    the alleged victim may be examined or cross-examined.”).
    We have held that even if evidence of specific instances of sexual
    conduct is relevant, the defendant has no constitutional right to
    introduce that evidence when its probative value is outweighed by its
    prejudicial effect. See State v. Mitchell, 
    568 N.W.2d 493
    , 498–99 (Iowa
    1997) (refusing to allow evidence of a victim’s sexually transmitted
    diseases which the defendant did not contract because “the probative
    value of the evidence was substantially outweighed by the danger of
    unfair prejudice” and stating, “relevant evidence is not constitutionally
    required to be admitted if the prejudicial effect of the evidence outweighs
    the probative value”); State v. Jones, 
    490 N.W.2d 787
    , 791 (Iowa 1992)
    (noting there is no constitutional requirement to admit evidence of
    45
    victim’s past sexual history where it is “more prejudicial than probative
    for the purposes urged”).
    In this case, it is highly questionable whether the evidence was
    even relevant. The argument that the disclosure of private information
    about an individual’s sexual liaisons with others is indicative of a
    friendship rather than a counseling relationship does not seem logical. It
    is certainly not unheard of for an individual to discuss an extramarital
    affair with a counselor or to request one’s counselor to keep that
    information secret.
    Additionally, the fact that V.B. lied to her husband about an affair
    with another man would add little, if anything, of value to Edouard’s
    defense. V.B. admittedly lied to her husband about the money she gave
    Edouard, and of course she kept the entire sexual relationship with
    Edouard secret from her husband.
    Finally, V.B.’s willingness to give a far more modest ($2000 as
    opposed to $70,000) financial gift to another person with whom she had
    a later affair would not make it much less likely that her relationship
    with Edouard was an uneven one in which he acted as her counselor.
    The district court in this case correctly concluded the evidence of
    V.B.’s alleged affair fell within the protection of the rape shield law, rule
    5.412. The court noted the testimony had a clear prejudicial effect: It
    would tend to suggest that because V.B. had a consensual affair with
    another individual, she therefore had a consensual affair with Edouard.
    We find no error in the district court’s ruling.
    G. Restitution. Finally, Edouard claims the district court erred
    with respect to the restitution it awarded against him.         Each of the
    women and two of their spouses received payments from the crime
    46
    victim compensation program (CVCP). See Iowa Code § 915.86. 8 The
    State sought to charge those payments against Edouard.                 See id.
    § 910.2(1). At the restitution hearing, the State called to the stand the
    restitution subrogation coordinator from the crime victim assistance
    division.      The State also presented six exhibits—the crime victim
    assistance division’s files for all four victims and two of the victims’
    husbands.       Following this hearing, the court ordered that the State’s
    CVCP could recoup a total of $12,956.74 in restitution from Edouard.
    In State v. Jenkins, we held that amounts paid to victims by the
    CVCP may not be automatically charged back to the defendant.               
    788 N.W.2d 640
    , 645–47 (Iowa 2010). Rather, there may be a review by the
    district    court   to   determine    whether     the   statutory    causation
    requirements of Iowa Code section 915.86 have been met. Id. at 647.
    The district court conducted such a review here but Edouard challenges
    its sufficiency.
    Specifically, Edouard claims the State’s witness had no firsthand
    knowledge that the treatment received by the victims could be linked to
    his criminal conduct.      He maintains a causal connection cannot be
    shown simply by calling a witness who brings in paperwork completed
    by others.
    The State’s witness testified to the manner in which requests for
    compensation are approved by the crime victim assistance division:
    In every claim that is filed with our office, the victim
    signs a release of information, and they put on the release
    who the providers are that they want assistance with for
    payment. And also on the application there is a place to
    8Under    certain circumstances, spouses can be eligible to receive victim
    compensation as “secondary victims,” such as for mental health care and
    transportation. See Iowa Code §§ 915.80(5), .86(12), (15).
    47
    mark what benefits they’re seeking. So based on that
    information, we send out . . . request forms to those
    providers and they complete them. And we also ask for
    itemized statements and the medical records, and then the
    compensation specialist reviews that and determines
    whether or not it is crime related.
    And . . . then we have a quality control system also
    that reviews that file to make sure that everything was done
    right.
    She further testified that each mental health or medical provider also fills
    out a verification form regarding the treatments that indicates whether
    the service was related to the crime.
    In this case, the providers in question had attested in writing that
    all the treatments were related to the crime. Each exhibit contained a
    form signed by the treatment provider that verified the treatments in
    question were “provided as a direct result of the crime.” The coordinator
    also confirmed this in her testimony. Edouard did not attempt to present
    any evidence of his own but did vigorously cross-examine the
    coordinator.
    We do not believe restitution proceedings are subject to strict rules
    of evidence. See Iowa R. Evid. 5.1101(c)(4) (stating the rules of evidence
    do not apply in sentencing proceedings). In the review of a restitution
    order, “ ‘we determine whether the court’s findings lack substantial
    evidentiary support, or whether the court has not properly applied the
    law.’ ”     Hagen, 840 N.W.2d at 144 (quoting State v. Bonstetter, 
    637 N.W.2d 161
    , 165 (Iowa 2001)). As the district court explained,
    [t]he court has reviewed the mental health services provided
    to the victims, and to the secondary victims, to the extent
    the notes and records are available, and finds that the State
    has established the propriety of assessing those mental
    health costs as part of the restitution herein.
    We uphold as supported by substantial evidence the district court’s
    conclusion that the mental health care costs charged to Edouard were
    48
    incurred “as a direct result” of Edouard’s crimes.                  See Iowa Code
    § 915.86(1); see also id. § 910.2(1) (requiring sentencing courts to order
    offenders to make restitution “to the victims of the offender’s criminal
    activities”).
    Next, Edouard contests the travel expenses granted for attendance
    at trial. 9      Edouard maintains these were costs of prosecution that
    should not have been charged against him. However, Iowa Code section
    915.86(15)         makes       clear   that   victims   can   be   compensated    for
    “[r]easonable expenses incurred by the victim [or] secondary victim,”
    including “for transportation to medical, counseling, . . . or criminal
    justice proceedings, not to exceed one thousand dollars per person.”
    The district court’s award was therefore proper.
    Edouard’s reliance on State v. Knudsen is misplaced.                 See 
    746 N.W.2d 608
    , 610 (Iowa Ct. App. 2008). True, the court of appeals there
    noted that prosecution costs generally cannot be included in a
    restitution order. See id. But the difference here is the State is seeking
    reimbursement for crime victim assistance as opposed to direct
    restitution.       See Iowa Code § 910.2(1).            The crime victim assistance
    statute         specifically     authorizes        compensation    to   victims   for
    transportation expenses under the circumstances presented here. See
    id. § 915.86(15). The State produced evidence to support the victims’
    claims of trial attendance.
    Edouard’s third argument is that the victims were not eligible for
    compensation under Iowa Code section 915.87(2)(a) because they
    consented to their relationships with Edouard.                     That subsection
    9As noted above, the trial location was changed from Marion County, where the
    victims resided, to Dallas County.
    49
    provides that victim compensation “shall not be made when the bodily
    injury or death for which a benefit is sought was caused by . . .
    [c]onsent, provocation, or incitement by the victim.” Id. § 915.87(2)(a).
    The trial court correctly found this provision did not apply.    It would
    miss the entire point of the counselor–therapist sexual exploitation law
    to hold that these victims’ mental health injuries were caused by their
    “consent,” as opposed to the conduct of the defendant, which we have
    described in detail above.
    Finally, Edouard urges that the trial court erroneously overruled
    an objection that the victims had failed to comply with certain
    limitations and reporting requirements contained in Iowa Code sections
    915.84(1) and (2).       The first subsection requires a victim seeking
    compensation to apply within two years after “the date of the crime” or
    “the discovery of the crime,” and the second subsection indicates an
    individual is not eligible for compensation “unless the crime was
    reported to the local police department or county sheriff department
    within seventy-two hours of its occurrence” or “within seventy-two hours
    of the time a report can reasonably be made” if it cannot be reasonably
    reported within seventy-two hours of its occurrence. Id. § 915.84(1)–(2).
    However, both subsections also indicate the department of justice may
    waive the time limitation and reporting requirements “if good cause is
    shown.” Id.
    Edouard points out that some of the victims used the date of their
    police reports, January 2011, as the crime date, despite the fact that
    much of the sexual abuse and exploitation occurred years before.       He
    argues the crimes were not reported within seventy-two hours of their
    commission and reimbursement was not sought within two years of the
    crime.     Therefore, unless good cause was shown, the victims and
    50
    secondary victims (i.e., the spouses) were not eligible for compensation
    under the statute.
    The State argues, in effect, that Edouard has no standing to raise a
    claim of untimeliness because “the decision is between the agency and
    the applicant” whether to award compensation from the CVCP.            We
    disagree. We think the rationale of Jenkins holds otherwise. Regardless
    of whether the State has paid some amount to a victim of crime, in order
    to recover that same amount from the defendant as restitution it must
    show it complied with the underlying law. Otherwise stated, defendants
    should be able “to challenge erroneous CVCP payments.” Jenkins, 788
    N.W.2d at 645.
    The State’s witness did testify that a timeliness review is regularly
    performed and that a memo is usually prepared if an extension of time is
    approved. However, the memo is “considered confidential.” The witness
    did not know if a memo existed in this case.
    We believe this evidence is insufficient to establish the department
    for justice actually found good cause.         Indeed, if it were deemed
    sufficient, no defendant would ever be able to raise a timeliness
    challenge. Admittedly, we have not previously held that Jenkins permits
    a defendant to object to a CVCP restitution award on the ground that the
    deadlines were not waived for good cause.        Therefore, we believe the
    appropriate course of action is to reverse and remand to give the State
    the opportunity to introduce evidence that the CVCP waived any
    deadlines in sections 915.84(1) or (2) for good cause shown.
    IV. Conclusion.
    For the foregoing reasons, we conditionally affirm Edouard’s
    conviction and sentence under Iowa Code section 709.15(4)(a) and his
    conviction and sentence under section 709.15(4)(c) with respect to W.B.
    51
    We affirm Edouard’s remaining convictions. We reverse the restitution
    award to the State. We remand for further proceedings consistent with
    this opinion.
    DECISION OF COURT OF APPEALS VACATED; DISTRICT
    COURT JUDGMENT AFFIRMED IN PART AND REVERSED IN PART;
    CASE REMANDED WITH INSTRUCTIONS.
    All justices concur except Appel, J., and Cady, C.J., who concur
    specially, and Hecht and Wiggins, JJ., who concur in part and dissent in
    part.
    52
    #86/12–1899, State v. Edouard
    APPEL, Justice (concurring specially).
    Part I.
