Words are hard labor. Let’s therefore add some pictures. The moving kind in matters of the therapist’s heart.
Much is written about erotic transference, but this is countertransference. Ladson and Wilton (2007) report:
The intense emotional experience of countertransference in psychotherapy … is not rare. Some studies have reported 95 percent of male therapists and 76 percent of female therapists admit they felt sexual feelings toward their patients.
The above video, from the HBO series In Treatment, offers you a glimpse. Enough to know — if you are open to knowing — how a therapist’s erotic countertransference can divert psychotherapy from its intended aim.
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Observe TV’s portrayed counselor (Paul). His discomfort is evident in his speech, his body, his silences. The grip on his role is slipping.
The first and last two minutes of the nine-minute excerpt offer the session and the words. The center segment is given over to silent film.
Do you believe their relationship will turn out well? Do you think office hours will remedy the problems for which Laura booked her first appointment?
The second clip begins with Paul looking for guidance from his analyst Gina. He has lost himself to a mutating agenda. Laura came to him to improve her psychological state. This man was sought as an expert healer, not a man soon to be in love.
The pair now struggle with a different goal. Doc Paul is like a person hanging from the wet window ledge of a twenty-story building. The strength and clarity of the woman who is his client will overpower his ambivalence. The flashing EXIT sign makes no difference.
The most remarkable moment in these two fragments opens at 7:47 of the first one. Paul is told who he is, what his weaknesses are, by his perceptive patient … and that she loves him just as he is. No wonder the ledge is slippery. To be known and accepted — here is the ultimate aphrodisiac.
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You might be stirred or troubled by your own transferential emotions if you are in treatment yourself. Perhaps you hope for physicality, but should the professional’s self-control crumble, the collapse renders impotent all his education and ethical resolve; and your safety with it.
A therapist must draw a line never to be crossed.
Lower your eyes to his office floor. The indelible mark was present long before your meeting.
Any other barrier, more movable or less precise and clear to him, risks injury to both of you.
STOP signs help only if you recognize where to look, and the brakes still work.
Dr. Gerald Stein 
So what do you recommend if the therapist has already allowed that line to be crossed and now the entanglement is messy?
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I’d need to know much more, Wildheart, in order to even approach an acceptable answer and personal answer. One might start with a consultation with an expert in this department if the therapy remains rocky. But, almost certainly, it is easier to get the toothpaste out of the tube than to get it back in.
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Thank you for providing a flavor of the insight it’s not really possible to ask about… or maybe believe the answer.
I often see the line on the floor and sometimes resent it. I’m not looking for a lover, but for a father.
Outside the room I want my therapist to be full, to be strong, to be able to be there for me next week, next month… next year(?) Inside the room I want to be special, to have more time, more interaction. I want to know more about him, to give to him, to share something deeper.
I can’t quite grasp the strength of character it takes to keep the line. I seem to fall in love to some degree with anyone that shows me their true selves and can accept a piece of me. To walk so close to someone in pain or in happiness or in love and hold the faint distance necessary for the therapeutic frame… it all astounds me. I guess that is why I am on the couch and not in the chair.
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Your lack of grasp, Rebecca, is not a failure on your part. Your openness sounds quite brave to me. Keeping the frame bounded is necessity and training and hard work as much as anything else: a discipline one must practice over and over. And then there are supervisors and colleagues and mentors and therapists to help, too. Thanks.
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I liked this the first time I read it. But what is strange is that I had all three transference types at various points in therapy, or with different therapists. Other times, there was no transference at all. I do not have transference with my current therapist, but I have had transference issues with other therapists and only one out of four mentors I have had in the recent past and present. The one research mentor I had transference issues with was both the admiring kind (I forgot what it was called), the erotic kind (but never disclosed or shown), and the hostile kind (never physical, of course, for any of the three). It seems to begin with the topic of discussion, then the level of bonding and trust, and then the level of reminders or triggers from the past. A desire for reconciling that which never had closure, and a longing for belonging and acceptance, appear to be my reasons behind these transferences. When I experience countertransference, however, I will react with a different form of transference, I think. When I consider my history of growing up in a disorganized attachment style at home and in the military, I think about the reasons why my transference changes and emerges. Not only am I insecure, but I am also disorganized. No therapist has told me that, but I am guessing about myself here. Am I correct, wrong, or partly correct?
