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Sunday, November 7, 2010

Psychotherapy and the Erotic Transference: Falling "In Love" With Your Psychotherapist

When Freud first encountered the erotic transference among his patients, he was very concerned and he didn't think it was a useful part of treatment. But, as he continued to work with these patients and to explore the transference, he discovered that it was, in fact, a very useful part of psychoanalysis, and the transference could be worked through so that the patient could gain insight and grow in treatment.

Psychotherapy and the Erotic Transference:  Falling "In Love With Your Therapist

Psychotherapists who are psychoanalysts have rigorous psychoanalytic training as well as years of their own psychoanalysis so that they are trained to work with the transferential aspects of therapy, including the erotic transference.

But, first let's understand what we mean by the word "transference" in the context of psychoanalysis or psychodynamic psychotherapy.

What is Transference?
There are many explanations for transference but, basically, transference entails, primarily, unconscious feelings that clients develop for their psychotherapists where they usually "transfer" feelings related to their childhood. Transference can be positive, negative, idealized, erotic and so on.

Usually, the clients develop these transferential feelings based on unmet needs from their childhood, so that if their parents were cold and neglectful, they have a strong desire for the psychotherapist to fulfill these needs that weren't met by their parents.

When you consider that psychoanalytic clients meet with their psychoanalysts any where from 2-5 times per week, you can see how transference, in whatever form, would build up quickly. Psychoanalysts also usually delve into the most intimate aspects of a client's interior world, including dreams, which can also fuel transferential feelings.

Psychotherapy and the Erotic Transference:  Falling "In Love" With Your  Therapist

Also, most psychoanalysts, especially at the beginning of treatment, don't reveal that much about themselves because transference is an important part of treatment. Since they want to work with the transference, they are unlikely to reveal a lot of personal information because the more a client knows about his or her therapist, the less room there is for transference to develop. So, the combination of the frequency of sessions, the intimate nature of what the client is sharing in the treatment, and the lack of information about the analyst (where there's lots of room for clients to project their fantasies) can create powerful transferential feelings.

Sometimes, clients' transferential feelings are not totally unconscious. They might be very aware of feelings that they're developing for the therapist, although they might not realize that the basis of these feelings is based on childhood experiences. This is all very common and part of what would be discussed in treatment.

Transference is not a phenomenon that is only found in treatment. In fact, it is a normal part of every day life in many areas of our lives. I'm sure that many of us can think of teachers that we had crushes on in school. This is also usually transference because it's a projection of the student's feelings for the teacher. Usually, students outgrow these crushes and, eventually, develop healthy relationships with their own peers.

What is Countertransference
I've chosen to focus on a particular type of transference in this blog article, namely, erotic transference, but I wanted to add a few words about countertransference. Countertransference is also a form of transference but, in the context of treatment, it's the transferential feelings that the therapist has for the client. Therapists who are psychoanalytically trained know that they will feel countertransference for some clients, and they often experience the same type of transferential feelings as clients do.

The big difference is that therapists who are psychoanalytically trained have the therapeutic skills to deal with these countertransferential feelings, and will usually recognize that it's not really about the client.

Rather, it can point to something that is lacking in their own lives, something from the past, or some unconscious feelings regarding their own unmet needs. Early on, in psychoanalytic training, psychoanalytic candidates in training use their own personal psychoanalysis and supervision to deal with these feelings and learn how to handle them without compromising the treatment. If countertransference becomes an issue for a therapist after his or her training, usually, he or she will seek professional guidance either in his or her personal therapy, in supervision, or among peers.

Psychotherapy and the Erotic Transference:  Falling "In Love" With Your Therapist

When psychoanalysts act on transferential and/or countertransferential feelings, rather than seeing them as a signal for work to be done with the client and/or with themselves, there can be boundary violations, especially sexual boundary violations, which I discussed in an earlier blog post. This type of boundary violation, whether it occurs during the treatment or after the treatment, is usually most harmful to the client. It can leave a client feeling devastated since these types of "relationships," which continue to be unequal even if the treatment is over, almost never work out.

There are some psychotherapists, who are not psychoanalytically trained, who are uncomfortable with clients' transference or their own countertransference, and they avoid dealing with it and don't know how to deal with it. This is usually detrimental to the treatment and has been the cause of many treatment failures.

