The “Sex” of Therapy and the Road to Erotic Transference

The internet is filled with worried psychotherapy patients: worried over their therapists. They are brimming with fear of being discarded, frustrated at their inability to get closer: wanting a permanent relationship, a kind of family tie, or the therapist’s touch. Much of the day is preoccupied with worries involving the counselor, a fresh slant on the distress that brought them into the consulting room initially.

On offer today is the likeness between the “desire” implicit in the client’s wanting the safety and secure guidance of a caregiver … and the romance and caring of a new love.

Treatment begins with a “getting to know you” phase, entirely one-sided, except for the therapist’s way of interacting, the knowledge he imparts, and the questions he asks and answers. But there is more:

  • his attention, concentration, intensity of focus
  • the tone of his voice
  • his physical state of being
  • the office setting (if he approved the decoration)
  • his consideration and understanding
  • the comfort he offers
  • his “presence”

The contact is not so different from meeting a new, potential romantic interest, and going on a date. An appointment is made, a limited time is expected, and the initial stage of acquaintance with “who he is” is part of the agenda. Many questions after the first contacts will still be unanswered in both situations. The newness makes it electric, whether the charge is one of excitement or trepidation.

As feelings unfold, therapy offers a kind of seduction or foreplay: a back-and-forth in conversation, a dance without movement. If there is a desire for physical contact, then the patient experiences the ache before touch, enlarged because he cannot touch: a yearning magnified by the boundary the doctor will not cross (assuming he follows a therapy model insisting on such an invisible moat). The appeal is ancient: the forbidden fruit in the Garden of Eden.

Allowing the therapist inside is an intermediate goal of psychodynamic treatment: to permit release of material in need of expression, of grieving, of working-through. Transference is expected: the development of feelings about the counselor similar to those tied to significant people in the client’s past, including parents. Without the patient “exposing himself” and dropping his guard, a dynamic therapy will be unsuccessful. To continue the many metaphors here, you are giving yourself over to the other, putting yourself in his hands.

Jealousy may develop. There are significant-others in the counselor’s life, known or unknown: lovers, children, and friends. He also maintains a practice full of patients, competitors for his time. The weekly session is but a mini-slice of him, something shared when you are starving and have shared too much in your life already. In the course of working-through the transference, such feelings diminish. The counselor steps more “off-the-pedestal” than earlier, if not fully off. Only, that is, if the transference has been resolved.

Not all treatment models include enough time, in my opinion, on launching the patient into the world. Outside, sympathetic others represent a more appropriate target for strong and continuing attachment once the client is ready.

Part of the reason therapy is often eroticized is because of our instinctive desire for contact and kindness, a buffer against the inherent loneliness of the human condition. We want permanence and protection to face the transitory inevitability of life. Many of us wish to crawl into another’s skin, not be the solitary creatures we are, manufactured by nature into different sausage casings. We yearn for merging and this yearning is easily sexualized because intercourse involves momentary joining.

The illusion of the perfect therapist can create something of theΒ honeymoon period. The blindness of new love enabled our species to survive. We need the illusion to bond in both treatment and everyday life. A persuasive mirage is not inevitable, but the risk of it is.

Powerful emotional attachment, assuming it happens, is maintained (in part) because of the distance and lack of consummation. Marriage, in contrast, involves consummation, routinized closeness, and repetitive exposure and over exposure. The illusion disappears, at least to some extent. The honeymoon ends and marriages fall into the world of reality from the lofty plateau of apparition and romance. Without a continuous fight against this gravitational force, starry nights and champagne morph into partly cloudy daylight and carbonated soft drinks that have lost their fizz.

A couple of additional thoughts: not everyone develops the sort of attachment I’ve described. Nor is there a way for those vulnerable to enchantment to protect themselves against it. Remember, however, some therapy models depend on the development of strong transference for ultimate healing.

Life teaches us we can’t have everything we want, nor forever keep what we have won. Yet our time here offers the possibility of joy even though many wishes are denied. We adapt. We must adapt.

If impermanence is the nature of things, the sooner one accepts that truth, the sooner one will come to appreciate and enjoy what is still possible here: on a rich, confusing, dark, but dazzling place called Earth.

Two versions of a Starry Night, above: the first by Van Gogh and the second, Edvard Munch. Both come from WikiArt.org.

32 thoughts on “The “Sex” of Therapy and the Road to Erotic Transference

  1. So true. It’s very easy to get caught up in your feelings around your therapist that the reasons you came to therapy get shoved way in the background. It can be an almighty distraction from the work that needs to be done. After decades of therapy and getting older, missing out on many longed for things doesn’t mean you have to miss out on many of the joys that life can bring. My life hasn’t turned out anywhere near what I wanted but what my life is has still left a lot of room for joy, new opportunities, friendships, family, children (although not my own) and the excitement and motivation that comes with new goals. It has been so important to focus on these as much as possible. The affection I feel for my therapist each time I see him gets put aside quite quickly as we both start to knuckle down and get the work done and by the end of therapy my head is in such a whirl. And I try to keep in mind that one day the work will be done and will be able to move on with my life on my own. And that’s the reason I went to therapy in the first place.

