Are Therapists Ever Really Irreplaceable?

Counselors offer conventional wisdom to solitary, long term patients who are attached to them:You have grown, and that growth will enable you to meet new and satisfying people. I’m merely the first person who understands and affirms you. I won’t be the last.

I shared this with those whose attachment to me was substantial. Some doubted my words. Now, at a distance created by retirement, I’m less sure which of us was right.

For those who said I was wrong, I’m more than a little late in offering an affirming message in response to their concern. The belated acknowledgment is double-edged good news. The confirmation of your fear means you never found another person in your life who understood you enough, saw you clearly, and deemed you worthwhile.

Am I giving myself credit for insightful, redemptive compassion no one else duplicated? It is not as if I didn’t work hard to understand. It is not as if I didn’t recognize qualities that had gone long unseen and unappreciated. Many healers do this, however. I was not unique.

But, I was singular in several lives because I was their psychologist.

Clinician and patient encounter each other at a challenging juncture. The latter’s life is like a coin tossed above the crowd. Will it land heads or tails? If the therapist is a figurative fair wind, he tips the spinning silver for the better in an unrepeatable moment.

To the extent such an instant is a decisive one, perhaps the client will never meet another like him in a similar, poignant, and needful time. Whenever life is fraught after the treatment concludes, he might look back on past psychotherapy as an oasis worthy of an expensive return ticket.

Alternative paths exist. Not every person who enters counseling becomes so attached to the purported wise man sitting opposite him. Even among those who did bond before its conclusion, multiple people perhaps now provide more fulfillment than a therapist. Those relationships extend to meals together, bus rides, weekend evening plans, and physical intimacy. None of these occur in the patient/doctor range of interaction.

Nonetheless, the doc can be a hard act to follow for several reasons.

For a significant number, the healer made an indelible impact, perhaps an imprint. Remember what you learned about imprinting? Some birds and mammals will attach to another creature, not even of their species, who arrives during a critical, brief period: a moment fertile for bonding.

The right counselor at the right time with the right kind of intervention might be a bit like this.

Most patients — if they continue to work on themselves — will encounter new people who evoke as many positive emotions as the old psychotherapist. Still, these relationships are about both people, not so much about the client alone.

Trust develops in different ways inside and outside the clinic. Within the office, it is carefully orchestrated and permitted to be gradual. The room holds the possibility of becoming almost holy because faith (in another mortal, not a deity) enshrines the place.

In contrast, routine contact in the real world provides riskier opportunities to achieve confidence in another. The restaurant, workplace, and movie theater do not resemble sanctuaries. The ethical guardrails of the cloistered healing space are absent.

An impatient civilization puts down hurdles to closeness not everyone can overcome. Moreover, even best friends and mates do not hear all of the secrets some clients hide in the shadows.

Therapists do and, because they do, they double as confessors. They listen to the sins and inadequacies the client believes about himself. By bearing witness and accepting the reported frailties and flaws, the counselor frees him from the weight of the insecurity and doubt he carries.

Regardless of the wonders of a new friend or love, those companions cannot always be so focused on you as a person who gives professional guidance. This is true despite a weekly, clock-governed hour or two of purchased attention.

Indeed, the hour’s brevity and artificiality assists in creating the uniqueness and makes such focus possible. Where else in our busy, routinized adult experience does anyone get this?

There is a potential erotic quality present in the consulting room too, adding another level importance. Secrets are involved. Providers make appointments in advance, like a date.

The eager sufferer thinks ahead to these future engagements, considers what he wants to say, hopes to feel something soothing and enlivening.

Other competitors for the healer’s time exist (families, friends, spouses) as do additional “suitors” (other patients), and the troubled one worries about termination (aka getting dumped) just as we do in romance.

Experiences in the consulting room, as confined as they are by professional borders, remind us of impassioned events in our history. Perhaps the reminders come because we find ourselves talking about such past times and resurrecting dormant feelings. The memory of exposing one’s inner life to a psychologist lingers for many of those who allow this lowering of their defenses.

The ghost of the therapist might reside in the remembering mind as does a first love. Youthful friends, too, occupy a place in the heart to the end of many lifetimes. You passed with them through the same moment in history in the same place, experiencing like challenges and the same people in your shared world.

Wartime buddies, as well, understand things no one else fathoms. Nor should we forget the long-married, aged couples who are so molded to the other that they pass away close in time.

The sharing of something important, formative or reformative, is present in all these intimate contacts.