What is the Erotic Transference?
The erotic transference is a particular form of transference that occurs when the client thinks that he or she has fallen in love with the therapist. Once again, as mentioned previously, feelings can develop quickly in psychoanalysis or psychodynamic psychotherapy due to the intensity of the treatment.

Initially, this can be emotionally painful for clients because, an ethical psychotherapist who maintains the treatment frame, won't gratify these erotic transferential feelings and fantasies, so that clients feel a yearning for their therapists that cannot be satisfied. These feelings are explored in treatment and, usually, as previously mentioned, they have their origins in unmet childhood needs.

The Erotic Transference in Therapy Often Involves the Client's Fantasies About the Therapist

It's easy to see how someone who grew up in a home where their emotional needs were not met or not sufficiently met, for whatever reason, would feel like he or she is falling in love with the therapist who is spending so much time listening to his or her most innermost feelings. The early yearning to have these needs met can come roaring to the surface very quickly. Many times, clients have repressed (pushed down) these needs for so long that. before starting treatment, they might not even be aware that they still have these needs. Then, lo and behold, these needs are tapped into and they often erupt with full force.

Note that I emphasized that this can be part of the initial part of treatment. The reason for this is that a skilled psychoanalytically trained therapist will use these transferential feelings not only to explore those unmet needs but also to help the client to develop healthy relationships outside of treatment where those needs can be met. So, although it can be initially painful to feel unrequited love as part of the erotic transference, the client is helped to develop into an adult who can have his or her needs met.

The erotic transference can occur regardless of the client's and therapist's gender or sexual orientation. That means that a heterosexual woman can develop an erotic transference for a heterosexual female therapist, even if this client never had erotic or romantic feelings for women in the past.

It can also occur with a heterosexual man and a gay therapist, even if the client never had sexual or romantic feelings for gay men before. A gay male client can develop an erotic transference for a heterosexual female therapist. And so on. This can be very confusing for clients and, at times, causes them to question their sexual orientation. But, most often, especially if they're not having these romantic and sexual feelings outside of treatment, it's not about a change in their sexual orientation. It's usually about unmet childhood needs and, as an adult, these needs can be transformed into romantic and/or sexual feelings for the therapist.

In a successful psychoanalytic or psychodynamic treatment, the client matures into a person who can work through these early unmet needs and find mature love among his or her own peers rather than continuing to fantasize about the therapist.

But it would be misleading to say that this happens quickly in every psychoanalytic of psychodynamic treatment or that, for some people, it happens at all. Some clients can spend years feeling that they're in love with their therapists and not understanding why the therapist is not willing to satisfy their needs by seeing them outside of the therapy sessions or going out with them or telling them about personal aspects of the therapist's life.

If a therapist is not able to help a client work through the transference so that the client can transfer his or her feelings from the therapist to a healthy, mature relationship with a peer, the therapist might have to refer the client to a different therapist to work out these issues. This can feel very rejecting to the client, who might not understand why this is necessary, but it is sometimes necessary and preferable to allowing a client to spend year after year feeling deprived because his or her therapist won't gratify his erotic or romantic needs.

The fictionalized vignette below demonstrates how the erotic transference can develop in a psychoanalytic treatment. As an aside, I also want to reiterate that, although I'm focusing on psychoanalytic and psychodynamic treatment, transference can develop in any type of therapy and, overall, transference out in the world (outside of the treatment setting) is ubiquitous.

Terry:
When Terry began treatment, she had just ended her third long-term relationship with a man who turned out to be cold and distant. She felt depressed and "a failure" because she continued to choose men who didn't meet her emotional needs.

Terry chose a woman psychotherapist who was recommended to her by her doctor. During the initial few visits, the therapist asked Terry about her childhood history, and Terry recounted a childhood where her parents provided her with everything that she needed and wanted materially, but they were emotionally distant. Whenever she wanted to talk to her parents, they were too preoccupied with other things to listen to her. As an only child, Terry grew up feeling lonely. She loved to go visit her best friend's home because her friend's mother was very warm and affectionate. Terry used to secretly wish that her friend's mother would become her mother.

