We have been talking about love and relationships this month and I thought I would explore a slightly different twist on this topic. In this post we are going to talk about the feelings one can develop for their therapist. What is normal and what can be considered out of bounds within the therapeutic relationship?
If you watch television and movies you would think that therapists and patients falling in love, dating, and even having sexual affairs was an everyday occurrence. In the comedy sitcom, The New Adventures of Old Christine, Julia Louis-Dreyfus plays the part of a neurotic divorced mom who keeps trying to find the right relationship. In one episode she begins to going to therapy and finds she is attracted to her therapist, Dr. Max Kershaw played by actor Eric McCormack. Max has already had his license suspended multiple times for getting too close to his patients. But it doesn't stop him from doing it again and he finds himself falling for Christine. Christine stops going to therapy and begins dating Max. Christine's brother, Matthew, played by Hamish Linklater, is a budding therapist. He too breaks the boundaries of the therapist-patient relationship and enters into a romantic and sexual tryst with one of his clients.
Then there are movies which depict love affairs between therapist and patient. The award winning film, Prince of Tides, comes to mind as a movie depicting such an elicit relationship. Nick Nolte plays the character of Tom Wingo, who goes to New York to talk to his sister's psychiatrist, Dr. Susan Lowenstein, who is played by the film's director, Barbara Streisand. Although Tom is not technically a patient, he assumes that role, in consulting with his sister's psychiatrist. He begins to discuss his own psychological issues in addition to seeking information which can help his suicidal sister remember traumatic events from childhood. The viewer witnesses the evolution of their mutual attraction and feelings for one another. Boundaries are crossed when they act on their feelings and begin a sexual love affair.
One of my favorite dramatic television series explores the topic of love affairs between therapist and patient in great depth. The HBO series, In Treatment, dedicates multiple episodes to the romantic and sexual tension present between psychotherapist, Paul Weston, and his much younger patient named Laura. The show does a very good job of delving into the interpersonal dynamics of psychotherapy and also highlighting where things can go awry. When Laura tempts Paul by discussing a detailed story of her sexual exploits we applaud his professionalism in not straying off course. Yet in each session with Laura we begin to see the vulnerabilities and human frailty of this man who happens to also be a therapist. We know that an emotional train wreck is inevitable but we don't know who will be the victim. We may also wonder if Paul is attempting to trick Laura with some therapeutic technique or if he is really falling for her. When we find that he does have genuine feelings for her and is thinking of acting upon them we want to yell, "Stop No! Don't do it!" For me it provoked the sense of great discomfort that the patient's safety zone in therapy was violated. It was difficult to watch even though it is just a television show.
Yet these are all fictional stories written by writers who wish to tell a story or even to entertain. Does this sort of thing happen in real life? Are there patients who fall in love with their therapist? Are there doctors who develop feelings for clients beyond the expected therapeutic boundaries? And how does this predicament happen in the first place?
If you look at forums such as this one on PsychCentral where the issue of falling for your therapist is discussed, it seems that this is not such an uncommon experience. In fact, it is considered part of the therapeutic process to develop some sort of feelings for one's therapist. How can someone help you if there is no connection? The problem occurs when the therapist, for whatever reason, is not able to deal with the patient's feelings or begins to reciprocate them in a way which violates the ethical code of his or her profession.
At the extreme end of violating this ethical and professional code are therapists who have sexual relations with their patients. How many therapists are actually doing this? One estimate is that as many as 4.4% of therapists have admitted to having sexual relations with their patients. It goes without saying that in addition to the fact that such an act is grounds for legal and disciplinary action for the therapist, it has enormous negative psychological repercussions for the patient.
What you see on television and movies is not the norm and is hopefully a rare event when a doctor or therapist violates the sanctity of the therapist-patient relationship. So what is normal in the context of the therapeutic setting? As mentioned previously, it is expected that you may develop some sort of feelings for your therapist. Therapy can be very intimate in that you are exploring your deepest darkest feelings. Even in cognitive behavioral therapy there is a certain amount of sharing which occurs. Hopefully a trust develops despite feeling emotionally vulnerable, in order to work on your goals. For some, the process can mimic that of falling in love.
Transference and counter-transference are two terms to explain the emotional feelings which may occur during therapy between patient and therapist, especially with regard to psychoanalysis. Transference is the psychological phenomena where we may unconsciously re-enact previous relationships with a new person. Something about your therapist may remind you of another person in your life. Something about your therapist may remind you of your parent, a childhood friend, or past lover. Feelings may develop which were similar to how you felt about a significant other. A skilled therapist understands this may happen and will attempt to use the transference to help you work out interpersonal issues or problems from your past.
Counter-transference is defined as the therapist's projections and feelings for the patient based upon their previous relationships. So it works both ways. A therapist is only human and may have to confront their emotions for the patient during the therapy process. Usually a therapist will have their own mentor, guide, or personal therapist to help them through such issues. Transference may be erotic in nature but it can also include putting the therapist on a pedestal, feeling hate or mistrust, or even feeling like one must compete with the doctor.
When I was in therapy during my early twenties I developed transference for my therapist in that he was a father figure. We discussed my transference as part of our sessions and it was pivotal for my being able to grieve over the father I never had. It was a simple discussion where I said something like, "I wish you were my father." My therapist in turn, explored this openly, by asking, "What would that be like if I were your father?" Boundaries were also set in an explanation of reality that he was not my father and that nobody could ever replace the father I had lost. This gave me the permission to deal with my feelings of loss. A skilled therapist will explore issues of transference openly with you.
My best suggestion for you if you are developing feelings for your therapist whether they are thinking of them as a parent figure or even as someone you have romantic or sexual feelings towards, is to talk about it. Bring it up in therapy so that it can be worked through in a safe way.
If your therapist says or does anything which makes you feel uncomfortable or does anything which violates your feelings of safety, you also need to bring up this issue immediately. Sometimes it can be a misunderstanding and other times the issue is serious enough for one to terminate therapy. I once stopped seeing a therapist because he insisted upon hugging me before the session. Perhaps some other patients were comfortable with his touchy feely style but I certainly was not. Remember that this is your time, your money, and your investment in your mental wellness. Choose your therapist wisely. Trust is essential for therapy to work. If you don't feel safe with your therapist it may be time to explore other options.
We would like to hear from you. Have you ever had the experience of falling for your therapist? Did you talk about this in therapy? How was it handled? Have you ever had a therapist who violated the patient-therapist relationship? Tell us your story. We are listening.