Intensity is a determinant in what can seem irreplaceable in such connections, whether with parents, childhood and adolescent friends, lovers, wartime comrades, and counselors. Similar ties are elusive.

I do not wish to understate the chance you will meet people who “get you” after you depart psychotherapy. Still, I now believe the possibility you may not is higher than I did before.

Each of us, no matter the losses we have had, must search to find new people who can become precious to us. Risks are required. The tightrope of homo sapien interaction offers no safety net, but we are a resilient species.

While many candidates for intimacy exist, if the task were comfortable, the patient would have been embraced by numerous such people before entering the mental health clinic.

Happiness is not a constant. Counselors do not erase the demands of living, including the filling of our social sphere. At their best, however, they empower you to identify and enhance the capabilities inside you to surmount them.

Even for those who profited from therapy and still lack fulfilling nearness, that satisfaction may yet occur. Our emotional lives never can be flash frozen. Children and grandchildren grow or move away and make their own families. Friends die or seek work elsewhere. Conflict with those we love is not always avoidable.

The cemetery is full of irreplaceable people who must be replaced.

Aristotle believed a person who did not require human connection was either a god or a beast. Thus, our quest for an essential other is a part of our nature.

You are not alone in your need to take on this challenge.

Many, many are looking.

They may be looking for you.

—–

The paintings reproduced above begin with Man with a Pipe by Joan Miró. It is followed by three works of Edvard Munch: Self-portrait in Bergen, Young Woman on the Beach, and Woman Looking in the Mirror. The final image is The Mask with the Little Flag by Paul Klee.

Thinking About Transference in a New Way

Transference — erotic and otherwise — is worth an unconventional look.

What past events push one toward an unconscious like or dislike of his therapist? What previous learning does the patient now misapply to a stranger who offers help?

A child reacts to his parents based on reiterated experience. If the adults are pleasant and welcoming, his sentiments tend toward the benign. If the guardian’s proximity signals rash criticism, irrational outbursts, or inappropriate physical contact, he associates them with troubled, private states of mind and feeling.

The young one’s mood changes even in anticipation of adult attention. Looking forward to mom or dad’s return home from work can trigger joy or fear. Repeated signals of happiness or trouble will be learned. When an alcoholic overseer opens a beer can, the internal stir tells the child what might soon happen.

The scene or place connected to a wound matters. The familiar location informs a sensitive offspring of potential discomfort. A bedroom, for example, causes alarm if sexual abuse tends to occur there. The boy or girl’s emotional alteration becomes automatic. Conscious thought isn’t necessary.

We are thus conditioned by neglectful or abusive parents. The brain is a predictor, foreseeing danger. Our time at home trained us to notice subtle warning signs of mistreatment. High alert occurs in proximity to anyone resembling those who inflicted the injury, as if we are wearing glasses enlarging false positive features of menace. The distorting lenses sometimes govern how we see employers, friends, and lovers. Youthful coping mechanisms kick into gear.

A trauma survivor’s life is one of constant reliving.

What characteristics of the therapist contribute to this? First, counselors are most often older than the patient, just as the mom and dad were senior to him. The treating professional has an advantage of authority and power in the relationship, as guardians do. He also sets rules and requires their fulfillment. Payment is expected, rather like the home stipulation to do your chores, or else.

The doctor creates the schedule and determines the length of the session. If you wanted more intimacy with your parent, you might be frustrated by your provider’s boundaries. If you never felt special in the family, the doctor’s full caseload reminds you of growing up without status. You are one of a crowd, not first in line.

A clinician needn’t do anything remarkable to provoke a facsimile recreation of a historical script he never read. As if by magic, he arranges the set for the client’s long-running drama. The latter’s well of resentment, love, sadness, and yearning reveal themselves act by act.

A considerate and wise healer gives all his attention, looks in your eyes, and accepts you without judging. You know little about his life. His imputed resemblance to the rejecting sire allows you a mirage-like new chance at the love you never won. He assumes the form of the imagined caretaker you didn’t have, now come to life.

Transference is a kind of disguise, a costume the unknowing client applies to his doctor, who is taken for someone else. The apparel designer’s imagination fills him with qualities belonging elsewhere.

A risk exists here: the mistaken identity can overwhelm the therapist’s capacity to interpret it and refer it back to the initial source.

If this sounds like a guarantee of a bad outcome, however, it isn’t.

Once you accept the idea of transference, you may begin to actively catch the triggered emotions as they develop (or soon after) and work on their underlying cause: the ancient shadow of old relationships and the need to grieve them.

