Erotic transference is troublesome. Counselors are trained to view its occurrence in one way only: a counterfeit of real love. Sexual feelings toward the therapist are pathologized, made into a kind of specimen for microscopic examination rather than something more basic. Is there another way? Are a patient’s affection and desire for the counselor ever no different than the early stages of romance? Perhaps we therapists go too far in making something unusual of a thing we might otherwise call love.
For those unfamiliar with the topic, I’d suggest you read my 2015 essay before proceeding. The psychoanalytic view of erotic transference refers to its infantile nature, an unrealistic and intense quality of “wanting” presumably not found in other romantic attachments. The contrast with non-clinical love is emphasized more than the likeness.
What I wrote in 2015 reflected the field’s accumulated wisdom and the observations of countless practitioners who recognized the amorous gaze of the patient across the room: the look that signaled “I only have eyes for you.” The allegedly misplaced affection is a common therapeutic occurrence, marked down because of its commonness and the clinician’s need to guide the process toward a therapeutic end, not a romantic one.
I am not talking about the extreme of erotic transference, where desire becomes obsession and stalking. Within the less acute expression of feelings, however, I would include those patients who profess their love (or keep it secret), say their genitals lubricate (or, for men, become erect) in session; offer themselves in words, dress to seduce, and bring suggestive gifts to the doctor. All these happened in my practice. They happen in every practice.
More than rejection frustrates such clients. They can feel discounted, their yearning made into another treatment issue to be worked on, worked through, and worked-over. They are told their emotions will likely disappear even if those stirrings are the most enlivening experience in their lifetime. The therapist’s intellectualization of the heart-throb and heartache makes the matter of the client’s heart a conundrum for the doctor’s head. The patient and practitioner then operate in two universes: the former feeling the issue, the latter thinking about it, unless he reciprocates the patient’s sentiments.
My profession considers erotic transference a kind of mistaken identity due to your history and because of the nature of treatment. A sensitive and wise healer gives all his attention, looks in your eyes, and accepts you without judging. You know little about his personal life. You automatically infer qualities in him for which you have no evidence, unconsciously imagining he is like the loving parent you never had (for example). He seems to fill a vast, cavernous, lonely gap in your heart. All true, but not so different from other infatuations.
Perhaps we would do better to recognize that love often depends on what we don’t know about the other, not only what we do. How many people understand the partner well before they fall in love? Many questions have not been asked – may never be asked and answered by words or observation. This is true in the extreme for young people, where the right questions are not yet known. They do not even know themselves. Hormones rule the day.
Counselors also should admit – especially in this day of therapists’ websites describing their practices, listing credentials and schools attended, and maybe even including a blog (!) – that we aren’t the blank slates we believe ourselves to be. Unless seated behind the reclining patient’s pillowed head, we have always had a physical presence, tone of voice, a smile, laughter, and movement. No, the client is not dealing with a shadow or computerized speech.
In almost all fresh attractions, aren’t the fantasy, the newness, and imagination what it means to be in any romantic, early-stage love? Throw in uncertainty, idealization and physical urging. These are among the most magical and wondrous qualities of romance. Over the long haul it can be argued that loyalty, devotion, kindness, respect, similar interests, proportion, compatible values, pulling together, and shared experience are more important, but they do not send a shiver down the spine.
Devotion does not levitate, no matter however precious and essential.
Therapists are not the only people about whom one experiences transference (or stimulus generalization). Has not a new person reminded you of someone else in your past? Think for a moment:
- Bosses, teachers, the next door neighbor.
- The neighborhood bully, father and mother figures.
- Political leaders.
- Mentors, the people we instinctively dislike, and those we are automatically drawn to.
If I am right, the therapeutic management of transference requires a different kind of sympathy, more recognition for the genuine nature of what is in the patient’s heart and the sensual pulse in her being. This will be difficult for the therapist, rather like dealing with someone who says “I love you” outside the controlled atmosphere of his sealed-off office; with its sex-discouraging moat, doctor-patient ethical boundaries, and the requirement of therapeutic distance.
All this suggests that the process of her “getting-over” erotic transference may not only be a matter of uncovering the mistaken identity nature of feelings more properly attached to other people and earlier times, and releasing emotions derived from past relationships. The unrequited love then demands grieving not unlike other lost loves. Perhaps such grief-work can only be managed with a different therapist, although – one hopes – after the remaining treatment goals have been accomplished.
Though many counselors know better, those who believe the mistaken identity only happens in the office need to think again. The same patient who falls for you might already have fallen for others who reminded her of a loved one, with as little ability to look past the transferential aura to the truth of who her partner really was.
One more thought. Should therapists give a written warning to all their new clients?
BEWARE! YOU MIGHT FALL IN LOVE WITH ME!!!
If you are laughing for more than a few seconds, begin reading again at the top.
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The first (undated) photo, School Cafeteria, was taken by the Adolph B. Rice Studios and comes from the Library of Virginia. The following picture of Swimmers Annette Kellerman and C.M. Daniels was taken in 1907 by G.G. Bain and is the property of the Library of Congress. Both are sourced from Wikimedia Commons.
Dr. Gerald Stein 
I loved watching In Treatment, and reading this post. I’ll read the link to your previous post about erotic transference shortly after I reply here, Dr. S. I think that some (not all) therapists have difficulty dealing with their clients’ erotic transference, in addition to their clients’ hard times with that as well. The clients are the first ones who notice a bit of stoicism and change and seemingly fear from their therapists who assume that their clients need more boundaries, instead of the natural evolving emotions that come from a client learning to trust their therapist and perhaps feel heard and understood for the first time – until, the admittance of the transference. Some therapists can handle transference of any kind well, but some therapists either can’t, won’t, or aren’t trained in that particular orientation of emotional exploration and psychoanalysis, it seems. After having moved (for work in the past, and then for resettling in the present), I’ve gotten to know so many different types of therapists and people. I could tell who works with me best and who doesn’t, who misjudges me and who doesn’t, who misdiagnoses me and who doesn’t, and why etiology matters. The right kind of questions/dialogues/training and patience and trust in what the client is saying (i.e., not infantilizing the client or utilizing the power too strong over the client to tell the client what to do or to kind of make suggestions that are like telling the client what to do; respecting the client’s desires and goals and talents and intelligence) is what is needed to truly get to know someone; the wrong kind of questions or dialogue might feel nothing short of (mis)judgment, etc. Erotic transference, to me, is something that comes from a natural place of feeling connected with someone, wishing that the losses never happened in the past, wishing for some safe place to grieve the losses while admitting that your erotic transference for the therapist brings up questions in the client like, “Why couldn’t so-and-so be so understanding and nonjudgemental?” “Why couldn’t my parents be so understanding and caring?” “Why do you care and they don’t?” Yes, transference of any kind can occur in any relationship, not just with therapists. And once a person has had experience over the years with many therapists, it becomes easier to deal with transference and countertransference issues later on. It becomes easy to question why I feel something in response to some stimulant or relationship, or why I don’t feel or connect or attach at all. I feel something with those I trust, I don’t feel anything with those whom I don’t trust. I trust because the triggers aren’t there, I don’t trust because the triggers are there. For a person who has been sexually abused in the past, the feelings of fear and arousal concurrently exist, and confusion typically settles in moments thereafter. To learn to trust a person enough to grieve and to say how you’re feeling is the most important, and to learn who not to trust is equally as important. Triggers aren’t just “irrational,” but they can also be rational – as in protective – only it’s heightened. Some therapists don’t get that, as well-meaning as they are. Erotic transference for some people with sexual abuse histories are confusing enough, but some survivors can learn how to trust someone enough to share those confusions and to work through a lot of grief issues without misdiagnoses mistreatments, and misjudgments about someone’s ability to actually be rational. For me, I learned to figure out what the feelings reminded me of from the past, and what grief work I still haven’t worked out completely with a trustworthy person or people. Having support networks outside of therapy is equally as important, and knowing you can feel close and connected with *SAFE* friends, *SAFE* family, and a *SAFE* therapist makes it all the more easier to remember, process, grieve, and become free from the loss, the want, the fantasy, the avoidance, the fear, or the numerous other feelings that can co-exist for some. Finding people who truly listen and trust you, too, is great. When a client feels that their own therapist doesn’t trust their words or emotions, it’s hard to reciprocate that trust back. I think trust is needed to process through erotic transference – for both the client and the therapist – otherwise, it won’t work. But I could be wrong.
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You are an eloquent and gifted writer!
