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On the Issue of Sexual and Other Feelings Towards the Therapist

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

One of the many issues that comes to the fore on our site, Mental Help Net is the issue of sexual attraction and fantasy towards the therapist. The many posts I have read about this indicates that there is a lot of anxiety and misinformation about the issue. The major problem seems to be that many people believe that sexual attraction and fantasy are irrelevant to the therapy and can interfere with it. In fact, many of the same people believe that it is inappropriate to entertain these sexual feelings and thoughts. Many of the same people believe that the therapist should have no sexual feelings and fantasies toward the patient.

Nothing could be further from the truth. In fact, I would go so far as to say that sexual attraction, as well as other emotions (anger, disappointment, anxiety and fear)are extremely important to the therapeutic process and needs to be brought out into the open where the process of psychotherapy enables the patient to learn, grow as a person and gain improved functioning in their life.

Part of the process of psychotherapy, particularly psychodynamic therapy is based on what is called “transference.” This concept has been explored elsewhere in this site and can be searched for on Mental Help Net. Transference refers to the idea that our reactions to people in the present are shaped by past relationships. In other words, the ways in which we were treated in the past, such as by parents, gets repeated in the present because those are the expectations that we have.

One way to think of transference in the context of psychotherapy is that sexual attraction to the therapist might be a repeat of the child’s wish to have something that is not permitted. When a parent says “no” to a child it can establish lots of resentment and anger. Skillful parents know how to handle this without turning it into a crisis. Parents with little or no patience with the child might meet the child’s disappointment and complaining with a huge angry and punitive reaction. The entire scenario of wanting something that the parent forbids can, possibly, represent for that person, the formula for what they come to expect from life. Some people may grow up unable to accept the word “no.” Others may become people who expect nothing from other people. Some people might come to feel resentful as adults because of their perception that the other children in the family always got what they wanted.

Here is a hypothetical example: A patient is sexually attracted to the therapist but believes that their wishes and desires will always be frustrated. This patient is in therapy because of many interpersonal failures and a lack of intimacy in their life. This desire for the therapist and the expectation the desire is wrong leaves the patient feeling depressed and hopeless as has happened throughout their life.

It is not the job of the therapist to gratify the wishes of the patient toward the therapist. Rather, it is the job of the therapist to help the patient understand these wishes and why they feel so frustrating resulting in feeling hopeless and depressed. Therapist and patient work on this transference issue in order that the patient can enter into a fulfilling intimate relationship with a partner from the world outside of psychotherapy.

On the other hand, there are those times when a therapist will feel extremely attracted to the patient. Does this mean that he/she should tell the patient and then act on those feelings? The answer is a most definite “no.” A well trained and skillful psychotherapist recognizes the transferential nature of the patient’s desire for a romantic relationship. At the same time, a skillful therapist is trained to recognize the feelings that he/she is experiencing in relation to the patient. When a therapist is experiencing feelings towards the patient it is referred to as “counter-transference.” Part of what the therapist is trained to recognize and think about is that the patient may be helping (unwittingly) to provoke those feelings in the therapist. As with transference, counter transference feelings can include sex, anger, boredom and a myriad of other emotions.

Rather than using sex as an example, let’s examine the fact that a therapist might start to feel bored and sleepy during a session with a patient who is otherwise very lively. A skillful therapist recognizes that something is going on between patient and therapist. The therapist does not report that “I am bored with you,” but asks if how the patient is feeling at that moment. More often than not the patient, after some discussion, may reveal the fact that they have been hiding some thoughts and emotions towards the therapist.

An example of just such an occurrence happened one day when a lively and verbal patient spent a large part of the session “boring the tears out of me,” so to speak. I finally caught on to the fact that I was neither tired nor angry at this person. So, I asked “what was going on” at that moment” Sure enough the patient confessed that he was angry at me because I had passed him on the street several nights ago without saying “hello” after he had greeted me. I was shocked because I had no recollection of either seeing him or hearing him on the street that particular evening. I honestly reported that to him and confessed that on the particular evening I was walking home from the office lost in thought about someone I had seen earlier in the day.

You see, the patient who was angry because he was convinced I was ignoring him on the street was gay and believed that, based on past experience, that I really had low regard for him and did not want to acknowledge him on the street. Of course, nothing could have been further from the truth. This vignette helped him understand how he constantly felt threatened by all heterosexual men based on his experience with his father who could never accept his sexual orientation. On a deeper level, he even rejected or criticized himself for being gay. Simply, he experienced a lot of self hatred.

The fact is that, in the context of psychodynamic psychotherapy, the transference and counter transference feelings that are evoked are extremely valuable.

Thoughts, feelings, fantasies and ruminations all have meaning in the context of psychodynamic psychotherapy. That is one reason why dreams and dream interpretation are an integral part of that type of psychotherapy.

However, under no circumstances is the therapist ever to act on feelings in therapy. The therapy office is supposed to be a place of complete safety where the patient talks about all of this. The therapist then relates all of the information to the current life circumstances of the patient in order to enable that individual to make better and healthier choices now and in the future.

Your comments and questions are welcome.

Keep Reading By Author Allan Schwartz, LCSW, Ph.D.
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