    I agree with Justice Mansfield’s opinion regarding the proper
    interpretation of Iowa’s sexual exploitation statute.      I do not join,
    however, the discussion of the state constitutional issues presented in
    this case. Instead, I present a different analysis, which today, as it has
    in many recent cases, commands the support of the majority of the
    court.
    Part II.
    Where a party raises issues under the Iowa Constitution and the
    Federal Constitution, but does not suggest a different standard be
    applied under the Iowa Constitution, we generally apply the federal
    standard. This comes, however, with an important and indeed critical
    caveat, namely, that we reserve the right to apply that standard
    differently than its federal counterpart.     See, e.g., Freeman v. Grain
    Processing Corp., 
    848 N.W.2d 58
    , 93 (Iowa 2014) (“[W]here a party does
    not suggest a different standard under Iowa law, we adopt for the
    purposes of the case the federal standard, reserving the right to apply the
    standard differently than under the federal cases.”); State v. Ragland,
    
    836 N.W.2d 107
    , 113 (Iowa 2013) (noting “we . . . reserve the right to
    apply the [federal standard] in a more stringent fashion than federal
    precedent”); State v. Kern, 
    831 N.W.2d 149
    , 172, 174 (Iowa 2013)
    (applying federal standards but explicitly reserving the right to apply
    those standards “in a more stringent fashion than federal precedents”);
    State v. Tyler, 
    830 N.W.2d 288
    , 291–92 (Iowa 2013) (“Where a party
    raises both state and federal constitutional claims but does not argue
    that a standard independent of the federal approach should be employed
    53
    under the state constitution, we ordinarily apply the substantive federal
    standards but reserve the right to apply the standard in a fashion
    different from federal precedent.”); State v. Becker, 
    818 N.W.2d 135
    , 150
    (Iowa 2012) (“Even where a party has not provided a substantive
    standard independent of federal law, we reserve the right to apply the
    standard presented by the party in a fashion different than the federal
    cases.”); NextEra Energy Res., LLC v. Iowa Utils. Bd., 
    815 N.W.2d 30
    , 45
    (Iowa 2012) (“Even in cases where a party has not suggested that our
    approach under the Iowa Constitution should be different from that
    under the Federal Constitution, we reserve the right to apply the
    standard in a fashion at variance with federal cases under the Iowa
    Constitution.”); State v. Oliver, 
    812 N.W.2d 636
    , 650 (Iowa 2012) (“[W]e
    do not necessarily apply the federal standards in the same way as the
    United States Supreme Court.”); State v. Breuer, 
    808 N.W.2d 195
    , 200
    (Iowa 2012) (“[E]ven when the parties advance no substantive distinction,
    we may apply the principles differently.”); State v. Pals, 
    805 N.W.2d 767
    ,
    771–72 (Iowa 2011) (“Even where a party has not advanced a different
    standard for interpreting a state constitutional provision, we may apply
    the standard more stringently than federal case law.”); State v. Fannon,
    
    799 N.W.2d 515
    , 519 n.1 (Iowa 2011) (“[A]lthough we reserve the right to
    apply the principles differently, we generally assume that the legal
    principles governing both provisions are the same.”); King v. State, 
    797 N.W.2d 565
    , 571 (Iowa 2011) (“Even in . . . cases in which no substantive
    distinction ha[s] been made between state and federal constitutional
    provisions, we reserve the right to apply the principles differently under
    the state constitution . . . .”); Simmons v. State Pub. Defender, 
    791 N.W.2d 69
    , 76 n.3 (Iowa 2010) (“Even in cases where no substantive
    distinction has been advanced by the parties [between Iowa and federal
    54
    constitutional law], we reserve the right to apply the principles
    differently.”); State v. Bruegger, 
    773 N.W.2d 862
    , 883 (Iowa 2009) (“[W]e
    do not necessarily apply the federal standards in the same way as the
    United States Supreme Court.”); Varnum v. Brien, 
    763 N.W.2d 862
    , 878
    n.6 (Iowa 2009) (“[W]e have jealously guarded our right to employ a
    different analytical framework under the state equal protection clause as
    well as to independently apply the federally formulated principles.”
    (Internal quotation marks omitted.)); In re S.A.J.B., 
    679 N.W.2d 645
    , 648
    (Iowa 2004) (“In analyzing claims under the Iowa Equal Protection
    Clause, we independently apply federal principles.”); Racing Ass’n of
    Cent. Iowa v. Fitzgerald, 
    675 N.W.2d 1
    , 6–7 (Iowa 2004) (“[T]his court’s
    independent application of the rational basis test might result in a
    dissimilar outcome from that reached by the Supreme Court in
    considering   the   federal   constitutional   claim.”).   Of   course,   this
    established principle does not necessarily mean that we will depart from
    federal applications, as our independent judgment may lead us to agree
    with the federal caselaw. See Breuer, 808 N.W.2d at 200–01 (recognizing
    authority to depart in application of federal caselaw but declining to do
    so).   As noted by Robert F. Williams, a leading expert on state
    constitutional law, “State courts might even agree with the United States
    Supreme Court on the meaning—both textually and historically—of
    identical or similar federal and state constitutional provisions, but
    proceed to apply them differently under particular circumstances.”
    Robert F. Williams, State Courts Adopting Federal Constitutional Doctrine:
    Case-By-Case Adoptionism or Prospective Lockstepping?, 46 Wm. & Mary
    L. Rev. 1499, 1501 (2005).
    The distinction between a standard and its application is especially
    important where the legal principles have high degrees of generality,
    55
    such as “totality of circumstances” tests, tests based upon “gross
    proportionality,” and tests based upon “reasonableness.” See Robert F.
    Williams, The Law of American State Constitutions 169–71 (2009); cf.
    Jeffrey S. Sutton, What Does—and Does Not—Ail State Constitutional
    Law, 59 U. Kan. L. Rev. 687, 707 (2011) [hereinafter Sutton]. 10                      Even
    accepting the generalized standard, there is often no single correct
    answer to the interpretation of generalized constitutional commands, but
    only a range of plausible answers which must be decided on a case-by-
    case basis with the exercise of independent judgment. See Chicago &
    N.W. Ry. v. Fachman, 
    255 Iowa 989
    , 996, 
    125 N.W.2d 210
    , 214 (1963)
    (noting in the context of state and federal equal protection claims that
    “[w]hile the general rules applicable in such cases seem pretty well
    settled, as is so often the case the difficulty arises in their application”).
    A majority of the court today reaffirms the principle articulated in our
    many cases, namely, that where a party raises both state and federal
    constitutional claims, we generally apply the federal standard but reserve
    the right to apply the standard in a fashion different and more stringent
    from federal caselaw. To the extent there is any implication by silence in
    10As   noted by Judge Sutton:
    Why the meaning of a federal guarantee proves the meaning of an
    independent state guarantee is rarely explained and often seems
    inexplicable. If the court decisions of another sovereign ought to bear on
    the inquiry, those of a sister state should have more to say about the
    point. State constitutions are more likely to share historical and cultural
    similarities. They necessarily will cover smaller jurisdictions. And in
    almost all instances they will be construing individual-liberty guarantees
    that originated in state constitutions, not the Federal Constitution . . . .
    Sutton, 59 U. of Kan. L. Rev. at 708. See generally State v. Baldon, 
    829 N.W.2d 785
    ,
    803–35 (Iowa 2013) (Appel, J., concurring specially) (discussing the historic role of state
    constitutions in the protection of individual rights and the status of independent state
    constitutional law after the incorporation of the Bill of Rights). .
    56
    our cases that do not explicitly cite this well-established principle, we
    reject it.
    Turning to the merits of the constitutional claims presented in this
    case, we conclude Edouard has not advanced a separate standard for
    analysis under the Iowa Constitution, and therefore apply the general
    standard in the federal caselaw. Based on the available cases applying
    the generally applicable standards, we narrowly conclude, as does
    Justice Mansfield, that, as applied under the facts and circumstances of
    this case, the sexual exploitation statute does not invade a fundamental
    right under the United States Constitution. See State v. Hollenbeck, 
    53 A.3d 591
    , 597–98 (N.H. 2012) (concluding constitutional right recognized
    in Lawrence v. Texas, 
    539 U.S. 558
    , 
    123 S. Ct. 2472
    , 
    156 L. Ed. 2d 508
    (2003) does not extend to imbalanced relationships that are not fully
    consensual).       We similarly conclude that Edouard has not shown the
    statute as applied to him violates the Establishment Clause under the
    United States Constitution, largely for the reasons discussed in Justice
    Mansfield’s opinion. Cf. State v. Wenthe, 
    839 N.W.2d 83
    , 88–91 (Minn.
    2013) (“But the inclusion of religious actors [in the Minnesota clergy-
    sexual-conduct statute] does not violate the Establishment Clause
    because the limitation on members of the clergy is part of a larger
    statutory scheme that regulates the behavior of those involved in certain
    sexual       relationships—relationships   for   which   the   Legislature   has
    determined there is a power imbalance between the parties.”). We then
    proceed to the next step in the analysis and decline to apply the
    substantive standards advanced by Edouard in a fashion different from
    the prevailing caselaw under the Iowa Constitution. We decline to apply
    the legal standards on these issues differently than in Hollenbeck and
    Wenthe under the Iowa Constitution because we are persuaded that the
    57
    legal standards accepted by those parties have been sensibly applied in
    those cases.     As a result, we reject the specific constitutional claims
    raised by Edouard in this case under both the United States and Iowa
    Constitutions.
    Cady, C.J., joins this special concurrence; Wiggins and Hecht, JJ.,
    join in Part II only.
    58
    #12-1899, State v. Edouard
    HECHT, Justice (concurring in part and dissenting in part).
    I concur in that part of the majority’s opinion reversing the district
    court’s ruling denying Patrick Edouard’s request for in camera review of
    W.B.’s counseling records. I respectfully dissent from the remainder of
    the majority’s opinion because I believe Edouard was prejudiced by the
    district court’s failure to properly instruct the jury and its abuse of
    discretion in excluding expert testimony that would have been helpful to
    the jury and essential to the defense.      I would therefore reverse the
    convictions and remand for a new trial.
    Edouard served as the pastor of the Covenant Reformed Church in
    Pella, Iowa, from 2003 to 2010. At various times during that seven-year
    period, Edouard engaged in sexual relationships with four female
    members of his congregation. Details of the relationships first emerged
    in December 2010, and in the next few weeks, Edouard and each of the
    four women had confessed the relationships to their church elders.
    In January 2011, the women attended group therapy sessions in
    which they discussed with each other their relationships with Edouard.
    After attending the therapy sessions, the women filed a report with the
    Pella police department, alleging each “was the subject of [Edouard’s]
    counseling and pastoral care.”     Edouard was later charged with four
    counts of sexual exploitation by a counselor or therapist, in violation of
    Iowa Code section 709.15(2)(c); one count of a pattern, practice, or
    scheme to engage in sexual exploitation by a counselor or therapist, in
    violation of Iowa Code section 709.15(2)(a); and three counts of third
    degree sexual abuse, in violation of Iowa Code section 709.4(1).