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Nancy, I think Dr. S is an amazing writer! I don’t know if you were responding to Dr. S or to me, but I thought I’d say thank you just in case. I wrote from the perspective of having different therapists over the course of 20 years – some who trusted me enough to be able to process through all transference, some who didn’t trust me enough to process through any transference, and some whom I did trust initially but harmed me by trying to create a dual relationship with me (e.g., a female therapist, same sex as I, who had me spend the night at her home as part of “therapy for DID,” clean her house, organize her files at work – including confidential patient files, etc.) and didn’t respect my boundaries as a client let alone tell me that I was able to set boundaries with her, the therapist. I’ve had some really awesome therapists, too, who truly understood my boundaries, needs, and triggers. We can’t avoid all triggers in life, but the specific triggers I speak of that are “unsafe” occur when a therapist tries to involve you into their personal life and gaslight you when you express feelings of doubt that this feels safe, or misdiagnoses you when you leave them (i.e., fire the therapist). I’ve never had to deal with that before, but I’ve had to deal with being misdiagnosed and therefore mistreated before. The iatrogenic effects almost killed me, literally. It wasn’t until years later when I had found good therapists who properly assessed me as in-patient for a total of 4 months and to treat me for PTSD and DID. It wasn’t too difficult for me to deal with erotic transference once I knew what it was and found therapists who trusted me and weren’t afraid that I was this or I was that; I would never “stalk” or “harass” a therapist, but some would start asking me questions like, “You’re not going to stalk me, are you?” Although an innocent enough question, that showed me that the therapist didn’t know who I was based on our working a year or more with that person, and that the therapists didn’t trust me. Of course, when you mention to a therapist what you were “misdiagnosed” with and how you need to feel safe again with therapists, you’ll get the therapists who will “test” you or seemingly explore to death all narrative-like questions pertaining to the misdiagnosis because the therapist doesn’t believe you at your word or because the therapist refuses to have me sign a consent form that will show my true diagnosis from a trauma treatment facility that went through thorough assessments to finally tell me what I did and did not have. The treatment for managing dissociation really worked for me, and the treatment for processing trauma and building a connection with my treatment team and therapist really worked for me. I like to feel connected and close to a therapist and build a strong therapeutic alliance; I want to trust a therapist completely so that I can tell him or her anything, and so that I can get better. I don’t feel comfortable talking with a therapist who doesn’t trust me, misdiagnosis me, disbelieves me, or straight out tells me that “you’ll be in therapy for the rest of your life; you’re never going back to work; you’re too old” – which infantilizes the client and places them on a permanent status of being disabled and undermines who they are and makes them totally dependent on the therapist. I once had a therapist who told me she couldn’t have children and wanted to be my surrogate mother; I told her I already had a mother, and I love my biological mother very much; she got upset an accused me of lying. For therapists who truly do trust the client to be safe with the therapist and in sharing very intimate details, the client can respond (or learn to respond) in a very open way that communicates feelings, works through longings, works through losses, etc. Without some minimal level of trust from both parties, it won’t work. When I speak about triggers and safety, I don’t mean the benign triggers that you can firmly tell someone a boundary or ask that the person you trust not trigger you that way, but rather I mean red-flag triggers like a therapist who invites you to spend the night at their home, the therapist’s lover/roommate who gets jealous and threatens your life and leaves that message on your machine (enough evidence to report to authorities), a person outside of therapy who keeps pushing you to date them when you’ve clearly expressed disinterest and asked them to not contact you again, or a person who won’t take no for an answer. These are all red flags for any normal person, but major triggers for trauma survivors. I need to feel safe and stable, and I HAVE THE POWER TO CREATE SAFETY AND STABILITY through boundary setting, utilizing community resources, utilizing authorities (e.g., calling police or filing harassment charges), utilizing the safety features of my building, and asking friends for help. If I have erotic transference with a therapist, as a trauma survivor, it’s more because I trust the therapist than it is that I want to have some sexual fantasy with the therapist; it’s more about my deep appreciation for the therapist and the spiritual agape love that I wish existed in this cruel world than a phallic love; it’s more about grieving the losses of the innocence of my body responding appropriately to true sexual stimuli as opposed to my body becoming sexualized in fear and pleasure situations; it’s the loss of life and relationships I grieve because of my DID and PTSD; it’s the loss of careers because of my DID and PTSD; it’s the loss of autonomy and being dependent on a therapist I trust so much so that I have many transference issues and defense mechanisms, including erotic transference. I recognize, explore, and process these transference issues, and I know when to state boundaries when countertransference happens or exert my right for abruptly leaving an unethical therapist who wants to get in my pants or wants me to be something other than a client to them (I don’t owe someone I don’t feel safe with an explanation or my money that comes with paying for yet another visit with an unethical therapist). We all have a right to feel, but we have to know what to do with those feelings and how to react to our feelings. We all have a right to grieve, but it is a choice to grieve with safe people or alone (safe people is best, alone is okay, too). We all have a right to be safe. Those who don’t provide safety are not trustworthy to be around – at minimum – or are breaking the law (including bylaws or ethics codes) – at worst. I’ve dealt with many, and I won’t be gaslit anymore by people who try to put all the blame on me as a “disgruntled client” or a “person with a mental disorder who doesn’t know what she’s talking about.” You know, many people with mental disorders are intelligent, are psychologists, are therapists, are doctors, are nurses, are lawyers, are competent enough to see unethical practices, are competent enough to make their own choices regarding treatment/therapy goals, are competent enough to set boundaries with the therapist, are competent enough to walk away from a situation that is clearly not beneficial (even harmful). There are situations where some people misjudge their therapists, too, or where there are “dangerous clients” who may harm others, but, on a statistical scale, there appears to be more trauma victims just looking for adequate support and treatment than dangerous clients or clients with cognitive delays. Anyway, I’ve been hurt by people in power, including some bad therapists, and I’ve been healed by people in positions of power, including therapists. I just wish that more of them and others in positions of power would understand the etiologies and heterogeneity of erotic transference.
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You are not wrong, PP. In fact, I think you might make a big contribution to the training of therapists. Maybe there is a grad school somewhere that would be open to your giving a talk or talks. When I was first involved with a clinical psychology internship program as one of the supervisors, I recommended that on the first day of their experience, the students be admitted to one of the hospital units. The staff was not notified, so everyone, but those of us involved in the administration of the internship would be blind to who they really were. It was an eye-opener for them, as you can imagine. Thanks again for your thoughtful and wise comments here.
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Thank you so much, Dr. S., for saying all that. I feel really inspired by what you said. I remember reading a study on professionals who were blindly admitted as in-patient to a psych ward or something, and they were all misdiagnosed and treated vastly differently from how they were treated as in-patients. I’d love to give talks, but I didn’t know it would be allowed because I’ve been warned by many not to state anything too personal about psychological or mental health issues on a personal statement for grad applications, which is completely opposite to what medical students studying to become doctors or nurse practitioners are told when they said that they would welcome personal statements with physical problems or less-stigmatized diseases that are non STI/STD-related. I don’t want to step on toes either, because I know how I, as a client, can also be wrong because of my own defenses. I like how your supervision over a clinical psychology internship program included a recommendation that the students be admitted to a hospital unit; that’s amazing! I think I watched a movie about a doctor who had been diagnosed with some terminal illness and was in charge of interns at the time, and only after he had experienced a medical illness himself, he decided to do the same with his interns so they can fully understand the need for good bedside manners and proper patient care. Eventually I’ll apply to grad school when the tuition waiver tax is lifted, LOL, but I’m okay where I’m at right now. But it would be awesome to offer something to help the professionals understand the viewpoints of clients, which would help them better in their careers and professions – not just for the sake of helping the clients alone. I don’t want to generalize or speak ill about therapists, but I do want to say something about the struggles clients face when seeking treatment for their mental health symptoms. It’s not like physical symptoms where a pill, cast, or physical therapy can help, but rather there are so many options that make it confusing to use clients to choose from (or to even know we have the choice to choose); I can’t imagine (yet) how confusing and challenging this would be for clinical training, too. I know those in the profession of healing truly do mean the best for all their clients/patients, but sometimes things get overlooked – similarly to how things can get overlooked in medical tests with false positives or false negatives, a lack of mental health insurance that covers appropriate tests and specialists, etc. I wish there were more parity for mental health, which would help advance research, clinical practice, and patient outcomes. But right now there isn’t, though I’m grateful for programs like yours that helped grad students experience what it is like to be a client/patient. That’s amazing! Thank you so much for your contributions, Dr. S! 🙂
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Although, Dr. S., to add on to my reply, there was one time I was in-patient in a hospital and found my “funny bone.” I rearranged some of the furniture in the middle of the night with the help of other patients that were there with me, to “surprise” the staff in the morning with something funny. The staff had already gotten to know me for a few weeks (almost a month), so I thought I could do it while they were in their meetings. We as patients were laughing all night, and I think some of the staff in the morning laughed too. But some other staff wasn’t so pleased, and we all had to work hard that morning to put all the furniture back. I know that it wasn’t cool to do that, but at the time (before I went back to college and knew better), I just wanted to counteract a day of crying with a night of laughter. We didn’t break any more rules after that. I wasn’t that good of a role model back then, not that patients are role models to begin with, LOL. But I did wish that there were some tool that would bring laughter into treatment (without minimizing pain, of course, and without breaking the rules like I had). I don’t know if I’d speak about this as part of my in-patient experience, but I just had to honestly state what I did. I feel bad for breaking the rules, but I feel kind of happy for laughing. It was a moment in life where I felt like I could always find ways to enjoy life despite having to deal with such hard and painful things – though I know how to do that without breaking the rules. It was almost like an April Fool’s joke (since I was hospitalized around that time, I believe). I won’t do that again or suggest that it be done again, especially since this could have went really wrong depending on the staff, trauma hospital policies, or the patients that were there with me. I’m just glad it turned out to be a funny thing.