Since Terry was significantly depressed (although not suicidal), Terry and her therapist agreed to meet three times a week. As the treatment went on, Terry described how she had never felt that anyone close to her ever really listened to her. She was tired of going out with men who turned out to be so much like her parents, and she couldn't understand the unconscious process that compelled her to continue to choose the same type of man over and over again.

After a few weeks, Terry really began to look forward to her therapy sessions. Her therapist provided a safe and nonjudgmental environment for Terry to express her innermost feelings. Terry told her therapist about thoughts and feelings that she had never revealed to anyone else in her life, and she was amazed at how easily she was able to do this with her therapist. Most of all, she felt that her therapist was caring, attentive and really listened to her in a way that she had never been listened to before.

Psychotherapy and the Erotic Transference:  Falling "In Love" With Your Therapist

Soon after that, Terry began having erotic dreams about her therapist. These dreams made her feel very frightened, confused, and embarrassed because she considered herself to be heterosexual, and she had never had romantic or erotic feelings for a woman before. She had gay and lesbian friends, and she didn't think she was prejudice against gays. She was just bewildered by these dreams and wished that she would stop having them.

Terry also began to notice that she was ruminating about her therapist between sessions, wondering what she was doing and with whom. She fantasized about meeting her therapist outside of their sessions for dinner and getting to know her therapist personally. When her fantasies turned erotic, she began to worry because now she was having erotic feelings for her therapist in her dreams as well as her waking hours. In fact, she worried because she was feeling obsessed.

Psychotherapy and the Erotic Transference:  Falling "In Love" With Your Therapist

At that point, whenever she went to therapy, she wished that the session wouldn't end. She looked at her therapist's ring finger to see if she was wearing a wedding ring, but she saw no signs of whether her therapist was married or had a significant other. She felt that, at least, if she knew that her therapist was married, maybe she could stop ruminating about her day and night.

When her therapy session ended and Terry walked out into the waiting room and saw the next client about to go in to see the therapist, she felt jealous. On an emotional level, she wanted the therapist to only spend time with her and it was painful to think that she had to share her with other clients. On a rational level, Terry could step back and look at her feelings and know that they were irrational, but she couldn't stop them.

She had fantasies about standing across the street from her therapist's office, somewhere where the therapist couldn't see her, and waiting to see where she went or if she met up with a husband or lover. She felt that her curiosity and yearning to know more about her therapist's life was overwhelming. And, although she often had this fantasy, she never gave into it because she didn't want to feel like a stalker.

Finally, one day when Terry couldn't tolerate having these erotic feelings for her therapist any more, with much hesitation and embarrassment, she told her therapist about her erotic feelings. Part of her hoped that her therapist would tell her that she felt the same way about her, which she also knew would be terrifying for her. Another part of her was afraid that her therapist would think this was highly inappropriate and she would need treatment with Terry.

Terry's therapist listened intently to what Terry had to say. Terry became tearful because she was confused about what this meant about their therapeutic relationship and also what it meant in terms of Terry's sexual orientation. Terry poured out all the feelings that she had been holding back and allowed her tears to flow.

After she finished, Terry raised her eyes for the first time during that session to meet her therapist's eyes. What she saw was the same empathetic and compassionate look that her therapist usually had. She breathed a sigh of relief that, at least, her therapist wasn't throwing her out of the office. Then, her therapist talked to Terry about transference and, in particular, the erotic transference. Terry was surprised to hear that this is a very common experience in psychoanalytic and psychodynamic psychotherapy. At least, she knew that she was not some odd ball and that many other clients in therapy experienced the same feelings. Most importantly. she learned that most clients work through these feelings as they learn to develop healthy, romantic relationships outside of treatment.

Terry and her therapist continued to explore these feelings as they related to her unmet childhood needs. Terry did a lot of grieving for what she didn't get when she was growing up. Over time, she also learned to accept that her parents, who would never even think of getting into their own therapy, probably would not change. This is often a very hard part of treatment for many clients who still hold onto the wish, no matter how impossible it might seem, that one day their parents would change.