    Before trial, the State moved to limit the expert testimony of
    Dr. Hollida Wakefield, an expert offered by Edouard to explain several
    59
    features of the relationships to the jury and to aid him in presenting his
    defense that he had not been providing mental health services, for
    purposes of the statute, in any of the four relationships.                More
    specifically, the State sought to exclude any testimony about differences
    between pastoral care and pastoral counseling and any testimony
    indicating Edouard may have been engaged in the former, but not the
    latter, with each of the women. That testimony, the State argued, would
    be unhelpful and misleading to the jury and would constitute an
    improper legal conclusion.        The district court granted the motion,
    concluding Wakefield’s definitions would be of no assistance in
    explaining    the   statutory   meanings   of   mental   health    services   or
    counseling to the jury and would improperly invade the “function of the
    jury.”
    At trial, Edouard contended he had not, in any of the four
    relationships, acted as a “counselor or therapist” providing “mental
    health services” under the meaning of section 709.15.         He moved for
    judgment of acquittal at the conclusion of the prosecution’s case, and
    later renewed the motion at the conclusion of the trial, contending the
    State had failed to present sufficient evidence of sexual exploitation
    under the requirements of the statute. The district court denied these
    motions.
    Upon conclusion of the ten-day trial, Edouard submitted to the
    court a proposed marshaling instruction for the jury.             His proposed
    instruction enumerated the specific professions set forth in the definition
    of “counselor or therapist” in section 709.15(1)(a), with additional
    language clarifying that the definition required a “formal counseling
    relationship.”      Edouard also requested an instruction indicating a
    conviction under section 709.15 required proof that one or more of the
    60
    women had been his “patient or client.”          Finally, he requested an
    instruction    defining   “mental   health   services”   and   incorporating
    definitions we have used in previous cases for the statutory terms
    “treatment,” “assessment,” and “counseling.”      The district court denied
    these requests and gave its own less detailed instructions over Edouard’s
    objection.
    After deliberation, the jury found Edouard guilty of each of the four
    counts of sexual exploitation by a counselor or therapist and guilty of the
    pattern or practice count. He was acquitted of the three counts of sexual
    abuse.
    Edouard appealed the convictions, and we transferred the case to
    the court of appeals. Along with challenges to the district court’s rulings
    on his expert evidence and his proposed marshaling instructions,
    Edouard raised additional evidentiary challenges and a constitutional
    challenge to the application of section 709.15 to his conduct and to other
    members of the clergy engaging in similar conduct. The court of appeals
    concluded the trial court had abused its discretion in declining to give
    Edouard’s proposed instruction on “mental health services,” found
    Edouard had suffered prejudice as a result of the error, and reversed the
    convictions.   Although unnecessary to its resolution of the case, the
    court of appeals also noted the district court had erred in excluding the
    portions of Dr. Wakefield’s testimony regarding pastoral care and
    pastoral counseling.      Having resolved the case on the instructional
    ground and given guidance regarding the expert testimony, the court of
    appeals declined to reach Edouard’s other challenges. I believe the court
    of appeals correctly decided these issues, and I would affirm its opinion
    for the reasons explained below.
    61
    Section 709.15 prohibits a “counselor or therapist” from engaging
    in a number of enumerated forms of sexual conduct with an “emotionally
    dependent patient or client” who receives “mental health services” from
    the counselor or therapist.   See Iowa Code § 709.15(2)(c) (2013).      The
    section defines “counselor or therapist” as
    a physician, psychologist, nurse, professional counselor,
    social worker, marriage or family therapist, alcohol or drug
    counselor, member of the clergy, or any other person,
    whether or not licensed or registered by the state, who
    provides or purports to provide mental health services.
    Id. § 709.15(1)(a). “Mental health service” is defined as “the treatment,
    assessment, or counseling of another person for a cognitive, behavioral,
    emotional, mental, or social dysfunction, including an intrapersonal or
    interpersonal dysfunction.” Id. § 709.15(1)(d). A “patient or client” is “a
    person who receives mental health services from the counselor or
    therapist.” Id. § 709.15(1)(e). The provision also provides a meaning for
    “emotionally dependent,” defining it as “the nature of the patient’s . . .
    emotional condition or the nature of the treatment provided . . . is such
    that the counselor or therapist knows or has reason to know that the
    patient . . . is significantly impaired in the ability to withhold consent.”
    Id. § 709.15(1)(b).
    In examining the application of section 709.15 to specific
    relationships in the past, we have explained we must assess not just
    isolated words and phrases in the statute, but the section in its entirety,
    and we must look for an interpretation best achieving the statute’s
    purpose.    State v. Gonzalez, 
    718 N.W.2d 304
    , 308 (Iowa 2006).          In
    discerning the meaning of the phrase “mental health services,” we have
    noted it cannot “encompass strictly personal relationships involving the
    informal exchange of advice.” State v. Allen, 
    565 N.W.2d 333
    , 337 (Iowa
    62
    1997).   Instead, when we have analyzed the meaning and purpose of
    section 709.15 in the past, we have emphasized the specialized, technical
    meaning of mental health services and its close association with forms of
    therapy provided by professionals. Id.; Gonzalez, 718 N.W.2d at 308–09.
    In Allen, for example, we encountered a case of a woman who
    suffered severe emotional problems in connection with significant marital
    strain and due, at least in part, to physical and mental abuse she had
    suffered as a child. Allen, 565 N.W.2d at 335. She had been hospitalized
    frequently in the course of dealing with these problems and had several
    times attempted suicide. Id. After a particularly challenging pregnancy
    and pregnancy-related surgery, she began to experience physical
    symptoms, which went unabated despite medical and psychiatric
    treatment. Id. Eventually, she sought the assistance of an unlicensed
    hypnotherapist. Id. In several lengthy meetings over the course of four
    months, the hypnotherapist supplied her with alcoholic beverages and
    initiated and escalated intimate physical contact with her, assuring her
    “that such physical contact would help her to recover from the effects of
    the sexual abuse she had endured as a child.” Id.
    The hypnotherapist was eventually charged with and convicted of
    sexual exploitation under section 709.15.   Id. at 336.   On appeal, the
    hypnotherapist did not deny that he was a counselor or therapist for
    purposes of the statute, and likewise, did not dispute that he had
    provided, or at least purported to provide, mental health services.   Id.
    Instead, he contended section 709.15 was unconstitutionally vague. Id.
    Analyzing section 709.15 for purposes of that contention, we explained
    we would not entertain the “challenge unless the statute reache[d]” a
    significant amount of protected conduct.    Id. at 337.   We concluded
    section 709.15 presented no such danger of substantial encroachment,
    63
    because it clearly did not reach “informal exchange of advice” or
    “ordinary conversations.” Id. Moreover, we explained, the statute would
    not typically apply to “innocuous event[s]” in “romantic relationship[s],”
    and would rarely, “if ever, apply to a marriage relationship.” Id. at 338.
    The relationship at issue in Allen was much different, we explained: the
    hypnotherapist had at all times been acting “[a]s a therapist,” and in a
    “professional role[].”   Id. at 337 n.2.    Later in our analysis of the
    hypnotherapist’s challenges to his convictions, we emphasized the victim
    had sought the hypnotherapist out for help with her physical symptoms
    associated with her long history of mental health problems, and that he
    had engaged in his problematic contact with her while she was “in his
    office for treatment” for these issues. Id. at 339. Given those indications
    of a professional treatment relationship, we affirmed the hypnotherapist’s
    convictions. Id. at 340.
    In Gonzalez, we had occasion to analyze the meaning of the phrase
    “mental health services” more directly and extensively, as the defendant
    challenged directly, in a pretrial motion to dismiss, the allegations that
    he had been working as a counselor or therapist and had been providing
    mental health services. Gonzalez, 718 N.W.2d at 307–08. The defendant
    in Gonzalez worked as a nursing assistant in the psychiatric unit of the
    University of Iowa Hospitals and Clinics, and had been charged with
    sexual exploitation as a result of invasive physical contact with a female
    patient.   Id. at 306.     The trial court granted the nursing assistant’s
    motion to dismiss, determining the assistant had not, even accepting
    various allegations by the State as true, been providing mental health
    services within the meaning of section 709.15. Id. The State appealed.
    Id.
    64
    Analyzing on appeal the nursing assistant’s contention he had not
    been   providing   mental    health   services,   we   parsed    the   phrase’s
    component parts of “treatment,” “assessment,” and “counseling” “for
    certain dysfunctions.”      Id. at 308.    We consulted a dictionary to
    illuminate the meanings of these terms and recognized each incorporated
    a specific, technical meaning, typically associated with professional
    diagnostic and therapeutic modalities, for purposes of the statute.         Id.
    Armed with that understanding, we concluded the nursing assistant
    might reasonably be found to have provided treatment for purposes of
    section 709.15, given the allegations that he performed essential tasks in
    “providing care of psychiatric patients,” he assisted in “providing for a
    therapeutic environment,” and he participated “in planning patient care.”
    Id. Similarly, we explained, he may have provided assessment “because
    he performed nursing tasks to assist in monitoring psychiatric patients,”
    and had assisted with the documenting and reporting of patient
    behavior. Id. Most importantly, we emphasized, the nursing assistant
    might reasonably be found to have provided “treatment and assessment”
    to the patient because he had performed his tasks while she was
    admitted in the psychiatric unit for psychiatric care.          Id. at 308–09.
    Given the existence of that professional treatment environment and
    relationship, we concluded, the nursing assistant’s provision of certain
    services might reasonably have “qualifie[d] him as a ‘counselor’ or
    ‘therapist’ for purposes of Iowa Code section 709.15,” and thus we
    reversed the district court’s dismissal and remanded for trial. Id. at 310.
    Emerging from these analyses is a clear picture of the meaning of
    section 709.15 and its counselor or therapist and mental health services
    requirements. The statute proscribes certain specified forms of conduct
    undertaken in the course of specialized, formal treatment relationships
    65
    and environments. See id. at 308–09 (emphasizing the victim’s presence
    in   the   psychiatric   unit,    the   “therapeutic    relationship,”   and   the
    “therapeutic environment”).          The structure and language of section
    709.15 and related provisions in the Iowa Code illuminate this
    understanding.      The section’s requirement that the conduct occur
    between the counselor or therapist and a “patient or client” of the
    counselor or therapist, for example, plainly implicates a professional
    relationship, indicating the statute reaches only those relationships
    rising to the level of a formal professional treatment relationship. See,
    e.g., Iowa Code § 709.15(2)(b) (proscribing certain conduct with an
    “emotionally dependent patient or client” or an “emotionally dependent
    former patient or client”).