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It sounds funny – funnier than anything I ever heard about on my days evaluating and treating people in psyc hospitals. When at all possible, I laughed a lot with my patients. We need the humor, all of us.
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PP, I was referring to your ability to write beautifully, and as someone who does not have this ability, I admire it in others. Dr. Stein of course go without saying. I wish you well. 😊
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Aw, thank you Nancy. I was rambling more than writing, LOL. I wish you well too, Nancy.
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This was great! I love reading your posts. Thank you!
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I am not immune to applause! Many thanks, Karen.
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Transference is painful because when your brain is overcome by thoughts of another person, it is a form of suffering. I….gush….too…..much. No father, crazy household, no attention from any adult figure….why wouldn’t I feel adoration for someone who is in a position of power and gives me his counsel when no had ever taken the time to counsel me or give me guidance as a child or teenager? My core is lonely for this…what I never had. Wouldn’t this be expected and how would one move beyond this? I have hinted about this but it has not been discussed….maybe CBT doesn’t recognize this? I only hope my gushing does not cause him any discomfort…I worry about this. He is an ethical man and I am an ethical woman.
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I expect you can find the answers online, Nancy. The feelings of the patient should be respected and, where the roots return to a background such as yours, the therapist gradually guides the conversation to the neglect or abuse behind it, allowing for a grieving process. That, however, doesn’t provide someone to offer love and kindness outside the treatment, but may open the individual to recognizing and taking the risks involved in trying to find it. I hope you do, but you life sounds rich and worthy to me as it is. I wish we all got everything we wanted in life – for decent people, everything they would get in an ideal world.
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What a great, much needed, article! With which I agree, but wanted to raise the question….what about other types of love, the non erotic, non romantic kind ? Or indeed what about love that cannot neatly be put in any one category because love is too simplistic a term? The ancient concept of different kinds of love doesn’t specifically cover therapy (!) but it does make allowance for a spectrum of feelings….my therapist and I recently talked about this. What about love towards a parent, or even the type of ‘long haul’ love you described – deep respect, devotion etc ? I would say my feelings are a mixture of both of those. And as for therapists feelings towards their clients, perhaps sometimes they are even less easy to put in a particular category. Or perhaps that is wishful thinking ! 🙂
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I agree with this because I see my therapist as a mixture of all the different male roles one can have in life, but most importantly, I see him as mentor. And I adore him.
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You’ve offered lots of questions, but let me address at least the first, about non-erotic, non-romantic love. Part of the answer is still in the grieving process. But, I also think that part of the answer is in finding one or more people outside of therapy, (including, one hopes, a mate) who can provide the kind of sensitivity, affirmation, protection, and devotion that one hopes to have from a parent or from a spouse: someone who would give their life for you. Here’s hoping that is still in the cards for you. Fate’s wheel sometimes surprises us in ways we never thought possible (and this comes from someone who considers himself a realist, but who has lived on the planet long enough to have been the recipient of such surprises).
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Further thoughts….you spoke about grief – is grieving what we didn’t receive from our parents, the same as grieving not having our therapist as a parent? I’m struggling with this question now….and surely grief over the genuine loss at the end of therapy, is part of the therapy itself? And therefore perhaps to be distinguished from the possibility which you write about, that grieving the impossibility of a romantic relationship with ones therapist, may need to be processed with another therapist ? I guess I’ve always been quite adamant in my own mind that unlike grieving Jane with D, I will have received what I need from D to grieve her ‘alone’ by the time we finish. And that that will be part of the process, and includes grief over the impossibility of an ongoing ‘friendship esque’ relationship…..but I struggle hugely, as you know, with feelings of loss over not being her daughter, and I just don’t know what I’m doing ‘wrong’ or not doing, and how I can get over them or make them less painful. Hence my first question…..
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I’m so sorry you’re going through all this, Life in a Bind. I have the opposite problem: I can’t wait to be finished with therapy, the grieving process, etc., so that I can be whole, independent, and free. I love being alone and spending time with healthy friends and family, but I can’t imagine someone who lacks strong support systems who are loving, forgiving, accepting, and great grief comforts. I can’t imagine what you go through when you say that you’re struggling with identifying grief in your own life and determining how to handle grief issues related to erotic transference, related to a therapist-client relationship, and related to childhood relationships. It sounds like a lot of pain and confusion, which makes grieving really challenging to process, to identify, to face. I don’t think you’re doing anything wrong. What you’re feeling and processing now seems like progress to me, but I don’t know much other than being a client for so many years. I don’t know what it is like to have BPD, but it sounds like you struggle with a lot of pain, a lot of losses, and a lot of grief. Grief is hard because you have to not only identify it within yourself and with a trusted therapist, but you also have to work toward accepting the losses without trying to replace them – i.e., the “acceptance” phase that people with grief and loss issues struggle to achieve, but eventually do (with hard work and practice and a new outlook on life and the self). It’s hard to grieve the loss of a parent who never was and have to learn to parent yourself as an adult. It may feel lonely, but that’s where the therapist comes in to help. Sometimes we see our therapists (and other relationships) as those who gave us so much more than our parents were supposed to give us, which makes the loss even more painful and the desire (or bargaining) more evident when we try to replace that which we’ve lost with someone else (only, that never works, and no one can fulfill what was lost in childhood, unfortunately). You can find new love and strength in relationships, but it’s not the same as parent-child love that was lost. This may be terribly painful for you to hear, and it’s a painful place I had to mostly work out on my own (and minimally work out in therapy with safe therapists), but it isn’t a lifelong struggle. I felt so much pain in letting go, but so much relief in knowing that I can move on in life to be the strong person I am because I learned the difference of what kinds of love I lost in childhood and the *different* kind of love I can achieve in adulthood – beginning with a healthy balance between love for myself, love for others, and allowing safe others to love me back. Adulthood love will never replace parent-child love – which is one of many grief issues we work out. The therapeutic alliance is healing and only one of many support systems you’ll have in life, and it provides a tool for you to learn those skills to grieve over childhood love that never was, and to learn the new kind of adult love you feel, express, and receive so that you can heal and manage. I’ve had some loving relationships in childhood (which, according to the compensatory hypothesis, can partially but not fully make up for childhood neglect or childhood emotional abuse), so I think it was easier for me to grieve over parent-child losses because I had some other figures showing me that life was safe, that I was going to be okay (at least in some situations), and that there were some loving parts about my mom and dad. But I can’t imagine when children grow up without any of that love from anyone – not even other adults, other teachers, other foster parents, other peers in school, or partial yet *consistent* love experiences from a dysfunctional parent. All I can say is that I hear your pain and hope that there is a healing answer to your question, a way for you to find strength and love within, a way for you to find a new type of adult love across relationships, a new way for you to fully know that you deserve to be in this world and enjoy it, to be free of the longing for parents that never were, to be able to grieve and have a trustworthy therapist witness your tears and your pain as they leave your eyes, roll of your cheek, and fall to the ground, to be able to finally say, “Now how do I live life in a happy way? How do I find strength within? How do I live with this pit in my heart? How do I learn to accept that what was lost was lost, but what is in the future is hope, different kinds of love, my awareness that I’m worthy of love, my ability to find things I enjoy by myself and with others, my ability to let go of that longing, and my ability to (like the movie in the 1980s called “Nadia”) “do it on my own.” I’m so sorry you’re in such pain, and I’m so sorry it is really challenging for you. But I do get it, and I think your questions are totally rational, given what you’ve been through and what effects those childhood traumas have caused you. There are many types of grief, but it’s worth processing that pain with a trustworthy therapist. If you’re in therapy now, find a way to tell your therapist how you feel; you do *not* need to go to a different therapist or have more than one therapist; you only need one therapist to process this with. If you’ve been in therapy for quite some time, and if you have a good relationship with your therapist, I’m sure your therapist would welcome the discussion you presented here to us. There might be some painful things that the therapist would say, but a good therapist would also say, “Hey, I’m here. Let’s work on the painful things together. Let’s hear your fears – all of them – and your feelings – and let’s take one at a time, learn to grieve over them at a pace you’re comfortable with, and find ways to counter the pain and grief work with good things in life – reminders of what you have now and what you can plan for in the future.” –Or something to that effect. That is at least what I’d expect, in part (not in full), from a therapist. There are probably other ways a therapist would respond to this, and some might be great approaches, but it is important that you are able to get the most out of therapy by being honest with the therapist about how you feel – even if it is a preliminary statement like, “I want to tell you something, but I’m afraid to tell you. Can I work slowly on telling you what I’m afraid to tell you? Can I tell you when I’m upset at your reaction to what I’m saying, or your treatment goals, and why? Can you explain to me what options I have to work through this, and if there are minimal options, how I can process through the fears I have about a particular treatment for grief work? If the therapist feels that grief work “isn’t for you” or “isn’t a recommendation of your disorder,” tell the therapist that this is something you’re interested in because of x, y, and z, and ask the therapist to explain to you why he or she doesn’t think that grief work is a viable treatment goal (I’ve heard this when I was misdiagnosed in the past, so that’s all I’m going off of, so I may be wrong). If there are viable reasons that the therapist has regarding a different approach to grief work for different types of disorders, be open to them, but do ask questions and pick one with your therapist that would help you to navigate what you’re feeling and experiencing now. I hope you’re able to grieve, but I’m hoping that you’re also able to find something enjoyable in life and in yourself through the process. You need something strong to hold onto while you’re grieving, and you need to know that you are worthy to heal, to be free to enjoy life, to explore all the great things in this world.