    Liked by 1 person

    • I’m bowled over, Claire, by the tenacity and integrity you show in doing “the work” of therapy. You could be a poster child. I suspect many readers will admire you and what you’ve written as much as I do.

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  2. I feel you are leaving us hanging here and there is more to add to the subject. Guess I’m seeking something, waiting to hear the conclusion, yet I don’t know what it is I am waiting for…

    Liked by 2 people

    • Perhaps the conclusion is unsatisfying, in the sense that the ending if very much in the hands of the client and therapist to manage a difficult process. Not all transferences are resolved. Some patients get stuck on the intensity of affection they feel for their therapist. For others, he fades into the background over time. But, as Clair so eloquently wrote above, one must get beyond whatever fetters hold one back in life. If you care to say more about what is missing, Al, I’ll try to respond.

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      • Maybe that’s it. Maybe I want the ending neatly packaged in a box, with a ribbon on top. Maybe I want to hear that therapist and client lived happily ever after after the transference…

        Liked by 1 person

      • Some do, Al. I write my essays fully aware that I will not always satisfy that need, not just in you, but even myself. Beware of too much realism! Thanks for hanging in there with me anyway, Al!

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  3. Umm…it’s hard to comment only because you know how well this describes me! My attachment to Jane was certainly very idealised and she was ‘perfect’. I hope it is a more ‘realistic’ relationship with my therapist now, but I suspect you still believe her to be on a pedestal ! Perhaps just a lower one πŸ˜‰ a few things have changed – I don’t desire merging, I don’t expect her to always understand me or intuit my needs, I know she will sometimes say and do ‘the wrong thing’. But in terms of the strength of the attachment….well, I have a written a books worth of stuff about that, and you know it all already! πŸ˜‰

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    • Perhaps some therapists deserve a modest place on a short platform. We do what we can. Others definitely belong underneath a pedestal (to paraphrase Woody Allen’s explanation of why his first marriage failed: “I tended to put my wife underneath a pedestal”). But you are progressing. Your movement and change are to be applauded.

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  4. I’m doing Schema Therapy and it’s nearly cruel because of the attachment…….

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  5. I do not think you are alone in the feeling of being ensnared by a process intended to help you. I can only validate your pain and say that your working through the transference has the potential of eventually releasing you. Best wishes, Suzuki.

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  6. Its been awhile, but its me again
    . Want to know how strong feelings can become. We’re in NH, on our way to mini vacation in Maine, which I usually love. Right now, according to the overhead signage, I am at most 50 miles from where he lives and practices. I feel nauseous knowing he is so close, I’m in “his State”, and I can’t figure out a way to just get a glimpse of him going into work. October 31st it will be 4 years since he moved and I love my replacement therapist…she’s great, and these feelings have lessened, but when I’m depressed, or see NH license plates on a blue Subaru, or being this close to his offices, this longing comes back. Maybe not even the man himself, as much as the way he made me feel. Images and emotions are all jumbled together again and the hurt comes back. Not always. Often I look back instead on all he’s taught me. The unimaginable grip of erotic transference. Have a good day. You always make my day with your columns, insight and comments. Even writing the book didn’t take him his pedestal.

    Liked by 1 person

    • Thank you, Judy. I think what you are describing is more likely to happen to those for whom the therapist is the first significant person ever to accept them, show them kindness, take them seriously, etc. Kind of like a first love: it needn’t have been the particular person in question, but the “specialness” gets attached to the particular person who was “the one.” I can only say that given enough time, this too may fade, and you’ve identified some lessening thus far. Be well.

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  7. Dr. Stein, the danger of “erotic transference” during therapeutic care is outside of my personal experience. It reminds me of the case of a married woman with seven kids who eventually married her much younger parish priest after seeking his spiritual guidance during a period of marital distress.

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  8. Your example is apt, Rosaliene.

    Liked by 1 person

  9. Serendipity–I’m on a cruise ship in Bergen, Norway, and just heard a lecture on Munch and his work with emotionally tortured themes. Then I open my phone and read this! His work is an apt metaphor for your illustration! Also heard about other famous Norwegians, Edward Grieg and Ole Bull, with whom I’m sure you are familiar. Interesting country.

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  10. This is an excellent article, Dr. Stein, AND I would just like to say thank you!

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  11. I learn so much from your blogs, Dr. Stein! This particular article helps me to understand the therapeutic alliance better, and why some (not all) of my past therapists were uncomfortable with transference. I am still in the process of healing, and I am still learning to trust my new therapist (after having spent nearly 10 months in the getting-to-know-you phase, and counting). I still miss some of my really awesome past therapists, but I’ve also had some not-so-effective therapists, too. I’ve moved around a bit, so I wasn’t able to find stable treatment until recently. I have a pretty decent support system outside of therapy, but there’s something unique about the therapeutic experience that can be, at least in my experience, either quite healing or quite disheartening. I’m wondering, however, what happens to clients who have not had very good experiences with past therapists, which is to say that I’m wondering if it would make it more challenging for clients to trust their therapist enough to experience transference in a healing and productive way – an iatrogenic effect of sorts that must be worked out somehow. I wonder what your thoughts are on this particular topic, and how similar or different the transference process would be for those clients. I suppose, if I were to include the marriage and honeymoon analogy, having past negative experiences with therapists would be like entering into rebound relationship on some occasions with a new (time-limited) therapist, or entering into an arranged marriage on other occasions with a new therapist who is willing to help you in the long run (or if you are limited to the choices you have in treatment due to healthcare restrictions on mental health and/or the amount you’re capable of paying out of pocket). I suppose that your past experiences would have affected your ability to trust again – a sort of trauma on top of a trauma.