    The statutory definition of “emotionally dependent” is also
    instructive in my analysis, providing the emotional dependence required
    for an exploitation charge must arise from the nature of a patient’s
    emotional condition or “the nature of the treatment provided by the
    counselor or therapist.” Id. § 709.15(1)(b) (emphasis added). We noted
    in Gonzalez that a standard meaning of “treatment” is “ ‘the action or
    manner of treating a patient medically or surgically.’ ”          Gonzalez, 718
    N.W.2d at 308 (quoting Webster’s Third New International Dictionary
    2434–35 (unabr. ed. 2002)).             The incorporation of this specialized
    concept in the statutory definition of emotionally dependent suggests
    section    709.15   reaches      a   specific   class   of   formal   therapeutic
    relationships—namely, those relationships where the services provided
    may be characterized as constituting formal professional treatment. See
    Iowa Code § 709.15(1)(b).        The related civil damages provision, setting
    forth the statute of limitations for damages claims brought in connection
    with sexual exploitation charges, underscores that understanding, in
    66
    providing “action[s] . . . shall be brought within five years of the date the
    victim was last treated by the counselor or therapist.” Id. § 614.1(12)
    (emphasis added).
    Section 709.15 very clearly bounds the categories of actors and
    types of relationships that may run afoul of the statute in setting forth its
    definition of “counselor or therapist.” Physicians, psychologists, nurses,
    professional counselors, social workers, marriage and family therapists,
    and alcohol and drug counselors, I recognize, fill specialized, technical
    roles in the realm of psychiatric care, and perform highly specialized
    functions in providing professional mental health services for clients and
    patients. The definition of “counselor or therapist” itself emphasizes as
    much, incorporating the specialized elements of treatment, assessment,
    and counseling we parsed in Gonzalez in identifying these professionals
    as providers of mental health services.          Id. § 709.15(1)(a).     The
    longstanding inclusion of clergy in this class should not alter this
    understanding, as several sections of the Iowa Code and administrative
    rules indicate clergy, in certain contexts, may provide precisely these
    kinds of formal therapeutic mental health services.           See, e.g., id.
    § 154D.4(1) (noting clergy may provide mental health counseling in
    accordance with standards in their profession); Iowa Admin. Code
    r. 481—53.15(1)(a) (noting spiritual counseling in hospice environment
    shall be provided in accordance with an “interdisciplinary plan of care”).
    Various provisions in the Iowa Code addressing similar subject
    matter highlight the specialized nature of the services these classes of
    professionals provide and the specific training they typically undergo.
    See, e.g., Iowa Code § 135H.1(5) (setting forth coursework and clinical
    training requirements in defining “mental health professional” for
    purposes of chapter addressing psychiatric medical institutions); id.
    67
    § 154D.4(1) (establishing that certain statutory licensing requirements do
    not prevent “nurses, psychologists, social workers, physicians . . . or
    members of the clergy, from providing or advertising that they provide
    services of a marital and family therapy or mental health counseling
    nature consistent with the accepted standards of their respective
    professions” (emphasis added); see also id. § 135G.1(6) (defining mental
    health services as “services provided by a mental health professional
    operating within the scope of the professional’s practice which address
    mental, emotional, medical, or behavioral problems”); Ingeborg E. Haug,
    Boundaries and the Use and Misuse of Power and Authority: Ethical
    Complexities for Clergy Psychotherapists, 77 J. of Counseling & Dev. 411,
    411 (1999) (“Clergy psychotherapists are defined as mental health
    professionals who have received dual education and training as clergy
    and as psychotherapists (the term clergy encompasses Christian and
    non-Christian religions).”).   Similarly, numerous administrative rules
    indicate these classes of actors generally receive substantial training and
    typically fill specialized, technical roles in diagnosing and ameliorating
    specific mental health dysfunctions.      See, e.g., Iowa Admin. Code
    r.   441—88.61 (defining “mental health services” as “those clinical,
    rehabilitative, or supportive services provided by an individual, agency,
    or other entity that is licensed, accredited, certified, or otherwise
    approved as required by law to treat any mental disorder listed in the
    International Classification of Diseases”); id. r. 645—31.1 (defining
    “mental health setting,” for purposes of licensure of marital and family
    therapists, as “a behavioral health setting where an applicant is
    providing mental health services including the diagnosis, treatment, and
    assessment of emotional and mental health disorders and issues”); id.
    r. 645—31.5 (marital and family therapists); id. r. 645—280.5 (social
    68
    workers); id. r. 653—9.3 (physicians); id. r. 655—6.1 (registered and
    practical nurses). The enumeration of these classes of professionals in
    section 709.15, the corresponding exclusion of other categories of actors,
    and the indications in section 709.15, other related sections of the Iowa
    Code, and the administrative rules, of the types of services these
    professionals provide highlight the formal therapeutic and diagnostic
    nature of the relationships contemplated by the statute.
    A   survey   of   related   statutes   and   jurisprudence   in   sister
    jurisdictions augments my understanding that section 709.15 is
    calculated to criminalize conduct in formal treatment relationships in
    which therapeutic mental health services are provided, or in which the
    defendant has purported to provide such services.        A few states have
    sexual exploitation statutes broader than ours, criminalizing conduct
    between various enumerated actors and certain vulnerable individuals,
    without requiring a formal professional therapeutic relationship.        See,
    e.g., Ark. Code Ann. § 5-14-126(a)(1)(C) (West, Westlaw through 2014
    Fiscal Sess.) (mandated reporters and clergy members); Tex. Penal Code
    Ann. § 22.011(b)(10) (West, Westlaw through 2013 Third Called Sess.)
    (requiring, in case of clergyperson, merely a role “as spiritual adviser”).
    See generally Bradley J. B. Toben & Kris Helge, Sexual Misconduct with
    Congregants or Parishioners: Crafting A Model Statute, 1 Brit. J. Am.
    Legal Stud. 189, 209–10 (2012) [hereinafter Toben & Helge] (“Of [thirteen
    jurisdictions with sexual exploitation statutes], only two have language
    that is designed to criminalize such conduct by clergypersons outside of
    the counseling context.”). Arkansas, for example, criminalizes conduct
    when a person is a “mandated reporter [of child maltreatment] or a
    member of the clergy and is in a position of trust or authority over the
    victim and uses the position of trust or authority to engage in [proscribed
    69
    conduct].”   Ark. Code Ann. § 5-14-126(a)(1)(C).   The Arkansas statute
    provides no further definition of “trust or authority,” contains no mental
    health services requirement, contains no patient or client requirement,
    and enumerates a list of relevant actors far longer and more inclusive
    than the list enumerated in our own statute. Compare id. § 5-14-126(a),
    with Iowa Code § 709.15(1)(a); see also H.F. 682, 78th G.A., Reg. Sess.
    (Iowa 1999) (proposing an “exploitation by a person in authority” statute
    which would have applied, had it been adopted, to relationships with
    certain school-aged juveniles).
    Other states, by contrast, have more narrowly drawn exploitation
    statutes, more closely resembling our own. See, e.g., Conn. Gen. Stat.
    Ann. § 53a-65(9) (West, Westlaw through 2014 Feb. Reg. Sess.)
    (enumerating in its definition of “psychotherapist” traditional classes of
    mental health providers and adding hypnotists); N.D. Cent. Code Ann.
    § 12.1-20-06.1(2) (West, Westlaw through 2013 Reg. Sess.) (defining
    “therapist” to mean “a physician, psychologist, psychiatrist, social
    worker, nurse, chemical dependency counselor, member of the clergy, or
    other person, whether licensed or not by the state, who performs or
    purports to perform psychotherapy”); S.D. Codified Laws § 22-22-27(3)
    (West, Westlaw through 2014 Reg. Sess.) (defining “psychotherapist” to
    include various traditional classes of mental health professionals, and
    including clergymembers, marriage and family therapists, and other
    “mental health services provider[s]”); Utah Code Ann. § 76-5-406(12)
    (West, Westlaw through 2014 Gen. Sess.) (enumerating specific classes of
    professional providers and requiring act “committed under the guise of
    providing professional diagnosis”); Wis. Stat. Ann. § 940.22; see also id.
    § 455.01(6) (West, Westlaw through 2013 Wis. Act. 380) (defining
    “psychotherapy” to include specific methods and functions performed in
    70
    “professional relationship”). By enumerating certain professional classes
    of actors, including clergy, while defining mental health services or its
    analog, psychotherapy, in terms of the technical therapeutic function
    being performed, these statutes underscore the technical nature of the
    relationships they cover.
    Of course, as the majority points out, the definition of “counselor
    or therapist” in section 709.15 does not require state licensure or
    registration, and makes reference to “any” individuals who provide or
    purport to provide mental health services. Those indications, however,
    should not alter the foregoing analysis. In both Gonzalez and Allen, we
    very clearly considered individuals operating in occupational classes not
    explicitly identified in the definition of “counselor or therapist,” and yet
    we examined the nature of the relationship and the nature of the
    environment in each scenario to ensure the interaction rose to the level
    of a formal therapeutic relationship. See Gonzalez, 718 N.W.2d at 308;
    Allen, 565 N.W.2d at 337.       As explained, section 709.15 limits its
    coverage in using and defining the term “counselor or therapist”—the
    statute very clearly does not use or define the term “any person,” or “any
    person who provides mental health services,” or “any person in a position
    of power or authority.” Moreover, the definition of counselor or therapist
    has not been set forth so generally as to cover merely “any person who
    provides mental health services,” as our general assembly has clearly
    identified instructive classes of actors before including the less specific
    “any other person” language.       As we have explained on numerous
    occasions, the “any other person” language must be read in the context
    of the language surrounding it. See, e.g., Sorg v. Iowa Dep’t of Revenue,
    
    269 N.W.2d 129
    , 132 (Iowa 1978) (“Under the applicable rule of Noscitur
    a sociis, the meaning of a word in a statute is ascertained in light of the
    71
    meaning of words with which it is associated.”).           In this case, the
    language preceding “any other person” indicates specific classes of actors
    who engage in professional therapeutic relationships.           Any faithful
    reading of the remaining language in the definition must incorporate the
    same lexical cues and constraints—much like we incorporated them in
    our analyses in Allen and Gonzalez.
    At least one court, analyzing the reach of its specialized
    relationship requirement, has concluded its statute can only be read to
    cover relationships “closely associated with the traditional profession of
    therapeutic psychology,” and relationships in which professionals employ
    “therapeutic techniques” in performing or purporting to perform
    “psychotherapy.” State v. Ambrose, 
    540 N.W.2d 208
    , 212 (Wis. Ct. App.
    1995). The court in Ambrose considered a case involving a high school
    teacher who was pursuing a master’s degree in psychology. Id. at 210.