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I think the two types of grief you mention are certainly, at the very least, very close. It may be that when you have someone in your life of the kind I described in my initial reply to you, you will more easily let go of D. Therapy, to work at the best level, must be a springboard to taking the lessons into relationships outside and, with luck, at least finding the closest of friends. Here is something you don’t know about me: when my dad died at age 88, but quite suddenly, I was knocked for a loop. Fortunately, I had a long time friend who was about 25 years older than I was. I am sure that my friendship with him deepened and helped me through the painful time after, even though we didn’t talk lots about my father. It was the closeness to him that helped.
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I recently came across this beautiful quote about grief, and hope it’s not out of place here since both you, Life in a Bind, and Dr. Stein speak of it in the context of the subject of transference.
“Grief, I’ve learned, is really love. It’s all the love you want to give but cannot give. The more you loved someone, the more you grieve. All of that unspent love gathers up in the corners of your eyes and in that part of your chest that gets empty and hollow feeling. Grief is just love with no place to go.” Jamie Anderson
That’s exactly what it is….GRIEF IS JUST LOVE WITH NO PLACE TO GO. And so is transference.
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Beautifully put, brewdun. 🙂
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“Perhaps we therapists go too far in making something unusual of a thing we might otherwise call love.”
Perhaps you do indeed!
As written by someone whose words often seem to speak my thoughts better than I could ever articulate,
“Watch out for intellect, because it knows so much it knows nothing and leaves you hanging upside down, mouthing knowledge as your heart falls out of your mouth”. Anne Sexton.
I see this issue from a very personal, very real, and unspeakably, relentlessly painful perspective. There are no existing words in our language to properly verbalize the depth and intensity and duration of this type of love. Not an erotic love (as in your title), not lust, not anything but a deep abiding platonic love for another human being. “Transference” seems a very cold and clinical word for feelings that are anything but. It’s a word that undermines everything in a heart that doesn’t feel “transference”, it feels love.
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Oh this is so it. Yes. Painful daily . And very real. Thank you Brewdun….
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I agree with this!
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Well said. I can add nothing but my sympathy and the hope that you will, yet, grieve the loss.
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Loved the Anne Sexton quote, thank you 🙂
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I see a lot of convergence in your ideas about transference and the sexual harassment event that is running through public life. We are going to have to muddle our way through men and woman together in so many ways outside the bounds of traditional marriage. Thanks for showing the clip from “In Treatment.” It reminded me of how much I loved that show.
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Thanks, Joan. I’ll let you or some other wise woman write the article about male sexual harassment.
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One more point…If someone has fleeting sexual thoughts about their therapist while not in their company, can it be less about sex and more about the desire to express natural affection?
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If I told you how often men have fleeting sexual thoughts that don’t count for much, you’d be amazed that we ever have the time to hold down a full-time job! 😉
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Thank you for all your replies, Dr. Stein. We certainly gave you a workout today! 😝
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You are welcome, Nancy. A small price to pay for people who spend time reading what I write and taking it seriously. Sometimes I learn from you, too!
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This situation between patient and therapist lies beyond my life experience. However, I’ve experienced such cases of erotic transference in the workplace with male bosses and colleagues. Very troublesome and intimidating (in some cases) to say the least.
BEWARE! YOU MIGHT FALL IN LOVE WITH ME!!!
~ I didn’t laugh. It works both ways.
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Indeed, Rosaliene. It is called countertransference and holds its own set of complications. Thanks for the reminder.
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Oh, there is so much in this post, it’s hard to know where to start.
This: “Perhaps we would do better to recognize that love often depends on what we don’t know about the other, not only what we do.”
Sometimes it’s the opposite: I work as hard as I can to shut out any information I happen upon about my therapist and get very panicky if he reveals even the tiniest details of his life or thoughts. It’s been the cause of many a rupture between us. I’m so afraid of becoming too attached to him.
He doesn’t even know about the latest one yet, involving the inadvertent display of a [his] wedding ring).
For me, information about him = him being a real human being outside of the room. Information = grist for the positive transference (read, therapy love) mill.
I can tolerate my therapy-love for him within a limited time frame in a single place.
But not blancmange-img into the world like an uncontrollable creature from the deep.
Maybe one day I’ll have the tenacity or resilience or secure base or whatever it takes to relax some of my therapy-rules.
It feels a long way off, though.
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With luck, things will come to you. There are lots of possibilities in life if one is bright, open, and eager (and willing to be disappointed by life and not give up). You sound like you have the right kind of energy to embrace that which is possible, Defraggingme.
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I’d be interested to know what research has been done on the effects of this sort of transference on clients’ marriages…
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To the best of my knowledge, not anything that would stand up to careful scientific scrutiny. I should say, however, to the extent that anything threatens a marriage, if the spouse who is tempted by another can pull-back from the stirred-emotions, preoccupation, and temptation, he can then put more effort into making the marriage better. So, paradoxically, such a transference experience might allow the patient to recognize what is most important to him and try to enliven the marriage. Finally, here is something a few decades old and anecdotal, but might be of interest. It refers to the danger to marriage of erotic transference in traditional psychoanalysis, where the patient is commonly seen several times a week: http://www.nytimes.com/1982/12/28/science/demands-of-intense-psychotherapy-take-their-toll-on-patient-s-spouse.html?pagewanted=all/
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Hello and many thanks for your reply. Yes, I had read that article and ‘got it’, but… Hmmm. I don’t know that it’s really that emotionally satisfying. (I’m longing for someone to contradict me, of course!) My favourite on the subject to date was this, about a woman who didn’t fancy her therapist at all, but a few years later found herself… (Well, she tells it much better than I would!) https://www.nytimes.com/2014/05/25/…/modern-love-transference-ill-take-it.html
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… Perhaps I should have said ‘disagree with’ me rather than ‘contradict’… and the article I referred to is to do with transference in general, rather than the particular challenges that may be faced by a married client…
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Lovely story. Ah, but the woman doesn’t like men who ever wear permanent-press shirts! I’d not have made the cut either, not until the end. 😉
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Four to five days a week??!?
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Yes, in classic psychoanalysis.