An erotic transference must be more tactfully managed. Tender feelings, romantic or not, are problematic even when unmentioned. While their connection to the past is identical to more common transferential moments, the universal hope for a sainted parent or perfect mate adds a layer of complexity to emotional resolution.

In each case, if your counselor does not overreact to your unhappiness, resentments, or thirst for unique closeness, your imbedded responses should lessen: they will be extinguished or unlearned with time. Likewise, the ability to recognize the difference between your doctor and early custodians is a first step toward doing the same with bosses, companions, and suitors.

People will be recognized more as they are, less similar to Halloween characters. Improved life choices and increasing ease of intimacy becomes possible.

Life and therapy offer us endless challenges. Muhammad Ali, a man who knew a bit about contests inside and outside the ring, offered this advice:

I hated every minute of training, but I said,
‘Don’t quit. Suffer now and live the rest of your life as a champion.’

——

The first and last images above are both untitled painting by V.S. Gaitonde, the last from 1953. The middle work is called Painting No. 1, 1962, by the same artist.

What Does Erotic Countertransference Look Like?

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.

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.

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.

What Does Emotional Infidelity Consist of?

You tell yourself you are faithful. You love your spouse. You pray every day, attend religious services once a week. You believe in the strength of your will — the ability to resist temptation, the perfumed heat emanating from a delicate hand.

Ah, how we fool ourselves. All around are enticements. They are the banana peels you don’t notice, the black ice waiting to skid the vehicle of your soul into dyscontrol, the quicksand but a step ahead. Springtime and flowers and a glass of wine. A comely presence attached to a sympathetic listener (a therapist, maybe) when you are unhappy about something.

There can be so much in a smile and a tilted head. And those eyes!

How do you know when you are unfaithful, even a little? Or heading for it?

A few questions:

  • Do you sometimes think about the “other” when talking to your spouse?
  • Do you, even a bit, wish your mate were more like someone else?
  • Do you imagine what you’d do if free to pursue something elsewhere?
  • Does your present lover know the stranger exists?

The ice is getting thin, no?

  • What do you imagine your mate would think if he/she overheard you talking with this special person or read your email?
  • Does the arrival of a new message give you a rush?
  • Can you sense the “sex of things” even if you haven’t acted on it?
  • Do you lie to disguise any aspect of the new relationship?
  • Is the mental and emotional space devoted to the stranger enlarging?

None of the above necessarily includes any sexual contact, not even a kiss.

  • Do you engage in secret phone calls with the other?
  • Have you arranged meetings in a park, coffee shop, restaurant or the like?
  • Do you share confidences not offered to your spouse?
  • Is your sexual desire for your mate now much smaller or larger than before you became otherwise preoccupied?
  • Are photo exchanges part of your new, hidden life?

Many of these actions can be rationalized. The new friend perhaps is a co-worker or someone you met on a commuter train. Each step seems small enough and might be something you minimize. Flirtation is enlivening. Sympathetic listeners are necessary in any life. A new person is fresh by definition and the glare from the unwrapped cellophane hides whatever imperfections reside in the package.

At some point the frail self is caught in a wave, swept away, young again. The experience moves you from underneath a pedestal to the top of one. Routine breaks. Your spouse knows you too well, but the fresh friend is dazzled. Your life goes from static to ecstatic. You assume your mate will not find out. You don’t face what your friends or kids or parents might think. No one will be hurt, you say to yourself. STDs? You laugh thinking they can’t happen to you and nothing will pass to your mate.

You are a fool in love. The early stages of love make us all fools. I do not disparage amour here, but surely you recall muttering (in the past, of course), “What was I thinking?” The question comes too late.

Some argue you should simply enjoy the ride, ignoring that you are not encased in protective bubble wrap. Better, ask yourself what is of ultimate importance in your life. What are the reasons you chose your spouse? Consider the gratitude you feel still toward him or her; all you share and have shared. How can you enliven the relationship to make it better? Who are you really, your best self? Who do you want to be?

An emotional affair is still an affair of sorts, even if not yet so dreadfully complicated. The new romance will almost make you believe the other is Christopher Columbus and you are the America he discovered. And vice versa. All this while you are upside down and so much the plaything of your emotions that you will not even recognize you are drowning. Your stable life was built of blocks made of prose (and prose is essential to sustain any lasting relationship), but the weights pulling you under are full of poetry.

Perhaps you can find some of the old poetry back at home, too.

You have my best wishes and deepest condolences. No judgement here: these things happen even without seeking them. Friends and therapists are waiting to help.