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One important feature of transference — too little discussed, I think — is that it is not an either/or experience. If we think in terms of stimulus generalization (the extent to which we respond to someone or something because it is similar to a person or thing we’ve encountered before and to which our responses are already conditioned), our actions can be thought of as more or less the product of past experience. Transference is rather like a mistaken identity, responding to a new person because of some improperly placed template of resemblance we unconsciously impose on that new person. But, it might be worth considering that few of our actions in the world find us like a blank slate, as if we were creatures without a history and producing behavior without any baggage or knowledge or unconscious motives driven by our past. Were we like that, every situation would be fully new, and all history would be forgotten almost as soon as it happened. Thus, whatever amount of insecurity or disorganization you might have, Multinomial, these also might be contemplated as characteristics of which we all have more or less, not necessarily either/or.
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Thank you for explaining that, Dr. S. I never really learned much about transference, and the little I did learn is not coming to mind. So I guess. Thank goodness it is not either or. I thought it was supposed to be, but I was wrong. I thought something drastically was wrong with me. And I do not know if I had disorganized attachment. I just assume so much about myself that I go down this rabbit hole of near self-pity. I am also calmly eating breakfast while trying to figure out if my dizziness and feeling weak after not being able to sleep is anxiety or hormones or a precursor to stroke or precuraor to heart attack at the present moment. I am not panicked but I am confused as a 44 year old when to go to the ER and when to just cope with panic. It is hard to tell the difference when you are middle aged and still dealing with all the mental stuff. Lightheadedness was not really panic for me, so this would be a first if that is what I am feeling. I am trying to do normal stuff to see if the dizziness dissipates, like responding here and checking emails. But I think I need to call the VA for approval to see my local ER and have them pay for the visit. Just in case I am out of commission, I thought I would reply. Anyway, I like new knowledge, so thank you for clarifying transference.
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Do be safe rather than sorry with respect to your medical concerns. With respect to transference, it is usually offered as an “either/or,” so my take on it isn’t the one I learned in graduate school. You were not wrong in thinking of it in the same way.
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Oh. That makes sense why I thought of it that way. I only recall my independent studies outside of college assignments as an undergrad. What I learned was from online, not from class. Makes sense why I would see the conventional aspects of it. And yes, safe than sorry is my motto with physical health. Thank you.
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Safe than sorry sort of worked out, as I spent the last 5 hours in the ER with mostly normal readings, except for low blood pressure and occasional heart palpitations. I’ve been referred to a cardiologist and to do a stress test in the future. Oh, the joys of growing older and managing even more. Self-management is the hardest job on earth at times.
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I kept thinking about your take on transference, and how profoundly true your statement is on how it isn’t either/or. I always thought I had to see people through a “new” lens, which is sometimes hard to do. There’s something about the people we meet that reminds us of something familiar – whether it be positive or negative or both. Now that would be something worth writing about, Dr. S! What you said deserves elaboration and new insights for professionals, researchers, and patients. There seem to be some professionals who don’t feel comfortable with transference at all. They seem to see it as a problem worth fixing or a hindrance worth avoiding whenever they tell patients things like, “I don’t do transference because of x, y, and z,” whereby x, y, and z would often include their own opinions on why it isn’t beneficial for the client or why they flat out don’t feel comfortable with it. I wonder if your new insights, Dr. S., would help clinicians feel more comfortable working with transference, even if it isn’t what they do as a professional. That would actually be cool to learn in grad school, or even as an undergrad. Regarding negative/hostile transference, the best example I can see with that was another clip on the HBO series, In Treatment, when the therapist (man) saw his old mentor (woman) for help when he was in the process of getting divorced. The male therapist seemed hostile toward his female mentor/therapist at the time. Or, the time when the male therapist found another female therapist sometime after that, and the male therapist appeared to initially show erotic transference for the new female therapist until she revealed her pregnant belly, at which time he seemed to change the transference to negative, but not as hostile as he was with his previous female mentor therapist. What you said, Dr. S., normalizes our experiences, even though treatment is needed to work on those areas.
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I’m glad the explanation works for you. Yes, it is a way of normalizing it, as you say, Multinomial. And, yes, I’m thinking of writing about it. Stay tuned!
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I had a stress test once. Survivable, not painful. Thought of in a different way, however, I had much preparation: lots of conversations in early life with my mom were certainly a stress test! Glad your ER visit was, as they say, “unremarkable.”