    A student had approached him and asked for help with her depression
    and related family problems. Id. He began meeting with her a few times
    a week, and at these meetings she “told him about her feelings, family
    problems, depression and thoughts of suicide.”       Id.    The relationship
    lasted several months, was briefly interrupted by summer vacation, and
    eventually escalated into a sexual relationship.     Id. at 210–11.     The
    teacher was charged and convicted under Wisconsin’s sexual exploitation
    statute, which prohibits sexual contact between “[a]ny person who is or
    who holds himself or herself out to be a therapist and who intentionally
    has sexual contact with a patient or client during any ongoing therapist–
    patient or therapist–client relationship.”   Id. at 209 n.1; see also Wis.
    Stat. Ann. § 940.22(2).
    The Ambrose court found several factors persuasive in concluding
    its statute could not reach the teacher’s conduct. First, the court noted
    72
    a   professionalism    requirement     in   its   statutory   definition   of
    psychotherapy, which required “ ‘the use of learning, conditioning
    methods and emotional reactions’ ” “ ‘to assist persons to modify feelings,
    attitudes, and behaviors.’ ” Id. at 209 n.1, 212 (quoting Wis. Stat. Ann.
    § 455.01(6)). Second, the court highlighted the statute’s enumeration of
    the relevant categories of actors, which read as follows: “ ‘physician,
    psychologist, social worker, marriage and family therapist, professional
    counselor, nurse, chemical dependency counselor, member of the
    clergy.’ ” Id. (quoting Wis. Stat. Ann. § 940.22(1)(i)). Those professionals,
    the court explained, “are closely associated with the traditional
    profession of therapeutic psychology,” indicating the statute’s coverage of
    relationships accomplishing the specialized “purpose of the profession” of
    psychotherapy. Id. at 212. Third, the court noted there was no evidence
    psychotherapy was typically a “part of the training, education or
    expertise” for teachers. Id. Fourth, the court observed that an individual
    “who conducts informal counseling, even one with a degree in
    psychology, is not engaged as a professional therapist.”        Finally, the
    court explained, the teacher had never held himself out as a therapist
    publicly or privately; he, much like most other teachers, was not trained
    or experienced in the field of psychotherapy; and he was neither
    employed nor compensated for the performance of psychotherapy
    services. Id. For those reasons, the court concluded, the evidence failed
    to establish the “counseling” performed by the teacher had reached the
    level of professional psychotherapy, and the court therefore reversed his
    convictions. Id.
    The Ambrose court’s analysis of Wisconsin’s narrowly drawn
    statute squares convincingly with my understanding of our own narrowly
    drawn statute.     Various cues in section 709.15, including the limited
    73
    enumeration of specific classes of professionals, the patient or client
    requirement, the incorporation of specific terms in the definition of
    mental health services implicating specialized, formal forms of therapy,
    and    the       numerous     other    statutory     cues     implicating     technical,
    professional forms of therapy indicate our statute reaches only formal
    professional therapeutic relationships. If we conclude otherwise—if we,
    for instance, conclude our statute covers less formal relationships,
    regardless whether they might be characterized as involving “counseling”
    or other forms of mental health services, as the majority appears to
    suggest—we must confront constitutional problems of overbreadth and
    vagueness, and might, in cases involving clergy members, encounter
    entanglement and other constitutional issues. 11                See, e.g., Allen, 565
    11After adopting its sweeping interpretation in lieu of the narrower one I favor,
    however, the majority attempts to sidestep these issues by asserting several times,
    inaccurately in my view, that Edouard has failed to raise overbreadth and vagueness
    arguments on appeal. I believe a few observations are warranted here.
    In the jury instruction colloquy in the district court, Edouard argued “[t]he scope
    of mental health services and the scope of the statute is overbroad, in that it covers
    protected activities” and “the definition and scope of mental health services is
    unconstitutionally vague.” In both his pretrial motion to dismiss and his posttrial
    motion for arrest of judgment, he argued the Federal Constitution and the Iowa
    Constitution provide protection against legislative acts that interfere “with certain
    fundamental rights and liberty interests.” On appeal, Edouard advances several
    specific overbreadth arguments. For example, he argues that under the State’s
    proffered definition of mental health services, “every person would have a mental health
    dysfunction.” Relatedly, he argues “[t]he constitutional flaw in the statute as applied in
    the State’s theory of prosecution is that it presumes an unequal power balance merely
    from Edouard’s status as a member of the clergy.” In addition, Edouard cites very
    prominently in his constitutional analysis Roe v. Wade, 
    410 U.S. 113
    , 164, 
    93 S. Ct. 705
    , 732, 
    35 L. Ed. 2d 147
    , 183 (1973). By most accounts, Roe was an overbreadth
    case, as the majority explained the Texas statute at issue “swe[pt] too broadly,” and
    made “no distinction between abortions performed early in pregnancy and those
    performed later.” Id. at 164, 93 S. Ct. at 732, 35 L. Ed. 2d at 183; see also Ada v.
    Guam Soc’y of Obstetricians and Gynecologists, 
    506 U.S. 1011
    , 1011, 
    113 S. Ct. 633
    ,
    634, 
    121 L. Ed. 2d 564
    , 565 (1992) (Scalia, J., dissenting) (explaining the Roe court
    “seemingly employed an ‘overbreadth’ approach”). These features, among others, of
    Edouard’s appeal are indisputably overbreadth arguments in my view.
    Similarly, Edouard’s vagueness arguments abound on appeal. “If [the Gonzalez
    definition] does not apply, as the State suggests,” Edouard argues, “then what definition
    74
    N.W.2d at 337 (explaining statute may be unconstitutional if it reaches
    “substantial amount of protected conduct” (internal quotation marks
    __________________________
    of ‘counseling’ should apply here?” Relatedly, he cites Knight v. Iowa District Court, 
    269 N.W.2d 430
    , 433 (Iowa 1978), for the proposition that “criminal acts that are malum
    prohibitum must be delineated clearly and unequivocally.” And, as noted, he cites Roe,
    where the Court clearly explained it would not address a vagueness challenge only
    because the overbreadth grounds were dispositive. Roe, 410 U.S. at 164, 93 S. Ct. at
    732, 35 L. Ed. 2d at 183. Given these features of Edouard’s appeal and others, I do not
    believe we can seriously conclude Edouard has failed to advance a vagueness challenge
    here.
    Finally, I would note I do not believe we can appropriately “compartmentalize”
    Edouard’s vagueness and overbreadth challenges for purposes of analysis here, as we
    have done many times without explanation in the past. See Smith v. Goguen, 
    415 U.S. 566
    , 577 n.20, 
    94 S. Ct. 1242
    , 1249 n.20, 
    39 L. Ed. 2d 605
    , 614 n.20 (1974)
    (“Appellant is correct in asserting that Goguen failed to compartmentalize in his state
    court brief the due process doctrine of vagueness and First Amendment concepts of
    overbreadth. . . . But permitting a degree of leakage between those particular adjoining
    compartments is understandable.”). As numerous authorities have recognized, the
    purpose of the special vagueness variant applicable in First Amendment cases and
    other cases involving fundamental rights parallels that of both the “ordinary” vagueness
    doctrine and the “ordinary” overbreadth doctrine: Each is designed “to avoid the chilling
    of constitutionally protected expression and to reduce the possibility that an open-
    ended delegation of authority may lead to selective enforcement against unpopular
    causes.” Richard H. Fallon, Jr., Making Sense of Overbreadth, 100 Yale L.J. 853, 904
    (1991) [hereinafter Fallon] (footnotes omitted) (internal quotation marks omitted); see
    also Kolender v. Lawson, 
    461 U.S. 352
    , 358 n.8, 
    103 S. Ct. 1855
    , 1859 n.8, 
    75 L. Ed. 2d
     903, 910 n.8 (1983) (“[W]e have traditionally viewed vagueness and overbreadth as
    logically related and similar doctrines.”); Goguen, 415 U.S. at 573, 94 S. Ct. at 1247, 39
    L. Ed. 2d at 612 (“Where a statute’s literal scope, unaided by a narrowing state court
    interpretation, is capable of reaching expression sheltered by the First Amendment, the
    [vagueness] doctrine demands a greater degree of specificity than in other contexts.”); cf.
    Michael C. Dorf, Facial Challenges to State and Federal Statutes, 46 Stan. L. Rev. 235,
    276 (1993) (“In fact, the Court has been applying overbreadth analysis in substantive
    due process cases for quite some time, albeit without expressly stating as much.”).
    Thus, it may well be that in a case like this one, Edouard’s vagueness challenge is “best
    conceptualized as a subpart of First Amendment overbreadth doctrine.” See Fallon, 100
    Yale L.J. at 904. Regardless the conceptualization, however, I believe Edouard, in
    addressing the broad interpretation the majority adopts with specific vagueness and
    overbreadth arguments, has asserted his “right not to be burdened by an
    unconstitutional rule of law.” Henry Paul Monaghan, Overbreadth, 1981 Sup. Ct. Rev.
    1, 4 (1981) (“[A]n overbreadth litigant [does not] invoke the rights of third parties; as ‘a
    theoretical matter the [overbreadth] claimant is asserting his own right not to be
    burdened by an unconstitutional rule of law, though naturally the claim is not one
    which depends on the privileged character of his own conduct.”); see also William A.
    Fletcher, The Structure of Standing, 98 Yale L.J. 221, 244 (1988) (“[Someone who makes
    an overbreadth challenge to a statute] is not directly asserting [an]other person’s rights
    to engage in protected conduct; rather, she is asserting her right to be free from control
    by an invalid statute.”); Marc E. Isserles, Overcoming Overbreadth: Facial Challenges
    and the Valid Rule Requirement, 48 Am. U. L. Rev. 359, 367 (1998) (“Thus, the
    overbreadth challenger might claim that he or she is asserting a personal right to be
    free from prosecution because an overbroad law that permits some unconstitutional
    applications cannot be enforced against anyone.”).
    75
    omitted)); State v. Bussman, 
    741 N.W.2d 79
    , 91–92 (Minn. 2007)
    (concluding sexual exploitation statute was unconstitutional as applied
    to clergy member, and noting it might reach any relationship in which
    clergy member and congregant had sexual contact “if the two were also,
    as would seem likely, discussing spiritual or religious matters on an
    ongoing basis”); cf. Carter v. Broadlawns Med. Ctr., 
    857 F.2d 448
    , 457
    (8th Cir. 1988) (“[T]he record established that Chaplain Rogers also
    provides a significant amount of purely secular counseling to the
    employees.       She testified that her exchanges with staff members
    primarily involved assisting the employees with personal problems, such
    as letting off steam about supervisors, dealing with gossip and teen-age
    children, and venting grief over loss of a family member.              Chaplain
    Rogers viewed her service as giving support and encouragement, and she
    stated that it was relatively rare for these interactions to assume a
    religious nature.”).