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Sorry to add one more thing: I’ve had erotic transference with both men (opposite sex) and women (same sex), depending. For some reason, I think most of the male therapists had an easier time with me (a woman) than the female therapists. This didn’t happen with all therapists (or with all authority figures outside of therapy), but it does with some. I’m primarily heterosexual, but I tend to second-guess myself. I don’t know if anyone else goes through this, and it would be interesting to know if those who have other sexual preferences deal with erotic transference toward someone whom they would not ordinarily be attracted to that way. I’ve not asked this question before, but I’ve been wondering about it for some time now. I’ve always chalked it up to my grief issues with my mother and father, grief issues with the loss of loved ones in the past, and grief issues with other areas of my life. I really have no idea why this sometimes is the case. Then again, I sometimes “fall in love” with non-Earthlings, like Starman (from the TV show, not from the movie; I was 10 or so years old when I watched this and had a crush on this guy), Data (from Star Trek; I could imagine myself in a relationship with this guy because I consider myself sapiosexual), and Mater (from Cars; I could see myself involved with a human being who is as goofy as Mater because I’m goofy). I love movies and fictional characters, and personality means more to me than looks. When I was about 12, however, I thought I was “in love” with my best friend (who was female). She didn’t feel the same, but we were both abused. She is no longer alive, but I remember doing everything with her. We’d both talk about boys we liked, and the trauma we both had to deal with. We kept each others’ secrets, and we didn’t know we could tell a trusting adult what was going on. I guess the closeness I felt with her got me confused at the time. I freaked her out when I told her though, but she was still my friend. I did try to be in a lesbian relationship, but I really didn’t like to have lesbian sex; I think I just felt aroused from my PTSD or something, but I really felt close. I ended that relationship after a very short while, and the lady was upset. I didn’t know until that experience that I am really heterosexual, even though my body was conditioned to respond to certain things. Sexual healing is a tough one, apart from erotic transference, because it’s also hard to be consistent with sexual intimacy with a partner (you love to be physically intimate some of the time, but fear it or get triggered at other times). Unfortunately, I don’t know how to detect or process that since I’m not in a relationship (nor do I really want to be). I’m kind of happy being asexual, but I remember taking a psychology of women course and learning that asexuality could be a sign of pathology (such as childhood sexual abuse or rape). But what if you really want to be sex-free and alone romantically the rest of your life? I’ve found a real comfort zone, I guess, but I have friends I can be close to. I’m also older, in my 40s, and have completely lost my sex drive, but I do get aroused (though I don’t act on it). That’s challenging to discuss because some therapists will respond with things like, “Well, you’re single, so you don’t need to worry about that right now.” or “I don’t think you should focus on romantic relationships.” When I was in my 20s and 30s, I was upset with the latter response because I knew my clock was ticking. But now, after having been alone for so long and getting used to really enjoying the work that I do plus my art hobbies and other adventurous hobbies with visiting new diners in the local area and what not, I really lost the desire to seek romantic relationships. I think the desire for wanting to be youthful again, or the grief of losing part of my youth and many years to this PTSD, has changed me. I feel more content than loss though, but I may be in denial due to the triggers that mask the grief. I wanted this to be a shorter add-on, but I guess my mind went here. With friends, you can be close, share intimate details, laugh, cry, support, do fun stuff, but you don’t have to deal with the sex. I guess I enjoyed sex before, and I can still enjoy self-soothing, but it feels more like a fairy tale to desire a romantic relationship than it does a real desire for sexual intimacy and passion in that way. Still, the erotic transference occurs – even though I have no intentions on acting on those feelings nor finding a romantic partner. But I do keep my options open for a romantic partner in the future. I just want to feel safe if that were to happen.
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To clarify (since there’s no edit button I can find): The short-term lesbian relationship I tried out was when I was about 30 years old, but never desired a woman after that. The feelings I had with my best friend as a child (she was female), was not reciprocated, but we remained close friends. I do plan on speaking about this when I get assigned to a new therapist at the VA, but not until I get to know the therapist for a while to see if we’re a good fit. Sorry for responding so much, but this is so cool to freely discuss this and to hear other people’s stories as well. It makes it less scary or stigmatizing.
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I’m glad it helps, PP. It pertains to the topic, so I’m happy you feel comfortable. Just a couple of things. First, we are all “in transit.” Who knows, really, where we are going to end up and what will occur on the trip? Maybe you will have romance. As to sexuality and aging, you might want to read Richard Posner, a U of Chicago law prof and judge (just retired); also a prolific writer. One point he makes is that sexuality is properly thought of as being on a continuum. That is, most of us lean one way or another pretty strongly, but some are closer to the middle or, under specific circumstances, can turn to sex with people other than those we would usually prefer. We know what happens in prisons, for example, and what happened historically on merchant ships when men were at sea for months at a time with no women available.
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Thank you, Dr. S. I will definitely check out that book by Richard Posner. I definitely keep my heart and mind open to new things, new adventures, and new journeys. I think religion (more so than stigma) scared me the most with my feelings toward same-sex persons, but when I was in that relationship with a woman, I was asked by the pastor not to return to their church if I were to “live in sin.” Things didn’t work out with the woman I was shortly with, but I was deeply crushed by the people at the church I once loved attending. That’s a completely different topic, but it’s connected in some way. The pastor was a pastoral counselor at the time, so I was even more crushed when my support system completely vanished. Thankfully, I found professionals and friends to help me deal with that, but it took about a year to really find my own spirituality and values without fear that I’ll be doomed to hell, punished for my sins, punished for my confusion, thoughts, or desires. I don’t really consider myself part of the LGBT community, but I can see (in part) why that population might be really struggling psychologically. I can’t imagine today what that population is going through as personnel of the Department of Defense or as veterans, or what those who were discharged because of their sexuality or “conduct” during the years when it wasn’t allowed in the military. It makes sense, too, that those who are isolated (such as in prisons, on merchant ships, on submarines, or on other tours) would turn to sex with partners they’re not normally with. What’s even more challenging is when the sex isn’t consensual and becomes military sexual trauma or rape. Unfortunately, there’s a lot of male and female veterans who struggle with MST, but for the ones who did consent, they struggle with confusion and shame. I like the idea that sexuality is on a continuum. Thank you.
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You are welcome, PP.
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The book by Richard Posner, is it “Divergent Paths: The Academy and the Judiciary”? He has so many published books, I’m amazed and impressed! I’m actually interested in this book, too, by Posner: “The Problematics of Moral and Legal Theory” – since I’m attempting to write a literature review that includes arguments related to child welfare, child maltreatment, and the moral and legal theories they utilize. I’m wondering if his statement about sexuality is in one of those books, or in a different one. He has like a dozen or more on Amazon. I can’t believe it!
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Two books: 1992, “Sex and Reason,” (ISBN 978-0-674-80280-3) and 1995, “Aging and Old Age,” (ISBN 978-0-226-67568-8). Good luck with your review.
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Thank you!
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If it quacks like a duck, waddles like a duck, then it’s probably a duck.
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I’m always delighted, Claire, when someone can put into one sentence everything I’ve said! Really, you have cut the the chase!
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You don’t have to act on those feelings. You can feel attracted and love for lots of people in your life time. It doesn’t need to be pathologised,
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Absolutely right.
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Well, yes. But surely the question here is one of intensity? A teacher or work colleague, for example, won’t know you in anywhere near the same way.
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Usually. But teachers and work colleagues do fall in love with you, nonetheless; and visa versa.
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In a previous post you mentioned (if I understood correctly) that transference was a goal of therapy, and that therapists, in essence, manipulate their clients in an effort to achieve this goal. In reading story after story, and comment after comment, it seems a rather cruel thing to encourage such deep attachment and feelings when you have nothing you can offer that will detach the patients from their counselor. I understand that some people never suffer from this and that some seem to be able to move through it or beyond it in therapy, but it appears that a huge number never do. You have a powerful switch that turns on the heart but you have no switch to turn it off, and if therapy ends before the transference has ebbed, the only solution you can offer is further therapy elsewhere to try and resolve all those feelings without any guarantee that the patient won’t then attach to the new shrink and is back to enduring the same anguish as before. Seems like an endless chain, and from the patient’s standpoint a torment that can last for many years.
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Yes, thank you. So well put! I almost wish someone would put their hand up and say, “We have no ‘exit strategy’ for this.” The point I intended to make above is that the therapeutic relationshship is NOT LIKE any other. Yes, you may fall in love with a work colleague, etc, but the degrees of pre-existing trust and exposure are completely different… Stories of good outcomes would be welcome, folks!
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No, it is not like any other. You have one person who is an expert in how to create an atmosphere of trust and is schooled on how to keep their feelings out of it, and another who usually comes to therapy emotionally battered and incredibly vulnerable. This is where the inequality lies. In the end the therapist always has an escape hatch. Their “Code of Ethics” protects THEM, while they are able to generate the myth that it’s in place to protect both sides. It really isn’t. Therapists can walk away, retire, move, change jobs, etc. or they can turn the client away if they feel at all susceptible, and then proudly point to that Code of Ethics to show the world how honorable they are in totally cutting all ties and sticking to this “ethical” code as required, a code they created and wrote, I’m quite certain, without any input from the other side. The patient has no such escape door. Yes, they theoretically can quit therapy but once they are caught in this “transference” web, there is no way they are going to leave of their own accord. Emotionally they are trapped in the relationship. The therapist becomes the center of their world. And, if any therapist believes they do no harm and are shielding patients when they refuse to have any contact (I’m talking about verbal contact, nothing physical), especially if the therapeutic relationship ends before the transference issue is resolved, then they have not seen it from the other side. The pain they leave in their wake is unimaginable. No harm? Hmmmm.