Just remember:

The brakes on your being are balky. The steering wheel is unresponsive. You’re heading for a cliff at high-speed.

Think about it.

Oh, but wait!

I forgot your brain no longer works.

Why Therapists (and Others) Don’t Always Understand

How often we hear someone say, “I understand.” How often we think, “I only wish it were so.” Beyond the imprecision of language, I want to consider 10 reasons why true comprehension – recognizing the other person as he is and in depth – is difficult.

  • The fog of appearances: We instantly react to the individual in front of us, even before he makes a sound. Beauty (including a lovely voice) or its absence rose with the dawn of man. Sometimes revealing, sometimes obscuring; sometimes enhancing, sometimes diminishing. Sometimes all of the above.
  • Stereotypes: Beyond what we take from the person’s facial symmetry, shape, and size, other factors can cloud deeper comprehension. Gender, age, race, religion, and nationality interfere with vision beneath the surface.
  • Secrets and history: Polite conversation sets boundaries around self-revelation. Many of us believe we have been misunderstood – judged to the point of harm – and hesitate to reveal much. Even in therapy this is an issue, though with time and growing trust, significant secrets are often divulged. Without exposure, the job of comprehending you is far harder.
  • Our limited access to important data: Think about what information you might need to understand someone else. No one can access to all three sources below:
  1. The individual is the only person who perceives his life from the inside. He does not, however, see himself from the outside and will be shocked the first time he hears a recording of his voice. His grasp of his own motivations cannot be assumed accurate and may not reflect the work of the unconscious. Similarly, he interprets his life without the benefit of external perspective; except whatever is received, understood, and accepted of the other’s body language, tone of voice, praise or criticism. Most of us would be unsettled to know what others say about us in private.
  2. Friends and acquaintances hear what the same individual says about himself, what he reports of life apart from the observer, as well as experiencing his behavior in real time. Even his intimates must contend with the fact that “a mask of him roams in his place through the hearts and heads of his friends.” (Nietzsche, Beyond Good and Evil).
  3. Finally, the therapist has the most limited exposure to the client in real life. Ideally, however, the patient is more open to the therapist than perhaps he has even been to himself. The counselor has the training to “figure out” who is facing him, and the opportunity to ask the most essential questions with some expectation of penetrating to answers not offered in the public world. He sees not from the inside and not only from the outside, but,  from closeup, below, and through.

  • How remarkable are you? Though I evaluated and/or treated well over 3000 people, I encountered only a handful who were unique. Such individuals represent an enormous challenge to one’s understanding.
  • Countertransference: We can have reactions to our patients that grow out of our own unfinished issues with persons of consequence who they resemble in appearance or personality. This is called countertransference. Objectivity and unbiased analysis flees the evaluator under those conditions.
  • The limits of our experience. One who hopes to grasp the essence of another will not have encountered the whole of humanity. If, for example, most of his contact is with like-minded people (let’s say small town residents of one religion) he will be at a disadvantage with those whose backgrounds are different. On the other hand, therapist and non-therapist alike can meet an individual with whom he is “in sync.” In that event, both might find friendship and sympathetic intuition effortless and uncanny.
  • The listener who wants to be right. Insecure counselors can be troubled, sometimes unconsciously, by their own uncertainty. They tend to find it more comforting to put people in a box than to recognize when someone doesn’t fit. The job of evaluator (not a judge) calls for two qualities not often mentioned. First, enough confidence to say to yourself, “I don’t understand yet.” Secondly, “I can do better and I’ll work until I get this right.” Therein they offer an odd combination of humility and security. From time to time the therapist must clean the slate and start over.
  • The observer’s own emotional wounds and defenses: Our personal wounds (we all have them) place a limit on the ability to absorb, accept, and seek the truth of all humanity. Indeed, who is to say there are not many truths. The best of us never fathom all we encounter.
  • The listener’s capacity and willingness to endure the other’s pain: Hearing personal stories, even with the therapeutic distance healers work hard to achieve, still creates vulnerability to the most poignant encounters. Too many such episodes close in time risk either overwhelming the counselor or making him callous. To understand the human condition one must recognize his limits.

Final thoughts. Treatment by someone who opened-wide your self-understanding can make you believe no one on the planet will ever know you so well. I’ve long believed that if you then allow yourself to take more real-life personal risks, other satisfying and close relationships are achievable. Nonetheless, the special nature of a therapy relationship may include a hard-to-duplicate quality of perception and acceptance “as you really are.” You then will want a friend or lover who is psychologically-minded, a patient and dedicated listener, and one who makes the effort to approximate what an expert analyst can manage. This might be a tall order.