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I’m laughing now at your prep with your mom. And regarding the “unremarkable”: I’m realizing that there are positives in the negatives; when all your blood tests and other medical tests result in negatives, they are actually positives for you. 🙂
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My therapist was kind and gentle with me and not having this as a child, I wanted to grasp it and hold onto to it as my own. It is that simple really, and all the other reasons I came up with were the result of too much internet research on this topic. I do not know how I gathered the courage to address this with him, God help me, it was one of the more difficult things I have ever done, and it placed me into a very high anxiety state which lasted a while, but as I sit here now many months later, this transference issue is behind me. Talking about it and getting it out there helped me because keeping it bottled-up inside of me added to the obsession with no place to relieve it. I cannot advise everyone to broach this subject with their therapist, because I have read that therapists handle it either badly or very well. I worried for quite sometime if my therapist considered me damaged goods now, but our sessions are pleasant and I do not detect any aversion. For me, it had to be discussed so I could put it behind me. I sensed my therapist would not send me away and I was correct. I am lucky to have a professional and ethical therapist.
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Thank you, Nancy. I’m glad you were able to master this problem for yourself. No easy task. And perhaps now you can see that therapists must do their own job of mastering their own history and the quite normal sexual and romantic desires that grow out of the present, as well.
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Oh, I do Dr. Stein. I watched this series and I could feel the struggle the therapist endured. She was quite agressive with her forwardness towards him and I did not like her character. I felt she was a manipulator and had some character flaws. It was a riveting series.
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I agree, though the question is always how we manage our flaws. Therapists have their share, and she was uncommonly perceptive of his and had him on a fraying string, don’t you think?
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Absolutely! Patients assess their providers as readily as the staff assesses them.
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I assess my therapists all the time. Hee hee.
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An interesting post, Dr. Stein. The more I learn about the workings of the human mind, the more I’m impressed with how complex we-humans truly are.
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Complex indeed, Rosaliene. If it were simple, I imagine we’d make different electoral choices! At least, I’d like to think so.
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Can we just fall in agape love or fileo love without the erotic love? For instance, sapiosexuals fall in love with intelligent people, and others fall in love with best friends. In therapy or therapy-like situations, can erotic transference include somewhat nonsexual desires but rather a desire to be close, bonded, and in awe of the other? It is hard for me to determine because I get easily aroused sexually as a sex abuse and rape survivor, but my thoughts almost always intend on seeing the other as an admirable and potentially intimate person.
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I’m certainly not the last word on the subject. Love is so complicated. Even a kiss from one person is more “right” than from another, if I’m recalling something I read long ago. In the sense I’m using it, it has to do with our biology alone, even where technique is a constant. And all the other factors you mentioned play a part, too, not to mention our history. When you get a satisfying answer to your question, write it up and send it to the Nobel committee for consideration!
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Thank you, Dr. S. I have no answers. I just remember learning about the three different types of love in a very distal bible study. I don’t go to church anymore, as I’m agnostic, but I thought I’d ask from that perspective. I’m curious but also weird. I think I’m more satisfied right now with what information you presented and with the unknown. Where I think I’m lacking in satisfaction is probably my own excuses and cover-up; my longing, desire, and erotic transference at times are harder to admit, so I may be fishing for alternatives just to inch my way away from the truth.
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‘In Treatment ‘ was a wonderful series much admired by therapists and psychoanalysts. It featured a psychoanalyst, Paul, who while dedicated to his patients, wrestled with own personal issues. One of, if not the most, interesting features of the series was the constant boundary struggle between therapist and patient, the sexual being the most overt and easily recognized. Thank you for a most interesting essay and have a healthy and happy new year.
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Thanks, Harvey, and best to you and yours this year, as well.
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This makes a good case for AI therapist. They will not be distracted by attraction.
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I never thought of it quite that way, Lander7. AI would need to develop to the point of having a rather human/affective capacity to relate to the human a few feet away, of course. Time will tell. Thanks for a unique perspective.
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Dr. Turing, the AI therapist… Hmm. That would make for an interesting dynamic. But then again, humans program machines, so to detect attraction and pass a turing test on a socioemotional intelligence level would be challenging in therapeutic settings. If too stoic, the delivery can appear insincere and perhaps neglectful to the client who deserves human connection.
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Agreed.