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I do not agree, Brewdun. First, I don’t recall ever saying, or ever hearing or reading a responsible therapist saying that we manipulate our clients. Second, transference is not the goal: healing is the goal, to the extent we can heal some of the injuries that come in the normal course of living, and some that come to those who have been particularly unfortunate. It is true, however, that the transference happens often enough by itself and one then uses the transferential relationship to assist in the healing process; which is part of the way (also) to resolve the patient’s feelings toward the therapist.
You make an assumption that “a huge number never” resolve the transference. Offer data if you have it, but I don’t know of any. We all get our hearts broken in life. Take a look back at the post I wrote about a mother who accidentally killed her child as an example of how even something as unimaginable as this can be treated with some success: https://drgeraldstein.wordpress.com/2016/06/12/a-remarkable-recovery-from-unspeakable-grief-and-ptsd/ As I’ve suggested, it is also the patient’s responsibility to deal with the loss (if it has not ended by the therapeutic resolution of the transference) either with another therapist (where it does not automatically get passed on in some sort of relay race, as you seem to believe) or to deal with the grief by finding other people and other things in life to attach to. Perhaps, like Meichenbaum’s patient, who found a way to give meaning to her suffering, you should become a public spokesperson for the dangers of psychotherapy (I am serious).
If unresolved psychotherapeutic transference were the death sentence you are suggesting, counselors would have their pictures displayed in the US Post Office with the added notice: “Wanted Dead or Alive.” I do not make light of it in saying this, but rather am trying to underline the severity and one-sidedness of your opinion. Be careful not to throw out the baby with the bathwater. Surgery also runs risks. Taking medication runs risks. There are always risks in life. As I’ve suggested, perhaps we need to alert patients more about the psychotherapeutic ones, (and maybe you can help and have already helped in this by your comments) but I doubt that such warnings would stop all people from coming to therapy. Many would say, “Oh, that won’t happen to me,” until it does.
I am sorry for what has happened to you and the continuing misery you describe.
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To respond now, Brewdun, to the issue of professional ethics, I again believe you take your concerns too far. The ethics are designed to protect the patient. You have read enough of my writing to know that the patient would be far worse off if the therapist were able to act on his “countertransference” in the form of romance with the client. Moreover, as I have written, if the therapist feels as much as the client in treatment – empathizes with her to the maximum – he becomes as overcome by her pain as if he were himself inhabiting her emotional life. He then renders himself unable to be of any assistance to her and is also lost to himself. The client is not passive, even if she is at a disadvantage of authority and power in the relationship. Life deals us all sorts of blows. The Stoic philosophers knew they could not give in to them: “The art of life is more like the wrestler’s art than the dancer’s, in respect of this, that it should stand ready and firm to meet onsets which are sudden and unexpected.” (Marcus Aurelius, VII, 61). In other words, all of us, when thrown to the floor, must take it on ourselves to get up. Even in the best of therapeutic relationships, the client must be putting in more effort than the therapist, as hard as he is trying to help. Perhaps in a fair world things would be otherwise. We both know, as Clarence Darrow said, “There is no such thing as justice – in or out of court.”
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With all due respect, Dr Stein, I am not sure that you are being altogether fair here. The poster has made a number of observations on the subject of unresolved attachment to a therapist, and your response seems rather personalised, viz ‘I am sorry for what has happened to you and the continuing misery you describe.’ I don’t believe that her feelings are peculiar to her (why, for example, would your own blogs on this subject prove so popular if they were?) and her observation that ‘it seems a rather cruel thing to encourage such deep attachment and feelings when you have nothing you can offer that will detach patients from their counsellor’ would appear to me to be the issue you should be addressing. I say ‘should’, because you are the seasoned professional who has raised the subject, and I don’t believe it’s fair to then back away from it. Comments along the lines of everyone getting their hearts broken seem to me to be doing just that, and I wasn’t sure what place the story of the woman who had lost her child had here(?) unless to trivialise the presumably much lesser issue of unresolved transference. (This may well be a complete misreading on my part.)
I am surprised to find myself sounding so critical here, but I do feel as though a subject such as this needs to be approached robustly, or not at all. We’re here – I’m presuming to speak for others for a moment – because we need help. There’s a line attributed to Rilke that stuck when I read it recently, ‘I am like the anemone I once saw in the garden in Rome, which had opened so far during the day that it could no longer close at night.’
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Ruth, thank you very much for taking the time to write this. Love the quote at the end!
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PS. Small technical query: I appear to be able to comment, but not to leave ‘likes’ without being a WordPress blogger. Have I (just possibly) missed a step here…?
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I believe you are correct, Ruth. If anyone knows what a non-Wordpress blogger can do to “like” something, please do let us know.
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I am sorry for the pain of all of those who suffer from unresolved erotic transference and much else in life. I do not mean to say that I therefore feel personally responsible for all of those who suffer from this or anything else in a particularly fraught moment in recent history. I have offered as much as I can say concerning how to get over this type of unhappiness short of taking on the job of being the therapist to anyone who is pained in this way, in which case I would have to know much more about their current life, at the very least, and see them rather than write to them. I hope all those who suffer from the condition described (assuming that this is the sum total of what underlies their difficulty), will consider taking the direction I have suggested or look to others who are writing about it for additional guidance. Better still, to enter into therapy once again, with all the dangers therein acknowledged. As to the reference I made to the woman who accidentally shot her child, you may be sure it was not intended to trivialize anyone else’s unhappiness, but rather to explain that such extreme conditions are amenable to treatment. That again, requires that one is willing to take on the risks of a treatment of the kind the therapist (Donald Meichenbaum) offered in the mother’s case, which I have alluded to above with respect to finding meaning in one’s suffering; and meaning in the actions they take and the life they live after the events that caused them pain.
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Dr. Stein I thank you for your responses as well, and stand corrected on some things I overstated. I have reread your August 27th blog entitled “The Sex of Therapy and the Road to Erotic Transference” multiple times, as this one in particular, spoke to some of the things I mentioned. You are correct you never said “manipulate” but the implication is definitely there. Your bulleted points listing all the things a therapist does to put the patient at ease reads to me as a (your word) “seduction” to get the patient’s trust, not by being your normal self but by being your very much enhanced self to (my word) “manipulate” that patient to “Allowing the therapist inside…an intermediate goal of psychodynamic treatment:…..Transference is expected.” You said this was a “goal”. Obviously I’m interpreting all this with my own spin on it, not how you meant it. Still it was difficult to read and did not get any easier with consequent readings. I have great respect for you and hope you know that my comments were not directed at you but rather just generalizations about my own feelings. Thanks, and as you quoted so aptly “There is no such thing as justice — in or out of court.”
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You are welcome, Brewdun. No, I never meant to suggest “manipulate,” nor did I say it, as you note. I used the word seduction, but part of the stated point of the essay was to talk metaphorically about the relationship between the therapist and the patient and to look at what likenesses exist between the therapeutic relationship and a love relationship, without saying they were identical. No responsible therapist would attempt to seduce. With respect to psychodynamic treatment, not every therapist practices this and many of those who do, use it as one of a number of approaches depending on the patient’s needs, at various times within the treatment. Only in traditional Freudian analysis is the transference (from Freud’s point of view) inevitable and viewed as the singular opportunity to resolve the patient’s early-life issues. Even then, the therapist does not have to do anything special for this to happen, as I have said repeatedly in the many blogs I’ve written. I do, Brewdun, as noted, urge you to consider therapeutic remedies.
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Well, reading through this entire thread has been very revealing to me. I knew nothing about the process of therapy, especially the twice-weekly Transference Based Psychotherapy I’ve been undergoing for the past three years. It’s probably just as well because if you had told me what it would be like, I believe I would have bolted (out the door). In doing so, I would have missed the opportunity of getting a chance to experience what love is all about. It’s pretty heady stuff and thank god there exists a treatment frame that allows this kind of (safe) interaction between patient and therapist. In my case, this never could have been done without a strong positive transference, which by the way I still struggle with. I do understand though; It’s “on me” to bring it into the room. (More often than not I also get a gentle nudge to do so). It has required more bravery than I’ve been able to muster on some occasions. I eventually spill the feelings, bring them to the table, and we get to explore them. That’s where the growth happens. It’s painful, but not without humor which has probably saved both of us. The best any of us can do in the end (as patients) is to make sure we’ve have let nothing significant on the cutting room floor.