In the meantime, Terry began to date again. Whenever she started to see a man who turned out to be cold and distant as all the other men she dated, she wished that she could be in a romantic relationship with her therapist. Sometimes, these feelings were so strong that she felt they were unbearable. Although she still really didn't know if her therapist was heterosexual or a lesbian and she didn't know if her therapist was in a relationship, she fantasized about her therapist being a single lesbian.

Although she understood that she and her therapist couldn't be romantically or sexually involved while she was still in treatment, she now had fantasies that they could be together after the treatment ended. She even had thoughts about terminating the treatment with her therapist and seeing a different therapist so that she and her current therapist could be together.

This thought made her feel happy and excited her sexually as well. She no longer cared if she considered herself to be heterosexual or a lesbian. It didn't matter. All she could think about at that point was that she and her therapist could be so happy together if she was no longer in treatment with her. She thought to herself, "Why didn't I think about this before? Surely, my therapist must recognize that there's a special feeling between us. She's too ethical to pursue this feeling while I'm in treatment with her, but she'd have no reason not to be with me if I was in treatment with someone else."

Terry was very excited on the day when she decided to bring this up in her psychotherapy session. She had fantasies about having romantic candlelight dinners with her therapist, being sexually intimate, and, in time, even living together. So, when she brought up her feelings about this in therapy, as always, her therapist listened to her intently. Terry was so happy to have someone finally listen to her as if she was the only person in the world, and she imagined how wonderful this would be to experience all the time, and not for 45 minutes several times a week.

Once again, Terry's therapist acknowledged that it is not at all unusual for a client to have these feelings and, in fact, many clients had these feelings. Then, she proceeded to explain to Terry how, even after their treatment ended, whenever it ended, they could never be together or have anything but a therapeutic relationship because it would ruin the treatment that they had together. Also, she explained that these romantic and sexual feelings that Terry had, while very strong, were still based on her unmet childhood needs. And a relationship between a former therapist and a former client would be disastrous for the client.

Even though her therapist normalized her feelings, Terry was extremely disappointed. She thought she had found a way to be with her therapist, only to be rejected. This was the subject of many sessions after that session. Terry's therapist was also able to help her connect her current feelings to her earlier feelings connected to the childhood emotional neglect.

As treatment continued, Terry began to feel deep down that she deserved to be with someone who was emotionally available to her. Since she didn't have attractions for women outside of her therapy sessions, she continued to date men and talk about these experiences in her therapy. She still held onto a wish that her therapist would eventually change her mind and get romantically involved with Terry after the treatment was over. But she also began to choose men who were more emotionally attuned to her.

Several months later, Terry met a man that she really liked and who was very kind and generous with her. Unlike her other relationships, he was attentive and also reciprocated her feelings. Initially, she was almost too afraid to get excited about this man because she feared that she would get disappointed and hurt like she had in the past. But, as she continued to see him, their relationship developed and became more intimate.

At first, Terry felt like she was "cheating" on her therapist, although, rationally, she knew this wasn't true. But, until then, most of her erotic dreams and fantasies had been about her therapist, and it had been the most intense relationship (albeit it a therapeutic relationship) that she had ever had.

Unlike her mother, who had almost never shown much concern for Terry's emotional well being, Terry sensed that her therapist was happy for her that she had met someone that she really cared about and who really cared about her.

As Terry continued to see this man and continued to talk about it in her therapy, gradually, over time, she realized that her feelings for her therapist were changing. Although she felt a deep caring for her therapist, she no longer had romantic or sexual feelings for her therapist.

This surprised Terry greatly because, when she was obsessing about her therapist, she thought these feelings would never change and she worried about what it might be like to terminate treatment and never see her therapist again. Whenever she had those feelings, she worried that she had become "too dependent" on her therapist. But much to her surprise, over time, she was beginning to feel that she could foresee a time when she could end treatment and be all right about it.

Psychotherapy and the Erotic Transference:  Falling "In Love" With Your Therapist

When she discussed this with her therapist, her therapist assured her that, even after she ended this treatment, if she felt that she wanted to work out other issues that had come up after this treatment was over, she could return to see her. She also told Terry that it wasn't unusual for people to return to their therapists after years of being away from treatment. She also told her that Terry had the option in the future of seeing a different therapist, possible someone who worked differently, to get a different perspective.