    As we have explained on numerous occasions, our doctrine of
    constitutional    avoidance     compels     us   to    avoid    constitutionally
    impermissible constructions of statutes where possible. See, e.g., State
    v. Dist. Ct., 
    843 N.W.2d 76
    , 85 (Iowa 2014). My understanding of section
    709.15 and its coverage of formal professional therapeutic relationships
    avoids implication of the issues recognized in Allen and Bussman, and is
    consistent   with      our   general   preference     for   steering   clear   of
    constitutionally problematic constructions. See, e.g., Toben & Helge, 1
    Brit. J. Am. Legal Stud. at 215 (“Numerous state legislatures such as
    [those in] Kansas and Texas have recently proposed or passed bills into
    law to attenuate this sexual misconduct problem, however, most of these
    bills passed into law include language that requires a court to interpret
    church policy or doctrine.         Consequently, these laws have either
    76
    encountered or potentially could meet constitutional entanglement
    issues.”); see also Robert J. Basil, Note, Clergy Malpractice: Taking
    Spiritual Counseling Conflicts Beyond Intentional Tort Analysis, 19
    Rutgers L.J. 419, 444–45 n.96 (1988) (“Analogy to medical malpractice is
    appropriate . . . when the standard addresses a procedural duty which is
    based on a duty of professionalism, rather than religious beliefs.”).
    I would therefore take this occasion to reiterate our longstanding
    recognition that section 709.15 has been narrowly drawn to reach only
    formal therapeutic relationships.     See Gonzalez, 718 N.W.2d at 308
    (concluding establishment of “therapeutic relationship[]” with psychiatric
    patient could constitute treatment for purposes of section 709.15); Allen,
    565 N.W.2d at 337 (explaining statute does not reach relationships
    “involving the informal exchange of advice[]”).         Further, I would
    emphasize the statute has set forth several specific requirements to
    ensure an interaction rises to the level of covered formal professional
    relationship including, but not limited to: the actor must fit comfortably
    within the classes of professionals enumerated in the definition of
    “counselor or therapist”; the emotional dependence must arise from a
    specific kind of emotional condition or from a specific course of treatment
    provided by the counselor or therapist; the alleged victim must be or
    have been a “patient or client” of the counselor or therapist; and the
    treatment provided by the actor must be consistent with and rise to the
    level of the specific diagnostic and therapeutic services contemplated by
    the terms incorporated in the statutory definition of “mental health
    services.”   See Iowa Code § 709.15; see also Gonzalez, 718 N.W.2d at
    308. Edouard’s entire defense was based on the propositions that (1) he
    and the State’s complaining witnesses did not have a formal treatment
    relationship of the type covered by the statute, and (2) he did not provide,
    77
    or purport to provide, mental health services to clients or patients. With
    these principles, requirements, and contentions in mind, I turn to
    Edouard’s challenges regarding the marshaling instructions and the
    district court’s ruling on the proffered expert testimony.
    A.   Marshaling Instructions.        Under Iowa law, the trial court
    must provide the jury with instructions setting forth the law applicable to
    all material issues in a case. State v. Marin, 
    788 N.W.2d 833
    , 837 (Iowa
    2010). In addition, the court must give a requested instruction when it
    states a correct rule of law applicable to the facts of the case and the
    concept is not otherwise conveyed in other instructions. Id. We have not
    required the trial court give any particular form of instruction; instead,
    we have explained the court must give instructions fairly stating the law
    as it applies to the facts of the case before it. Id. at 838.
    Here, the district court instructed the jury as follows:
    The State must prove each of the following elements of
    Sexual Exploitation by a Counselor or Therapist as to
    [alleged victim]:
    1. On or about January, 2006, through 2008, the defendant
    engaged in sexual conduct with [alleged victim].
    2. The defendant did so with the specific intent to arouse or
    satisfy the sexual desires of either the defendant or [alleged
    victim].
    3. The defendant was then a counselor or therapist.
    4. [Alleged victim] was then receiving mental health services
    from the defendant, or had received mental health services
    from the defendant within one year prior to the conduct.
    The court added an instruction defining “counselor or therapist” as
    including “a member of the clergy, or any other person, whether or not
    licensed or registered by the State, who provides or purports to provide
    78
    mental health services.” The court also provided the following definition
    for “mental health services”:
    the providing of treatment, assessment, or counseling to
    another person for a cognitive, behavioral, emotional, mental
    or social dysfunction, including an intrapersonal or
    interpersonal dysfunction.     It does not include strictly
    personal relationships involving the informal exchange of
    advice, nor does it include the giving of general spiritual
    advice or guidance from a clergy member to congregants. It
    contemplates a counseling relationship with the clergy
    member established for the purpose of addressing particular
    mental, intrapersonal or interpersonal dysfunctions.
    Edouard objected to these instructions on the grounds they failed to
    convey the patient or client requirement set forth in the statute, failed to
    convey the scientific definitions of the specific terms incorporated in the
    statutory definition of “mental health services” we relied on in Gonzalez,
    and failed to convey the statute’s enumeration of specific professional
    classes of actors in defining “counselor or therapist.”     He proposed a
    modified set of instructions incorporating each of these elements, but the
    court declined to adopt them.        On appeal, Edouard reiterates his
    contentions and argues the district court abused its discretion in
    declining to give his proposed instructions.
    Based on my review of the explicit statutory requirements and the
    principles articulated in our caselaw, I conclude Edouard’s contentions
    have merit. The “patient or client” requirement, for example, was very
    plainly applicable to Edouard’s defense and his proposed instruction
    accurately stated the relevant law. The requirement is set forth both in
    the statute itself and in the relevant pattern criminal jury instructions.
    See Iowa Code § 709.15(1)(e); Iowa State Bar Ass’n, Iowa Crim. Jury
    Instruction 920.3 (2013).       While the district court’s instructions
    incorporated a requirement that the alleged victims had received mental
    health services from Edouard, consistent with the statutory definition of
    79
    patient or client, they failed to include the important statutory “patient or
    client” language itself.   As I have explained above, this language is
    crucial to understanding section 709.15, as it explicitly emphasizes the
    formal professional therapeutic relationship contemplated by the statute.
    It was the State’s burden to prove more than the fact that Edouard met
    and spoke with the four women about intensely personal matters. The
    meetings and conversation must have been in the context of a formal
    professional therapeutic relationship in which the women became
    Edouard’s patients or clients—not merely members of his congregation.
    Lacking specific language capturing the basic statutory requirement of a
    formal therapeutic relationship, I believe the jury instructions as given
    allowed for an unduly broad understanding of the statute, risking the
    possibility the jury might have concluded the statute reached conduct
    even in the absence of the required specialized relationship. See, e.g.,
    Pub. Citizen v. U.S. Dep’t of Justice, 
    491 U.S. 440
    , 452–54, 
    109 S. Ct. 2558
    , 2566–67, 
    105 L. Ed. 2d 377
    , 390–92 (1989) (explaining reliance on
    statutory definition was “not entirely satisfactory” and looking for “other
    evidence of congressional intent to lend the term its proper scope”);
    Darryl K. Brown, Regulating Decision Effects of Legally Sufficient Jury
    Instructions, 73 S. Cal. L. Rev. 1105, 1113 (2000) (noting two or more
    “formally equivalent” descriptions of statutory element often lead
    “decisionmakers to different choices” because “one presentation triggers
    inferences and assumptions that change its effective meaning”); Peter
    Tiersma, The Rocky Road to Legal Reform: Improving the Language of Jury
    Instructions, 66 Brook. L. Rev. 1081, 1102–03 (2001) (noting model
    instruction committee will often recommend use of both statutory term
    and more ordinary meaning because jurors may be as familiar with
    statutory term and because ordinary meaning may not be “close enough
    80
    in meaning”); cf. United States v. Kozminski, 
    487 U.S. 931
    , 969–70, 
    108 S. Ct. 2751
    , 2774, 
    101 L. Ed. 2d 788
    , 822 (1988) (Stevens, J.,
    concurring) (“In my view, individuals attempting to conform their conduct
    to the rule of law, prosecutors, and jurors are just as capable of
    understanding and applying the term ‘involuntary servitude’ as they are
    of applying the concept of ‘slavelike condition.’ Moreover, to the extent
    ‘slavelike condition of servitude’ means something less than ‘involuntary
    servitude,’ I see no basis for reading the statute more narrowly than
    written.”).
    Similarly, Edouard’s request for an enumeration of the specific
    categories of mental health professions in the statutory definition of
    “counselor or therapist” duplicated the applicable statutory language,
    and would have provided important context for understanding the types
    of relationships covered by section 709.15. The statutory definition does
    not merely implicate clergy and any other person who might purport to
    provide mental health services, as the definitions offered by the district
    court and majority suggest.       Instead, the definition sets forth an
    illuminating list of specific categories of professionals who provide mental
    health services, while excluding other classes of actors who might also
    engage in relationships with emotional or related underpinnings. This
    definition, as I have explained, is crucial context for an appropriate
    understanding of section 709.15.     Section 709.15 covers not just any
    relationship involving an enumerated professional and having some
    mental health component, but only those relationships in which the
    provider and an emotionally dependent client or patient (or former client
    or patient) have engaged in a formal therapeutic mental health
    relationship.    The statute’s itemization of the professionals who
    commonly provide mental health services emphasizes the importance of
    81
    the existence of a formal therapeutic relationship as a key feature of the
    state’s burden of proof and Edouard’s defense. In my view, the district
    court’s omission from the instructions of Eduoard’s request for the
    statutory   itemization   of   professionals   providing      such   professional
    services left the jury with an unduly broad understanding of the statute’s
    circumscribed reach.      See, e.g., Sorg, 269 N.W.2d at 132 (“Under the
    applicable rule of Noscitur a sociis, the meaning of a word in a statute is
    ascertained in light of the meaning of words with which it is
    associated.”); State v. Roggenkamp, 
    106 P.3d 196
    , 200 (Wash. 2005)
    (explaining “shelter” in the phrase “food, water, shelter, clothing, and
    medically necessary health care . . . should not be isolated and analyzed
    apart from the words surrounding it”); see also United States v.
    Zimmerman,     
    943 F.2d 1204
    ,   1213    (10th   Cir.    1991)   (requiring
    instructions to “state the law which governs” and provide “the jury with
    an ample understanding of the issues and standards applicable”
    (internal quotation marks omitted)); Robert W. Rieber & William A.
    Stewart, The Interactions of the Language Sciences and the Law, 606
    Annals N.Y. Acad. Sci. 1, 2 (1990) (“In more than one instance,
    linguistics and the law have independently discovered the same
    principles of language.     For example, the legal canon of construction
    noscitur a sociis (indicating that the meaning of words is to be known
    from the other words with which they are associated) is, in essence, the
    semanticist’s principle of contextual constraints on lexical meaning.”).