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Hi, Dr. Stein…I just came across your blog post here and found it very interesting. I’ve been in therapy on and off for maybe close to 20 years, and have never experienced transference (erotic) until recently and honestly, it has been really difficult to deal with. I’m not sure whether to disclose it or not and sometimes I sense the therapist may be dealing with countertransference. I value the work and rapport we seem to experience in this therapeutic relationship but don’t know if dealing with this added and unexpected complexity is going to end up being healthy for me or not, so it’s a tough call. I’ve read that it’s recommended by some to broach this subject with the therapist but I’m a little afraid of what the results might be: A) I end up opening up a can of worms and the only realistic option at that point is to terminate therapy or B) The therapist can’t take the issues in stride and terminates therapy. Of course “Option C” might entail trying to work it out, but honestly, the thought of disclosing this makes me extremely uncomfortable. Do you think this could be a potential catalyst for progress ultimately or could this just wind up being uncomfortable?
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To answer both of your comments. Much depends on your therapist. Will your counselor be gentle and understanding? Will he be uncomfortable? Does he feel attracted to you and how strong might the attraction be? Does he have a good sense of his own therapeutic boundaries? Has he had experience “working through” the erotic transference of other people? Is he in a stable and rewarding relationship of his own? Among other considerations: are you and your therapist meeting virtually or in-person? Might this reduce the danger or discomfort either of you could feel? Of, course, I’m not able to answer any of these questions, but I know they are serious and important to you. Perhaps the first thing you can do is take a breath and weigh the risks and rewards. Best wishes.
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Or maybe it’s a catalyst because it’s uncomfortable?
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I will have edited my respons to you (above). I only wish to say right now that I appreciate your questions and am sympathetic to your quandary. Best of luck with this.
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Hi again Dr. Stein–I really appreciate your answers and empathy regarding this challenging situation. We are having virtual meetings right now, and yes, I agree with you: much depends on him and there’s so much I just don’t know about him and his life (he told me at the start of therapy that he doesn’t disclose much about himself or his life in therapy) so it makes it very difficult for me to gauge him and subsequently what the risks or advantages are of of disclosing this information to him (and what his response might be). Even though the sessions are virtual, I’m not sure if it actually lessen the stress or tension involved in talking about it. But yes, I feel kind of stuck in-between a rock and a hard place here. While I think it’s perfectly normal for people to find themselves attracted to each other in different situations throughout life, finding oneself unexpectedly attracted to a therapist is proving challenging to navigate. I guess time will tell how this will play out: If everything comes to light and we can work through it, or if it just becomes too stressful for me to continue on with this particular person.
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You sound open to what will come, and recognize we can’t control everything. These are rare qualities requiring both wisdom and courage, JM V. You sound like the kind of person who will find a way through the forest of confusion life sometimes presents us with. Good luck with this.
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Acting out ET/ECT is in my view only a problem when either of the subjects is already engaged in a romantic relationship with someone else, but if therapist and patient are single and seem to develop feelings of love for each other then I really don’t see any problem with this. I don’t understand why the literature talks about this as if it is a problem. A (single) patient and a (single) therapist falling in love with each other is a beautiful thing because the therapist is already intimately aware of the character, strengths, weaknesses, likes and dislikes of his/her patient and thus the emotional bond between them will be incredibly strong. I can imagine such a relationship to be very stable, long-lasting and passionate. How would this in any shape or form “hinder” the healing process?
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I will mention just a few potential problems. The assumption is that the therapist is genuinely in love. He or she might not be. He might be in it for sex, or the transference and erotic desire of his client might be tempting and accessible beyond what he has experienced in his life outside of the therapist-client relationship.
Another challenge is that the therapist now has two roles. He is both the lover and the one treating the other. Being a counselor is difficult enough without trying to juggle a passionate as well as therapeutic relationship. What if, under different circumstances, he would typically offer insights and risk the patient’s disapproval or injury? Might he now hesitate for fear of losing her?
Additionally, if the ethical guidelines didn’t exist, each new patient is a potential “date.” Erotic transference is so common (and potentially alluring) that more sexual relationships would occur.
Finally, if the therapist understands that his job is to manage and resolve the transference, what will he do for fear that the patient might not need him (in any sense) once he resolves it? Because he fears her loss, he might be torn by his professional obligation on one side and worried over his fear of loss on the other.
I appreciate your comment, SomeGuy, and since I am not God, I can’t say a genuine love relationship between doctor and patient never develops. Any psychologist considering entering the combination needs to reread the ethical guidelines and the reasons for them. He is potentially skating on thin ice.
Thanks again for reading and for your provocative comment, in the best sense.
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