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Your response is refreshingly different from most of those in this comment thread, Deb. Thanks for putting it out there. I’m glad the therapy, for all its difficulties, is helping.
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There’s a reason my transference has been so particularly painful and like everything else that happens, it becomes part of the discussion between the therapist and myself. You are absolutely correct in your description of what should and must happen for therapy to be successful for the patient. I’ve reread your responses on the subject of professional ethics and the duties therapist have in caring for patients. Sometimes I want things to be different, exceptions to be made, rules to be bent. Sometimes they can be. Often times, they simply cannot be. What I do know, at least for myself is that the experience I’ve had has been nothing less than life-changing. Was it Betty Davis who said, “Buckle up, it’s going to be a bumpy ride” (or night).
Thank you again, Dr. Stein for your candor and openeness in bringing up the one area where we all struggle so mightily. Happy Holidays!
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Thank you, Deb, and best wishes to you and happy holidays to all of those who visit this place on the web.
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I just read through more replies (those that I missed), and I totally get how transference can be confusing and painful – especially when there were past bad therapy experiences, when transference is scary because of our own past issues, when the therapist doesn’t include transference as part of treatment, or a combo of the above. I once had a pastoral counselor who I truly felt the love transference thing (for a female), but she wasn’t comfortable and ended therapy and interrupted transference, which left me deeply hurt, not to mention feeling really judged as a “sinner.” The therapist who I saw after that was licensed, but she wound up trying to have a dual relationship with me (not sexual, but more so of bartering my services in order to pay for 4-5 times per week for treatment she thought I needed, a “surrogate mom” because she couldn’t have children and though I could benefit from the role, and spending the night at her house as a “friend”). When the second therapist’s roommate threatened my life, and when the therapist didn’t feel comfortable discussing that, I knew there was a problem. I had to get treatment in a trauma treatment facility to get the courage to end treatment with her, to deal with that loss (in part, but not fully), and to deal with a transference issue that was really unhealthy and damaging. Since 2007, it has been very challenging for me to find a good therapist, let alone trust one. Whenever I bring up my need to process through the hurt, pain, and losses affiliated with bad therapy, the new therapist almost always wants to instead dive into my childhood or military sexual trauma or adulthood rape. I typically oblige, but my goals are to heal from these losses, process through my grief issues, build a safe relationship with a therapist, and truly experience the healthy healing that takes place in transference. Recently, from 2016-2017, I had tried out another therapist who negated my requests to speak about past bad therapy experiences, who kept telling me that she was one of the best therapists around and that I should be lucky, who told me I should quit my volunteering as a research assistant, who told me that I’d be retirement age (I’m 42 right now) before I’d ever get well enough to go back to work, who demanded that I form an attachment with her (without even building trust with me first), who embarrassed me in front of other female veterans on a retreat we all went on, and who kept getting things about me wrong (like my age, for which she said I looked much older than I am, which was a put-down or mishap; or like my credentials for having military experience, for which she said that she couldn’t do it, and therefore I couldn’t do it, as if not to believe me or to pathologize everything I say as grandiose; who didn’t believe me when I said I graduated at the top of my class at two colleges recently, etc.). My last therapist wanted me to “attach” to her and do the transference thing, but her countertransference preceded – with her telling me about her own traumatic issues, her own dealings with people who treated her inappropriately, with her having a sister with the same name as me and being as “timid” or “fragile” as me (which kept me wondering why she would project that onto me when she knew I was in the Marines), etc. She undermined everything about me and then told me about her sister, whom I reminded her of. When she told me that I would never be a ___ (insert my career goal here), and that I needed to depend on her for a large number of years in order for me to get better – perhaps for the rest of my life – I had to quit that therapy. There was no way for a natural attachment or therapeutic alliance or healthy transference to occur in that situation, and it brought up a lot of painful memories about the pastoral counselor and the bad dual-relationship therapist in the past. When I reported this to the psychologist in charge, the psychologist basically read her notes about me and started to “assess” me with questions I knew were targeted at misdiagnosing me with something, questions that had nothing to do with the situation at hand, but targeted toward my character, and a pathologizing blame on my childhood or accusatory assumption that the way I handle therapy is the way I’ve handled everything in my life (completely not true, and I explained this to her). From the beginning, I assured the psychologist in charge that I wasn’t trying to get the therapist into trouble; I merely wanted to process what I was going through so that I can heal from the losses of bad therapy, trust the therapeutic process again, and then finally be able to move on to the treatment I should have gotten in the first place had not all the bad therapy happened in the first place. The psychologist said that I needed to speak with the last therapist again, and I agreed, but almost two months had passed and I told her that, after three visits in speaking with her, that I don’t feel comfortable dragging this out, that I wanted to confront her (if that was their “requirement for closure” or something) sooner rather than later, and that I wanted to (on my own) seek a new therapist outside of their small facility and at a bigger VA facility. The psychologist stated that she knows most of the people at the bigger facility (almost sounding like a threat, but I caught myself just getting paranoid or feeling judgmental). I knew, however, that they cannot ethically share my file with the bigger facility without my written consent and permission (which I refuse to offer), and I finally mustered the courage to call and ask for a new therapist at the bigger VA facility. The new therapist called me, assured me that they don’t have records of me from the last place, said that it was okay for me to meet in person (as opposed to the initial suggestion for tele-health; online therapy; which I don’t feel comfortable doing, and I don’t mind traveling to get to their facilities), said that it was okay for me to try things out and suggest a new therapist if we don’t work out, said that she couldn’t share my information unless I give her permission to do so, and truly understood my concerns and boundaries when we spoke on the phone. I don’t know what our first visit will be like, but I have no choice (after all the trauma I’ve been through) to be cautious in trusting a therapist blindly until I get to know her a bit. I’m not afraid to be close, like some would assume. My relationship in therapy is really different from my relationships outside of therapy – at least now, since I’ve had all that unfortunate experience. I’m not afraid to attach, to go through the grief and loss process, to acknowledge my traumas, to acknowledge my strengths, to acknowledge my dreams, and to go through the temporary (long or short term) transference that should naturally (not forcibly) occur. I don’t believe that therapists “manipulate”; I believe that therapists do intend to help their clients heal. But I don’t think that all therapists are the same, or good and reliable. I’ve come across the ones who were not so good. A sad reality is that when you’re poor or receive free treatment, you don’t get treated as nicely as when you have money and pay more money for a therapist (which had been my experience before I went on disability and had to change from the “good” therapists to the ones who seemed burned out from taking so many “Medicare clients,” or “VA clients,” and some even acknowledged their own pains about not getting paid enough as a therapist – to me, their client. My only experience of healthy transference was cut short, temporary, or severed prematurely. I get the pain that others express here, but it will not make me look down upon the field of psychology and those who help us survivors heal. I try and try and keep trying to find the therapist I can get to know, and who can trust me enough to get to know me without thinking that I’m exaggerating, that a cigar means something other than the cigar I’m trying to present, without pathologizing every single thing I’m saying, without undermining my strengths, etc. I trust that I’ll find what I’m looking for in treatment, which I’ve heard so eloquently stated by Dr. S in his posts, which gave me hope. I just wished that I could find someone as kind and seasoned as Dr. S at the VA, or even a “rookie” who is willing to try. I’m just glad that some people have experienced the good about transference, the healing they needed via relationships. Those stories give me hope as I continue to try.
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Well, I’m not perfect, PP, but your confidence in me is touching and much appreciated. Your experiences with therapists is staggeringly unfortunate, but meets its match in your off-the-charts resilience. I’m sure those who read what you’ve written here and elsewhere with respect to the complications of therapy and the importance of a will to triumph can benefit. Thank you.
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Thank you, Dr. S. I still think therapy is beneficial, and I think many different approaches have helped me. I may also be bias because I’m the “client” who sees through a lens of pain, who transfers, who has defenses. But there are plenty of good, if not great therapists out there; those good/great therapists (like yourself) help me to stay resilient and build on even more resilience. 🙂 I couldn’t have accomplished many great things had it not been for the help of therapists, safe family members, friends, and community members. We clients can bring forth a lot of “attitude,” lol, but in the end, we see the hearts of those who care and are willing to help; we only hope that one day we could mirror those efforts onto others, so that we can be the helpers (or at least find a kind of peace in the world to enjoy life and the company of others in it). Thank you!
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You are a Sweetie!
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Tonight I finished season 1 of In Treatment. Love this series, but to avoid a spoiler alert all I am going to say is, “Thank God” and “I did not like her.” I loved his rapport with the young girl…..I guess I identify with their relationship.
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Even though I used the video, I have only seen one or two episodes. I gather it resonated with lots of people. Of course, the therapist went way over the line. Glad you loved it.