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    • I think you understand the potential for iatrogenic problems (those caused by the treatment, in this case, the therapist or the poor therapeutic relationship “match”). Counselors are used to hearing tales of past therapists, especially early in the process. Some are wonderful, some sad, some make you think the doc was incompetent, some where a therapist died, etc. Then part of the new work is to deal with the old work – what is left behind from previous dives into the counseling pool. Thanks for your comment, Blake.

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  12. “Nor is there a way for those vulnerable to enchantment to protect themselves against it.” I tried so much to not develop transference but I did. In my last session, I finally told my therapist my transference (which I had noticed brewing many many months ago and which I eventually told her of, but we never discussed it) is hindering our therapeutic work. Because I’m so convinced my parental, sibling and erotic transferences are “bad” and it’s causing me to shut down and go numb in sessions rather than opening up to DO the therapeutic work we need to do. Fortunately she listened to my words that I need to discuss the transference and agreed that we talk about it openly in our next session.

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    • Good for you in opening the question with your therapist! The feelings you describe are grist for the mill, and a good therapist won’t shy away from them. Nor are you “bad” to have these feelings. Good luck going forward.

      Liked by 1 person

    • Glad to hear it, Rayne!

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      • I’m not even sure where to start. Your blogs have helped me beyond what I’m really able to convey. I’ve been in a transference focused psychotherapy program now for 4-years, yet it’s really only been a year since I had the guts to address my feelings with the therapist. I’m so glad I did. I was not really sure what my Doctor would say, but she was absolutely amazing. I know many patients feel like someone should have warned them about the effects of transference, but I think it’s just one of those things you have to go through. I’m absolutely convinced that without the strength of my transference, I would never have made the progress I’ve made. There simply is no way to explain this type of relationship to someone that has never had it, nor would I trade it for anything else. Yes, it’s been excruciatingly painful at times, but the joys and rewards I’ve received are stunning.

        I sometimes liken parts of my therapy to a ride at Disneyland I took as a cautious child. I think it was called “Peter Pan’s Flight. The neat part now is I get to feel incredibly safe, secure listened to and loved. What could be better? Keep writing Dr. Stein!

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      • I think you do convey the intensity of feeling connected with transference, Deb. And that will be informative to the people who read your comment. Thanks.

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  13. I am very interested in hearing what you have to say about something called “Reality Therapy.”
    Additionally, there is also supposed to be a form of therapy where the Doctor starts a casual conversation with the patient in an attempt to find out how the patient’s mind works. How do you view that method?
    Lastly, if it’s not too much, are ink-blot tests still used widely? Was there ever any problem with these tests?

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  14. Reality Therapy is not a new treatment, but intends to be a practical one. Some psychotherapists characterize it as rather “on the surface” of things, dealing with immediate problems rather than long standing patterns or underlying issues of history that are reaching from the past into the present, and therefore holding the patient back. I know of no supportive research on its effectiveness. I have no knowledge at all of the casual approach you describe, Joseph. The inkblots of Rorschach have been around for a long time, nearly 100 years. There is also an inkblot test created by Holtzman. The long-standing complaint about the Rorschach Test was that it was subject to wide variations in interpretation by the examiner and produced invalid results. More formal methods of scoring the Rorschach were eventually developed. These tests are for diagnostic purposes rather than treatment. To the extent that psychological testing is not as widely used as it once was, there are likely fewer examiners who are well-practiced in the use of these instruments. Other methods of personality evaluation like the MMPI and the Millon Clinical Multiaxial Inventory are the standard in the field.

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  15. Does the dynamic of power and authority lead to transference? This can certainly happen, as you know, with other powers-of-authority such as a boss, clergyman, teacher, or a person who is a police, fireman, or military official. Remember the old saying by women, “I love a man in uniform.” If this is the case, why does this happen? Curious about the theory behind this.

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  16. The theory, though Freud wouldn’t have put it this way, is based on the idea of stimulus generalization. Think of a deja vu experience. If enough elements of a place or an event are present, they may remind you of something you’ve experienced before. So, an authority figure, especially if you have strong feelings about past authority figures (whether consciously or not) may evoke a response in you that traces back to those past individuals, with parental authorities having a particularly strong likelihood of having initially generated such feelings. That said, your response to the current authority figure is, to some degree, out of place, out of sync in time, and can become a mistaken identity, where your reactions to the current person don’t fit who he “really” is. You don’t literally think he is the past person, but you react to him and have feelings about him as if he were. Hope this helps.

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  17. It does help, Dr. Stein. Thank you!

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