therapist boundaries

August 27, 2017

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

—

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

April 12, 2015

Being Excluded From Your Therapist’s Life: Reasons You Haven’t Heard Before

598px-Ethiopian_Stop_Sign.svg

We’ve all had idols. Perhaps a sports hero, an older sibling, a teacher, or — God help you — your therapist. In the latter case, authorities tell you why a relationship outside the office is not permitted:

  • The shrink might exploit you.
  • Progress would be hindered if your therapist occupied the dual role of therapist and friend.
  • A healer needs downtime.
  • Personal information about the counselor complicates the transference relationship: the extent to which your issues will play out in session.
  • The therapist would be of little help if he feels too much of your pain, as he will if you become more than a patient — an important part of his life outside.
  • The ethical guidelines of the therapist’s profession prohibit intimacy.

Much of this sounds unfair and unfortunate to the patient, however true. Many believe they would benefit by having MORE of the therapist. Jealousy of those who claim more of him isn’t unusual. Additionally, the imbalance of the relationship is troubling. You pay the doctor, but hear little personal about him. The shrink takes your cash and wants to be told everything about you. I’ll try to shine a different light on this subject:

  1. Therapists are human. No one who admires, say, John Hamm or Scarlett Johansson, imagines them on the potty. At least, I hope not. Neither do those who esteem their psychoanalyst hold an image in mind of this particular pose. We stand on feet of clay and need to clip the toenails on those feet. In real life, we get bored, say the wrong thing, lose patience, etc. We are not always sensitive and sometimes we are self-serving. You understand this in the abstract, but don’t witness it. It’s not pretty.
  2. Think about the best dinner you ever had. Now consider having the same meal morning and night. Would you enjoy the food as much? Too much familiarity with anything dulls the experience. To some extent, your therapist’s time is precious because it is in short supply. You visit him once or perhaps twice a week while watching a rapidly advancing clock. Were you to win more access to him, you’d find the contact less special. Even for those psychologists who are terrific human beings, familiarity breeds routine. Should you disbelieve this, I can refer you to my wife and children. They love me like crazy, but also recognize me as the sweaty guy who doesn’t enjoy being disturbed while I’m riding my exercycle or lifting weights.
  3. Many a client needs, at least for a time, to believe we are incredibly special — gifted to heal the hopeless. The illusion of magic works for the patient and is created by the patient. He must think of the counselor as a paragon of virtue and virtuosity. The halo placed atop the psychologist’s head is an imaginative construction of the client, possible because he lacks a detailed vision of who the therapist is. Only with this undeserved enhancement of his benefactor can the man on the couch stand up to walk the tight rope therapy requires: exposing his secrets, tolerating emotional pain, and taking behavioral risks.  Should he see behind the shrink’s professional mask, he might hesitate. The worse for him.
  4. Because you have limited contact with us, we can make the time special for you. The counselor’s job is to invest every bit of his knowledge and concentration on you for the better part of an hour. He does not regularly do this at home, with his friends, on vacation or at the movies. He performs his wizardry for a small number of people. That is, an expert counselor does this for all his clients and only his clients. He tries to make you his exclusive focus every second of the 50-minute hour. Indeed, the shrink can only accomplish this because the time is short. You might think you would accept a lower-intensity version of the doctor, but I doubt it. And you shouldn’t accept such a thing if you already do. Patients receive the best of us in a very special way. Yes, we offer love and more hours of contact to those outside the office. You, however, and others who sit where you sit, get something no one else gets: the healing art.

I doubt that anything written above will dim your desire — cause you to give up what some of you want or think would please you: a chunk of the doctor’s real life. As I’ve said, in some ways it might be best that you don’t relinquish this wish. Still, occasionally a therapist, like a parent, is right when he says, “I’m doing this — keeping these limits — for your own good.” Granted, the frustration may persist. I hope, however, you recognize an element of necessity in your dilemma.

A good life requires our effort to accept those things we cannot change. However disappointing, no one gets everything he wants. The only exception is a kid in a candy store, and he leaves the sweet shop with an upset stomach.

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A follow-up to this post can be found here: How would a Friendship with your Therapist Work?

I just came upon this NY Times column adding still one more perspective on therapist boundaries: http://opinionator.blogs.nytimes.com/2015/04/21/beyond-the-boundary-principle/#more-156706/

The Ethiopian Stop Sign is the work of Gigillo83 and is sourced from Wikimedia Commons.