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good blog
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good writing and the video also
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As an update, I recently bit the bullet and addressed my own transference issues with my male psychologist, and it was the most difficult thing I have ever done but I was met with kindness, gentleness and grace. I presented this as a problem of mine which I would like addressed, and we have been discussing this topic which has greatly diminished and stopped the erotic piece for now….hopefully for good but if not, it will remain an open topic. I had abuse in my childhood, but as a teenager I was groomed and abused by a man with power and authority over me, and even though I was able to resist and not succumb, I dealt with a lot of abuse from him which was similar to many of the victims that are coming forth today with the #Metoo movement. I have been haunted by this my entire life but I also adored him and it was the adoration that landed in therapy, everything a repeat of those days gone by. I feel immense gratitude for my therapist who has such integrity, warmth, patience and decency…..he did not run from me, and he also talks to me and is not dimissive of anything I say. I guess my therapy is not all CBT because we talk, but he will help me strategize when needed and he is very supportive of me. He has helped me bring to a close this horrible chapter or at least almost close the door….the door is cracked-open just a tiny bit but when I started therapy it was opened-wide…unsure if I can ever forget because reminders can cause a flare-up, but I will definitely take this. Therapy does work and I am a big believer in it. Thank you Dr. Stein for keeping us on our toes with all your informative articles!
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You are welcome, Nancy. I’m happy for you that your courage has been rewarded and enabled healing. CBT also makes room for the things that need the windows opened to fresh air and grace and the healing that comes with expressing our grief to someone who witnesses it and abides with us.
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I agree Dr. Stein, just having him listen to my grief and to feel supported in this has helped me immensely. Your articles about this topic have given me the courage to pursue this, so you also have played a part in my healing, and I am grateful to you also. 😊
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Thank you, Nancy. I’m glad to have helped a bit.
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I respect the integrity of my therapist but upon rereading the consent form (which I did carefully read before entering treatment), I feel unjustly excluded from vital information about commonly experienced and possibly severely destabilizing emotional effects of the therapeutic interaction itself over and above any reactions to the patient’s psychological issues BY THEMSELVES. These effects occur much or most of the time in therapy and are a natural consequence of aspects of therapy that make it work; but patients do have a right to truly informed consent the last time i looked. Relationships and careers are ruined and lives ended over the intensity of the therapeutic relationship. While people seeking help may easily discount any reference to this subject on a consent form, it is unethical to omit such a reference. Trust in therapy can take time to achieve and the feeling of betrayal in my opinion constitutes harm.
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I think you make a good point. Historically, until the recent past, such considerations would not have been addressed on a consent form. I would also say, however, if consent forms become as detailed as the lists of possible side effects listed on prescription information sheets, the prospective patient might well be terrified and not seek treatment at all. One can make a case for saying too much as well as saying too little. The decisions to come to therapy is often prompted by some immediate event. Frequently, the individual wishes the first possible appointment. Anyone interested in the field might ask themselves how much time should be devoted to describing the details of potential destabilizing emotional effects of therapy within the initial interview, for example. In the case of a possible erotic transference, to take one such potentially destabilizing emotional event, many patients cannot imagine or predict who they will fall in love with and how immediate their emotions begin to head in that direction. Assuming they gave their informed consent about this, they might still dismiss the possibility until the feelings occurred. I’ve written all this, not to undercut your important concern, but only to point to a few of the possible complexities. Thanks for your thoughtful comment, Amy.
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Thanks for your reply.
Yes, there are complexities. But the issue of informed consent urgently needs attention, maybe including broader education, which may be underway – I am no expert in anything but my experience as a psychodynamic psychotherapy patient.
Perhaps consent and progress check-ins could help patients live in a state of good faith with their therapy, not that therapy is easy.
Regarding the consent form, the reference would not need to be detailed or alarming. Of course people in crisis want to feel confident that help is near without the burden of intricate decision-making; and it’s highly unlikely they would really expect any problematic effects of the relationship with the therapist at all to occur for themselves even if somehow understood as a possibility. Also therapists need clients. But the profession claims to preserve patient autonomy, which in my view begins on first encounter, however well or poorly a patient in distress can grasp what he is consenting to. Other factors in therapy can be destabilizing and are discussed very generally on the usual consent forms. But attachment to the therapist, much less in its extreme forms, is not even implied in any description of therapy – even though it often has the unique ability to destroy the psychological ability to LEAVE a therapy that has become, unexpectedly, deeply obsessive and shaming. Trapped, without the slightest warning, is not autonomous.
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I agree with all you have written, Amy. The mechanics of implementation will, I’m sure, be challenging. This is a highly nuanced issue. I would add that any consultation with a health care professional always involves risk. I suffered a permanent, if tolerable, injury in what was considered a routine procedure, one with only anecdotal evidence suggesting there was a chance of permanent harm at all. Moreover, so-called “knowledge” changes. Before Joseph Lister’s research and his battle to get surgical practices changed, surgeons did operations with dirty hands, surgical knives that were never cleaned, and gowns that were never washed, inviting people off the dusty streets to sit in amphitheaters above the operating theater to watch them perform. Again, thank you for your appropriate reminder and caution.
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I don’t know whether you will see this comment since this thread is old. I’ve been in psychoanalysis for almost 6 years. I can’t tell whether it’s helping or not. I fell in love with my analyst and I know most of it is transference. It is agonizing and at this point I’m wondering whether the best thing for me to do is leave. I’ve been very honest with her about my feelings since they started years ago but nothing has shifted or changed. It feels too painful to continue and I’ve let her know that I think I need to end analysis. I have a history of neglect and a pattern of falling for unavailable people and this transference feels more like a repetition but there is has been no working through it. When I’ve brought up my feelings she remains silent or says something about ‘every boy wants to marry his mother’ which I haven’t found helpful. The pain of these continues to feel overwhelming and agonizing. If it were shifting even a little I might feel more hopeful about it but it just isn’t. My question is at what point is it time to end analysis with this sort of unresolved transference? Or is there anything else I can do to resolve this? I’m also wondering whether she has the capacity to help me work through this. Thanks for any response or insight (if you see this) and thanks for this blog. I’m glad I found it.
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First, Matthew, I look at every comment and try to respond, sometimes shorter, sometimes longer. Thanks for your kind words about my essays.
Now, down to business. First, I can’t say whether you should stay or go. I’d have to know much more about your experience and background, which isn’t my role.
I will say this. First, it would not be inappropriate to ask her for something more than the comment she made about the Oedipus Complex (the “mother” response) as it relates directly to you. That said, if her answer is unsatisfying, six years is not a small amount of time to devote to treatment. Moreover, it is reasonable, by this time or even earlier, to be able to say to yourself whether it is helping or not. You could also get a second opinion, but you might wish to consider other kinds of approaches to therapy if you do.
You clearly are in pain. Transferences such as the love of a therapist are intended to be resolved with the help of the analyst. You are as free as you wish to be in the decision to stay or go, whichever you choose. I would say, however, that if you don’t want to hurt her feelings or you are looking for her approval, those issues by themselves are worth discussing. They do not constitute reasons to stay. No therapist deserves more than respect and financial compensation. One final thought. You should not remain in your current therapeutic relationship in the hope she will ever be able to reciprocate your feelings. That is outside the professional boundaries of most professionals, as they should be.
Best of luck, Matthew.
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Thanks so much for your response. I found it quite useful. When these feelings first started occurring I thought it was a great opportunity to work through some core issues but unfortunately it seems I’m just stuck in the painful repetition of them. It looks like I may have tried everything I know in terms of trying to work through them with her. At one point, not long ago I said that I don’t feel like I’m getting the help I need to work through them. Her reply was to ask me what working through meant so I explained what it meant to me (I have a PhD in Clinical Psychology). I’ve also asked her for more of a response than just that comment and was honest in letting her know I didn’t find was helping me other than to name something I already knew. I have a sense it’s time for me to leave. I will try one more time to see where it goes and at this point don’t feel any hope at all. I’ve been staying in this in the hopes that one day I’ll notice significant changes plus I’m told by her that ‘it wouldn’t be good for me to leave and that if I do I’ll be stuck in this state’ which is a big fear of mine. I wish I was having a different experience with her and I’ve longed for the day that I’ll be free of these feelings. It might be that I’ll have to leave to get that freedom. Thanks again. I look forward to continuing to read your excellent and relevant essays.
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Thank you, Matthew. Indeed, sometimes waiting to change our feelings before we act must be replaced by action before our emotions begin to alter. You sound like you have a grip on the situation. Hope is, as you suggest, a double-edged sword. The setting aside of hope can be an important step. Best wishes.
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