Do remember this: you and the therapist might not have much in common beyond his comprehension and kindness. Interests, compatible temperaments, and world view count for a lot. He exists, as well, in a fantasy world of your creation: literally, too good to be true. Were the light-reflecting cellophane of illusion to come off the package, you’d find his unshaven, distracted, and ill-tempered alter-ego – occasionally.

Another thought. A psychologically profound understanding of your inner workings isn’t always essential for a happy relationship outside of the office. Love and acceptance, even without full knowledge of all your moving parts, can go a long way. Not even your counselor has a total grasp of himself or anyone else. That said, his success at his work doesn’t require perfection.

Anyone close is “out of this world.”

The first image is called Rorschach-like Inkblot by Irion. It is sourced from Wikimedia Commons. The painting that follows is Vassily Kandinsky’s Composition VI, 1913. Finally, just above, is Honore Daumier’s Couples Singers, as sourced from Wikiart.org/

The Remarkable Impact of Being Seen: More on Erotic Transference and Love

I treated the unfaithful of every faith. Many led conscientious lives of mindful moral rectitude. How surprised they were when religion and family didn’t insulate them from infidelity.

What is the magic in the eyes of another – including a therapist – who looks, hears, and understands you? What characteristic of new love turns people upside down, in or out of marriage?

Let’s begin with what is believed about straying spouses. Conventional wisdom in the United States labels extra-marital sex as a matter of evil intent (active pursuit of someone else), lust, and “trading up” to an attractive partner who is often younger. Potential injury to the spouse is an afterthought, when thought at all. You are “bad” to cross the line. A more charitable opinion indicts absent willpower. Perhaps I believed such views myself when I began my practice.

Then I encountered people who were wracked with guilt and still loved the mate from whom they’d strayed. These folks led principled lives and consciously avoided or resisted such opportunities for years, until …

The secret ingredient explaining the attraction of a new person may be the same quality many a patient finds in her therapist.

Yes, most everyone wants sexual intimacy, but put warm bodies aside for a moment. Let us also set aside those who do seek to “trade up.”

Recognize this: we all want to be known or “be seen,” and once seen, embraced for the entirety of our being. Some don’t receive this gift because they hide themselves from others, avoiding openness. One can disguise oneself in public, creating a persona quite different from the truth of your existence. Then, even if people enjoy or admire you, the stunt double receives the applause, not you.

For many, the externals get in the way of being understood and accepted in totality. I’m speaking of those who are too beautiful, too plain; too fat, too thin; too rich, too poor; too young or too old. Even too gifted or too “average.” The barrier of these qualities is not surmounted. The other’s X-rays do not penetrate the dominating impression made by those outward facts. The “package” remains unwrapped, the contents unrevealed.

Now think of what a good therapist does. He gradually understands you, comes to know your secrets, observes how you think, what makes you laugh, grasps why you cry. He cups his hands and catches your tears. You become more than your externals to him. You experience less emptiness in his presence. Indeed, you might believe you have been newly minted because, for the first time in forever, someone perceives you with fresh eyes.

When you look in his eyes you see your reflection. In a flash the disjointed world takes form. For the first time. At last.

Think of a small child who loves you. You might be his mom or dad or grandparent, his aunt or uncle, his baby sitter or neighbor. You come into his home and he runs to you, embraces you, and shines the light of his being on your being. Therapists come close to having this effect on some of their patients. A new lover shares the capacity of the small one to make your heart full to bursting. You are their universe, the focal point of their life. The longer you have lived as an “unknown,” the more likely you will be overwhelmed.

Even in good marriages we can get taken for granted and take the other for granted. Or perhaps one’s universe was never fully encompassed by the spouse. Maybe the routine of working, getting, spending, raising kids, cleaning house, and mowing the lawn wears us down, dulls our vision. You might not have known the room of your life was dark and cold until an attractive stranger shines his light on you: looks at you in a way that makes you remember the long missing warmth of the summer sun. It is not only the sex that draws one to stray, it is the sparkle in the other’s eyes.

No, I’m not giving the unfaithful a pass. I am trying to understand them.

New or old, in love or friendship, we must see the other with new eyes. That is what therapists do.

Call it a survival technique.

Call it love.

Call it our duty.

We must try.

—————————

Bette Davis is the actress in the top photo.

 

Is Erotic Transference Ever the Thing We Call Love?

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.

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.