    Finally, Edouard’s request for specific definitions of “counseling,”
    “treatment,” and “assessment” duplicated the definitions we set forth in
    Gonzalez, and was clearly applicable to his defense.            The definitions
    would have provided additional important context for the jury, conveying
    the technical nature of these terms and their close association with
    82
    professional   diagnosis   and   treatment   of   emotional   and   cognitive
    dysfunctions affecting clients or patients. While the Gonzalez definitions
    need not constitute exhaustive definitions for purposes of section 709.15
    analysis, they do accurately convey the general statutory meaning, and
    they do clearly bound the universe of acceptable interpretations of
    mental health services in implicating only specific classes of formal
    therapeutic relationships.       See Gonzalez, 718 N.W.2d at 308–09
    (emphasizing therapeutic relationship, therapeutic environment, and
    formal psychiatric environment).     The omission of these definitions or
    any related indication of the technical meaning of mental health services
    in the jury instructions given by the district court again raises the risk of
    an unduly broad understanding of the statute.
    Because the jury instructions failed to convey these important legal
    limiting principles, I would conclude the district court erred in refusing
    to submit Edouard’s proposed instructions. See Marin, 788 N.W.2d at
    837.   Instructional errors of this kind, we have previously explained,
    warrant reversal unless the record demonstrates an absence of prejudice.
    State v. Frei, 
    831 N.W.2d 70
    , 73 (Iowa 2013).                 For errors of
    nonconstitutional magnitude, we have noted prejudice is established
    when it appears the rights of the complaining party have been injuriously
    affected, or it appears the party has suffered a miscarriage of justice. Id.
    The omission of the requested instructions here failed to ensure the jury
    would apply each of the distinct statutory elements substantiating a
    formal professional therapeutic relationship in evaluating Edouard’s
    defense he had never engaged in a relationship of the kind contemplated
    by the statute. A failure of that nature, we have often said, will establish
    prejudice. See, e.g., State v. Kellogg, 
    542 N.W.2d 514
    , 518 (Iowa 1996)
    (reversing conviction of domestic abuse assault where jury instruction
    83
    failed to explicitly enumerate all relevant indicia of cohabitation).
    Analyzing the instructional error here in conjunction with the evidentiary
    error I discuss next, I conclude the record conclusively establishes
    prejudice.
    B. Expert Testimony.         Turning to the first of Edouard’s
    evidentiary challenges, I note the district court limited Dr. Wakefield’s
    proposed expert testimony regarding the differences between pastoral
    care and pastoral counseling, on the ground it would be unhelpful to the
    jury and would usurp the “function of the jury.” At the outset, I note we
    have often emphasized our commitment to a liberal view on the
    admissibility of expert testimony. Leaf v. Goodyear Tire & Rubber Co.,
    
    590 N.W.2d 525
    , 531 (Iowa 1999).         For purposes of determining the
    admissibility of expert evidence, we have recently explained, it is of no
    moment that testimony addresses “ ‘an ultimate issue to be decided by
    the trier of fact.’ ” See In re Det. of Palmer, 
    691 N.W.2d 413
    , 419 (Iowa
    2005) (quoting Iowa R. Evid. 5.704).     Instead, we noted, our evidence
    rules compel us to consider whether the evidence meets our other
    longstanding evidentiary requirements. Id. The problem with a specific
    subset of expert testimony offered in a form embracing a legal
    conclusion, we emphasized, is “not that the opinion” may usurp the
    function “of the jury,” but rather that it may conflict with the
    responsibility of the court to determine applicable law and to instruct the
    jury accordingly.   Id.   To determine whether that conflict exists, we
    explained, we must look to standard evidentiary inquiries: the question
    of whether the evidence is helpful to the fact finder, the likelihood of
    misunderstanding by the fact finder of the legal terms used, and the
    question of whether the factual basis for any legal terms used has been
    adequately developed. Id. at 419–20.
    84
    Focusing attention on the appropriate inquiries, I note we have
    often looked for guidance to the approaches other jurisdictions have
    taken in analyzing their own closely related rules of evidence.    See id.
    (noting Iowa Rule of Evidence 5.704 is “identical to its federal
    counterpart,” and analyzing federal caselaw and standard evidence
    treatises). Several authorities have set forth principles applicable to our
    helpfulness analysis here.    Courts have explained, for example, that
    expert testimony is generally helpful where it relates to subject matter
    outside the common experience of the jury.       See, e.g., Fed. Crop Ins.
    Corp. v. Hester, 
    765 F.2d 723
    , 728 (8th Cir. 1985) (noting admissibility of
    expert testimony regarding farm production on this basis); United States
    v. Johnson, 
    735 F.2d 1200
    , 1202 (9th Cir. 1984) (“The federal courts
    uniformly hold . . . that government agents or similar persons may testify
    as to the general practices of criminals to establish the defendant’s
    modus operandi. Such evidence helps the jury to understand complex
    criminal activities, and alerts it to the possibility that combinations of
    seemingly innocuous events may indicate criminal behavior.”).       Expert
    testimony regarding business practices and customs unfamiliar to the
    general public has therefore often been deemed admissible.       See, e.g.,
    United States v. McIver, 
    470 F.3d 550
    , 560–62 (4th Cir. 2006) (concluding
    expert testimony that physician treated patients outside course of
    legitimate medical practice was admissible); United States v. Perkins, 
    470 F.3d 150
    , 159–60 (4th Cir. 2006) (permitting testimony regarding
    reasonableness of use of force, explaining touchstone was whether
    testimony was helpful to jury, and noting questioning focused on
    witness’s “personal” assessment of defendant’s use of force); Berckeley
    Inv. Grp., Ltd. v. Colkitt, 
    455 F.3d 195
    , 218–19 (3d Cir. 2006) (explaining
    testimony regarding securities industry practice and custom was
    85
    admissible and probative of buyer’s state of mind at time of agreement);
    United States v. Mohr, 
    318 F.3d 613
    , 624–25 (4th Cir. 2003) (explaining
    expert testimony that use of police dog “violated ‘prevailing police
    practices’ ” did not impermissibly tell jury “ ‘what decision to reach’ ”);
    TCBY Sys., Inc. v. RSP Co., 
    33 F.3d 925
    , 929 (8th Cir. 1994) (permitting
    testimony in action for breach of franchise agreement that franchisor’s
    site-review-and-evaluation process failed to meet minimum custom and
    practice observed by franchisors in fast food franchise industry); State v.
    LaCount, 
    750 N.W.2d 780
    , 787–88 (Wis. 2008) (permitting testimony
    regarding the basic factual characteristics of an investment contract to
    assist the jury in determining whether a transaction involved a security).
    In my view, Dr. Wakefield’s testimony was of a type that would
    have been helpful to the jury on multiple levels. First, as Edouard was a
    pastor rather than a psychiatrist, psychologist, or social worker,
    Dr. Wakefield would have provided important context for the jury.
    Unlike the other typical providers of mental health services, pastors
    spend much of their time providing pastoral care that falls outside the
    statutory definition of mental health services. Edouard’s defense turned
    on the jury understanding that pastors interact with their parishioners
    in countless ways that—although often very supportive and beneficial—
    do not constitute “mental health services” as contemplated in section
    709.15.    The district court’s ruling denied the jury this helpful
    information that was essential to Edouard’s theory of defense, and
    outside the jury’s common understanding.
    Even where proposed testimony falls generally within the common
    understanding of the jury, authorities have typically agreed testimony
    may be helpful when it offers specialized knowledge. See, e.g., Kopf v.
    Skyrm, 
    993 F.2d 374
    , 377 (4th Cir. 1993) (“The subject matter of Rule
    86
    702 testimony need not be arcane or even especially difficult to
    comprehend.    If, again in the disjunctive, the proposed testimony will
    recount or employ ‘scientific, technical, or other specialized knowledge,’ it
    is a proper subject.”); 7 Wigmore on Evidence § 1923, at 31–32
    (Chadbourn rev. 1978) (“The true test of the admissibility of such
    testimony is not whether the subject matter is common or uncommon, or
    whether many persons or few have some knowledge of the matter, but it
    is whether the witnesses offered as experts have any peculiar knowledge
    or experience, not common to the world, which renders their opinions
    founded on such knowledge or experience any aid to the Court or jury in
    determining the questions at issue.”).     Likewise, where the fact finder
    may have some knowledge of particular subject matter, but the
    knowledge may be incomplete or inaccurate, courts have recognized
    expert testimony may be helpful. See, e.g., United States v. Amuso, 
    21 F.3d 1251
    , 1264 (2d Cir. 1994) (“Despite the prevalence of organized
    crime stories in the news and popular media, [crime family structure and
    terminology] remain proper subjects for expert testimony.”). In this case,
    Dr. Wakefield’s knowledge of the important distinction between pastoral
    care and mental health counseling provided by pastors was specialized
    information that would have been helpful to the jury in sorting out
    whether Edouard engaged, or purported to engage, in counseling as the
    term is defined in section 709.15. Although jurors might be expected to
    have some general knowledge about tasks commonly performed by
    pastors, their knowledge of the distinction between pastoral care and
    pastoral counseling that could have been illuminated by Dr. Wakefield
    was likely incomplete or inaccurate.      Dr. Wakefield’s testimony could
    have minimized the risk jurors harbored a misunderstanding that
    counseling by pastors within the circumscribed meaning of section
    87
    709.15 extends beyond professional therapeutic relationships with
    emotionally dependent patients or clients receiving mental health
    services.   Just as the evidence would have assisted the jury, it would
    have been very helpful to the defense in this case.
    The    majority   perfunctorily    rejects   Edouard’s    proffer   of
    Dr. Wakefield’s testimony as an effort to redefine mental health services
    in a manner incompatible with the meaning of section 709.15 and opine
    that Edouard didn’t provide them.          I strongly disagree with this
    characterization.   The effort was instead calculated to communicate
    specialized knowledge about mental health services provided by pastors
    in formal therapeutic relationships with clients or patients.    The effort
    was to educate the jury that the same definition of counseling and
    mental health services applicable to a psychiatrist, psychologist, or social
    worker in a prosecution under section 709.15 should be applied against
    Edouard as a pastor.      In other words, the defense sought through
    Dr. Wakefield’s testimony to guard against the distinct possibility that
    the jury might misunderstand that “counseling” has a much broader
    meaning in the pastoral context than in other professional contexts.
    Accordingly, I believe the majority misses the mark when it asserts
    Edouard’s offer of expert testimony was calculated to redefine the
    statutory standard.     The offer was absolutely consistent with the
    statutory framework’s central limiting principles, and should have been
    received.
