I’ve known therapists who slept with their patients. I’ve known therapists who took “down on their luck” patients into their homes. I’ve known therapists who made friendships with their patients and socialized with them outside of the office. And, I’ve known therapists whose sense of their own value depended on their patients’ approval and improvement.

There are problems here and I hope most of them are obvious. But, just in case, I will explain.

A therapeutic relationship involves unequal power. Authority figures, be they bosses, teachers, parents, clergymen, or therapists, usually have a power advantage. Patients assume a therapist has only the patient’s best interests at heart. The patient might never previously have had someone in his or her life who seemed so interested, who listened so patiently, who seemed so caring. Under these circumstances, the patient is vulnerable if the therapist should pursue his own sexual agenda.

For a time, it might feel good to both parties, but it is a fundamental corruption of the therapist-patient relationship and, in the long run, can do extraordinary damage to the patient and add one more life-injury to the long list of hurts the patient has already suffered. This is true even if it is the client who provokes or initiates the sexual contact, as sometimes happens.

Dual roles are generally a problem. Thus, a therapist is well-advised to avoid the complication of being more than a therapist to his patient. Meaning he shouldn’t be a therapist/lover or therapist/friend. To take on more than one role almost inevitably confuses both the therapist and the patient as to which role takes priority. And, it compounds the potential feeling of rejection, if the therapist should say or do something that seems critical or indifferent.

Expectations of friends, therapists, and lovers depend on which role you believe that person occupies in your life.

Even the anticipation of a possible future friendship or sexual relationship after therapy ends can change the therapeutic relationship for the worst if either the client or counselor harbors such hopes. Imagine a therapist who desires a patient who is considering a possible divorce; if he anticipates the possibility of “dating” the newly divorced woman once treatment is over, might he be more likely to encourage her to end her marriage?

It is for reasons like this that the American Psychological Association’s ethical guidelines rule out any such contact between counselor and patient, during or after therapy, in virtually all cases.

None of this is to say doctors do not, sometimes, have feelings of attraction to clients. We treat the beautiful, the charming, and the handsome, as well as the less than beautiful and less than charming. But all counselors should be trained about and reminded of the boundaries concerning therapeutic relationships, boundaries that must never be violated.

Therapists run other risks, as well. Among them, is the need for approval from their patients. Certainly, it is human to want such approval. But the therapist needs enough confidence to be able to withstand his inevitable inability help everyone; and, that in order to help some people, it will be necessary to tell them painful truths that may cause the patient to end the therapy and reject the therapist.

If the counselor is too invested in the patient’s improvement for his own good, he can be laid-low if the patient does not get better. And, ironically, if the therapist is working too hard to help his client, harder (in fact) than the client is working, he is likely to steal the essential initiative of the client so necessary for his or her improvement.

Anyone in a helping-profession faces a problem with respect to how close he should get to his patient. If he is emotionally distant from this person, his ability to help is compromised. Most people, after all, want a doctor who cares. If you think your healer doesn’t care, or is only in it for the money, you are likely (and correctly) guided to go elsewhere for treatment.

On the other hand, however, is the problem of the health-care-professional who cares too much; who feels your pain almost as much as you do; who suffers the ups and downs of your mood as if he is a passenger on the same roller coaster, sitting right beside you. He is in danger of giving too much of himself, to the point burning out. Moreover, when you reach for him in your sadness or confusion, you are not likely to find a “rock” upon whom you can rely, but instead someone who is just as pained or disoriented as you are over the reverses in your life. From that vantage point, no therapist can be of any use.

Therapists need to be solid, emotionally and physically, to take on the complicated emotional and intellectual lives of the people sitting across from them. They need to be involved, but not to the point their own emotional well-being is compromised by the sadness or turmoil of the people who they are treating. They need to know their own limitations and set limits on the extent they provide care, lest they be sucked-dry by the process and unable to be of any use to anyone, including themselves.

It can be useful for therapists to receive their own therapy. But when the counselor’s world is rocked from the outside, or when he is unable to navigate the white-water of human emotion that he is attempting to traverse, sucked into whirlpools beyond his control, he is well-advised not only to seek supervision and treatment, but sometimes, to refer the patient or patients in question to those who do have the equanimity to be able to do good for those same people.

Nearly all therapists mean well. Nonetheless, as the saying goes, “The road to hell is paved with good intentions.” If you think your therapist is unstable, too involved, or in some way inappropriate, it is time to consider your options: there are lots of good therapists out there, but there is only one of you; one life to live and set on the best possible course you can.

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You may find the following related post of interest: How Therapists Fool Themselves.

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The above image is Cropped Photo of 2007 KKC Participant with Self-made Custom-fabricated Crutches by Rich Cosgrove, sourced from Wikimedia Commons.