    Further, where no other evidence is available on an issue, courts
    have explained expert testimony may be crucial to the fact finder’s
    understanding. See, e.g., Harris v. Pac. Floor Mach. Mfg. Co., 
    856 F.2d 64
    , 67–68 (8th Cir. 1988) (noting distinction between testimony regarding
    criteria by which expert would form an opinion about the adequacy of a
    88
    warning, which was important to fact finder’s understanding, and direct
    testimony regarding adequacy of warnings, which failed to provide
    similar aid). No other trial witness supplied the specialized knowledge
    offered by Dr. Wakefield.
    Perhaps most importantly, courts have recognized the importance
    of the issue to which expert testimony relates is a significant factor in
    assessing the testimony’s helpfulness.          See, e.g., United States v.
    Alexander, 
    816 F.2d 164
    , 167–69 (5th Cir. 1987) (explaining district
    court erred in excluding evidence bearing directly on issue central to
    determination of defendant’s guilt). In my view, the majority completely
    misapprehends the crucial significance of this evidence to the defense.
    There was no more important witness for Edouard in this case than
    Dr. Wakefield, who offered specialized knowledge illuminating what
    mental health counseling looks like when it is provided by a pastor to
    parishioners who are his clients or patients.
    Courts have also articulated useful principles for analyzing the
    likelihood of jury confusion and the question of whether adequate factual
    basis for any testimony has been developed. As we explained in Palmer,
    we are most frequently concerned with opinions implicating legal
    standards and terminology when the fact finder may not understand the
    legal definitions of the terms and standards used. Palmer, 691 N.W.2d at
    419.   Various courts have elaborated on this concern, noting where
    testimony fails to explain how tests and terms with legal meaning relate
    to the facts in the case, the fact finder may not understand the testimony
    or may attribute a meaning unintended by the witness. See, e.g., United
    States v. Simpson, 
    7 F.3d 186
    , 188–89 (10th Cir. 1993) (“When an expert
    merely states an opinion on an ultimate issue without adequately
    exploring the criteria upon which the opinion is based, the jury is
    89
    provided with no independent means by which it can reach its own
    conclusion or give proper weight to the expert testimony.”). Thus, courts
    have explained, experts may often avoid the problem of confusion by
    employing language that does not have unrelated meaning under the law
    applicable to the case. See, e.g., United States v. Duncan, 
    42 F.3d 97
    ,
    103 (2d Cir. 1994) (permitting testimony about defendant’s submission of
    false tax returns, where witness did not rely specifically on terms derived
    directly from statutory language but, instead, used terms laypersons
    could understand). Dr. Wakefield’s testimony was, as I have suggested
    above, clearly calculated to eliminate jurors’ confusion surrounding the
    nature and extent of mental health services provided by pastors.
    Similarly, experts have avoided problems of confusion by using
    language with a meaning accessible to laypeople, by using language
    having the same lay meaning as the legal meaning, or by clearly
    signifying the use of a specific meaning when the lay and legal meanings
    differ.    See, e.g., United States v. Nixon, 
    918 F.2d 895
    , 905 (11th Cir.
    1990) (“Considered in context, the police detective’s use of the term
    ‘conspiracy’ was a factual—not a legal—conclusion and did not track
    unduly the definition of the offense in [the relevant statute].”); United
    States v. Kelly, 
    679 F.2d 135
    , 136 (8th Cir. 1982) (permitting narcotics
    officer’s testimony that quantity of cocaine found on defendant at time of
    arrest was “a quantity that would be possessed with intent to
    distribute”); Maury R. Olicker, Comment, The Admissibility of Expert
    Witness Testimony: Time to Take the Final Leap?, 42 U. Miami L. Rev.
    831, 872 (1988) (“There is yet another group of cases [admitting opinion
    testimony] in which the court found that, although the witness reached a
    conclusion using a term of law, his statement must properly be
    understood in another context, completely disregarding the legal
    90
    meaning. This is not quite the same as saying that the jury will not be
    confused because it will automatically tend to attach the correct meaning
    to the term.   Instead, the court is saying that because of the broader
    context of the witness’s testimony, the jury will understand that he did
    not mean the word in a legal sense but in some other sense.”).            Dr.
    Wakefield’s testimony on the important distinction between pastoral care
    and pastoral counseling would not, in my view, have increased the risk of
    jury confusion. On the contrary, her explication of the context in which
    pastors—like other mental health professionals—provide mental health
    services to emotionally dependent patients or clients in a formal
    therapeutic environment was expressed in words entirely consistent with
    the carefully circumscribed meaning of the essential terms within section
    709.15.
    Finally, various courts have explained the distinction between
    admissible factual opinion and impermissible legal conclusion may often
    be difficult to perceive based on the overlap of the terms used. In these
    cases, cognizant of the potential for confusion, courts have nevertheless
    often allowed the proposed testimony, explaining “[m]edical and legal
    terms often overlap, and a medical expert cannot be expected to use
    different words merely to avoid this specific problem.” See, e.g., United
    States v. Two Eagle, 
    318 F.3d 785
    , 793 (8th Cir. 2003); Hagen Ins. Inc. v.
    Roller, 
    139 P.3d 1216
    , 1222–23 (Alaska 2006). Fairness and efficiency
    concerns will often dictate admissibility, courts have explained, as long
    as the testimony is confined to relevant issues, is based on proper legal
    concepts, and meets the other requirements of the rules of evidence.
    See, e.g., First Nat’l State Bank of N.J. v. Reliance Elec. Co., 
    668 F.2d 725
    ,
    731 (3d Cir. 1981) (permitting testimony regarding trade usage of terms
    having legal meaning, to inform jury of bank customs and to assist it in
    91
    determining whether plaintiff bank was entitled to claim benefits of
    holder in due course); Birchfield v. Texarkana Mem’l Hosp., 
    747 S.W.2d 361
    , 365 (Tex. 1987).
    In summary, I conclude Dr. Wakefield’s proposed testimony about
    the differences between pastoral care and pastoral counseling addressed
    subject matter not commonly known to the jury, contained specialized
    knowledge of the range and types of tasks typically performed in each
    pastoral role, and constituted the only means by which the jury could
    have gathered this information of central importance to the defense.
    Those factors, the courts have explained, are indicative of helpfulness,
    and weigh heavily in favor of admissibility. See, e.g., Kopf, 993 F.2d at
    377; 7 Wigmore on Evidence § 1923, at 31–32. Moreover, Dr. Wakefield’s
    testimony was central to Edouard’s defense. Her testimony was offered
    to explain the types of tasks Edouard might typically be expected to
    perform in his role as a pastoral caregiver, distinguishing those tasks
    from the types of tasks he might be expected to perform in a role as
    pastoral counselor.     In furtherance of this distinction, Dr. Wakefield’s
    proposed testimony would have supported an inference that the tasks in
    the latter role would closely track the types of services provided by other
    mental health services professionals under section 709.15. This factual
    background was directly relevant to the jury’s evaluation of Edouard’s
    defense that, although his conduct could be viewed as pastoral care, he
    did not provide mental health services as contemplated by the statute.
    Exclusion of crucial background information of this kind, courts have
    explained, may often constitute reversible error.     See, e.g., Alexander,
    816 F.2d at 169 (“The entire case against Victor Alexander turned on the
    photographic identification, and it was clearly erroneous for the district
    court to exclude without good reason relevant expert testimony bearing
    92
    directly on that issue.”); State v. Eichman, 
    456 N.W.2d 143
    , 150 (Wis.
    1990) (concluding sexual exploitation case was “particularly appropriate
    for the admission of expert testimony” explaining certain specific
    practices of psychotherapy and the defendant’s typical responsibilities,
    on the ground the factual background regarding these practices and
    responsibilities would not typically be “within the understanding of the
    ordinary person”).
    Furthermore, I note the distinction between pastoral care and
    pastoral counseling detailed in Dr. Wakefield’s proposed testimony
    presented minimal risk the jury would inappropriately confuse the terms
    and standards she proposed to use with those provided in section
    709.15. The statute makes no reference, in any provision, to pastoral
    care or pastoral counseling. In addition, her use of the word “pastoral”
    to modify the word counseling helped to alleviate concern the jury might
    be unable to distinguish her use of “pastoral counseling” from the
    statute’s use of the word “counseling.” Her description of the role of the
    pastoral counselor also worked to minimize the risk of inappropriate
    confusion, given her exposition of the tasks and techniques involved, and
    the fact that these tasks and techniques largely coincided with those
    associated with the technical meaning of counseling incorporated in the
    statute. See Palmer, 691 N.W.2d at 421 (“[T]here was an abundance of
    testimony by Dr. Salter concerning the meaning of the term ‘likely.’
    Under these circumstances, Dr. Salter’s use of the statutorily defined
    term ‘likely’ did not render her opinion inadmissible.”); id. (explaining
    danger of jury confusion may arise when expert and jury are not “ ‘on the
    same page’ ” with respect to differing statutory and testimonial meaning).
    Given the demonstrable helpfulness of Dr. Wakefield’s proposed
    testimony, its central importance to Edouard’s defense, the minimal
    93
    likelihood the jury might confuse the meanings of the terms used with
    unrelated lay meanings, and the extensive factual basis for the use of
    those terms overlapping with the statutory terms, I conclude the district
    court erred in excluding the testimony. As is the case with instructional
    error, I would presume the evidentiary error was prejudicial and requires
    reversal unless the record affirmatively establishes lack of prejudice.
    See, e.g., State v. Paredes, 
    775 N.W.2d 554
    , 571 (Iowa 2009).                      For
    evidentiary errors of constitutional magnitude, we may only find the
    absence of prejudice if we are convinced the “error alleged was harmless
    beyond a reasonable doubt.”         See, e.g., State v. Simmons, 
    714 N.W.2d 264
    , 278 (Iowa 2006).
    Regardless     whether     the   error   here    rises   to   the   level    of
    constitutional magnitude, I cannot conclude the record affirmatively
    establishes the absence of prejudice. The evidence would have provided
    helpful factual information for the jury directly related to Edouard’s
    defense that he was not engaged in the kinds of formal therapeutic
    relationships contemplated by the statute, and the evidence was
    unavailable from any other source. The instructional error compounded
    the impact of the exclusion, as the jury was left without both important
    factual nuance for distinguishing certain specific classes of relationships
    from others and important legal nuance for application of the relevant
    statutory principles to the types of relationships considered. In effect,
    the jury here was deprived of both factual principles and legal principles
    acutely relevant to the defense.              Those deprivations, I conclude,
    conclusively establish prejudice and warrant reversal. 12
    12Because   I conclude my resolution of the instructional and evidentiary
    challenges is dispositive of the outcome here, I will not address Edouard’s remaining
    challenges on appeal.
    94
    I join that part of Justice Appel’s special concurrence setting forth
    the analytical approach we take in addressing an issue under the Iowa
    Constitution where a party also raises the issue under the corollary
    provision of the Federal Constitution, but does not suggest application of
    a different standard, or suggest a different application, under the Iowa
    Constitution.
    Wiggins, J., joins this concurrence in part and dissent in part.