Soon after that, Terry and her therapist went through the termination process, which lasted a few months. During that time, they saw each other less frequently. They processed the therapy in a way that gave closure to their therapeutic relationship. During that time, Terry realized that her feelings for her therapist had changed to no longer feeling at all erotic, romantic or idealized in any way. Rather, she saw her therapist as being an ordinary person who happened to be very skilled at her work. And, when she looked back at her erotic transferential feelings, she was glad that her therapist was ethical, and maintained the therapeutic frame in a safe and empathic environment.

Terry and her boyfriend eventually got married and, overall, she was happy. After a few years, she returned to see her former therapist for brief treatment to work through particular issues. She was grateful to be able to return for treatment whenever she needed it. And rather than feeling caught up in transferential feelings that were based on unmet childhood needs, she felt that she was with a capable mental health professional who could help her to overcome these problems.

About the Fictionalized Scenario 
The fictionalized scenario that I presented above is one example, among many different types of situations, of the erotic transference and how it might appear in treatment and get worked through. There are times when clients, who feel too uncomfortable with their erotic and romantic feelings for their therapist, leave treatment and never work through these issues or the unmet childhood needs that tend to fuel these feelings.

While there are certainly times, especially if a psychotherapist is crossing professional boundaries, where clients should leave treatment before transferential feelings are worked through (and work them through with another more professional and ethical therapist), most of the time, it is beneficial to stay in treatment and get to the early core issues that are at the heart of the matter.

Getting Help in Therapy
If you're overwhelmed with problems that you've been unable to resolve on your own, you could benefit from seeing a licensed mental health professional who can help you to work through these issues so you can lead a more fulfilling life.

About Me
I am a licensed psychotherapist in NYC, who is psychoanalytically trained. Since my psychoanalytic training, I have also developed expertise in other treatment modalities, including EMDR, clinical hypnosis, and Somatic Experiencing.  I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (212) 726-1006 or email me josephineolivia@aol.com


8 comments:

redaz said...

Hello!
Thank you for your post: It is very interesting and complete!

I would like to know why the transference in psychoanalysis is so much stronger than in other reports.
You write that this is because the therapist and patient meet several times a week and because they speak of inner thoughts.
But this is enough to create powerful transference?
So even with a friend who I see 3-4 times a week and listen to me about what I think and my inner self, you will create a transference powerful as that of the psychoanalyst?


thanks

Johanne

Josephine Ferraro, LCSW said...

Thanks for your comment, Johanne. With regard to transference, your friend is your peer so, although you might develop intense feelings for your friend, I wouldn't consider it to be transference in the same way that transference develops between client and therapist. Part of the reason that a client develops a transference for the therapist is due to an emotional need to imbue the therapist with certain qualities. These feelings often become eroticized by the client, and the client develops erotic feelings for the therapist. It's not just a matter of seeing someone a few times a week, it also has to do with the nature of the relationship between client and therapist. No matter how egalitarian a therapist might be, the therapist is still somewhat in a position of authority, as compared to the client. Transference also often develops when the client sees the therapist once a week. It's just that the more times per week the client sees the therapist, the more intense the transference (and countertransference) tends to be. Please continue to read and comment on my blog posts. If you haven't already joined the blog, I hope you will consider joining.
Josephine Ferraro, LCSW

Tamara G. Suttle said...

Josephine, I'm so happy to learn of your work and your blog! Especially appreciate this post on transference / countertransference - one of my favorite topics. You are fortunate to by psychoanalytically trained and in the Northeast where there is a large like-minded community. Here in Colorado, there is not a large psychoanalytic or even psychodynamic community. Thus, the language of transference / countertransference is rarely heard or addressed here.

Josephine Ferraro, LCSW said...

Hi Tamara, Thanks so much for your coment. I consider myself to be an integrationist when it comes to therapy. I work w/transference, but my main focus now is mind-body oriented therapy, like Somatic Experiencing (SE), clinical hypnosis, and EMDR. As you probably know, SE originated w/Peter Levine, Ph.D., who is in your home state, Colorado. More East coast therapists are starting to train in SE, but my impression is that it's more popular on the West Coast. Please feel free to read and comment on my blog posts.

Brother Charles said...

Thanks so much for 'Terry.'

Josephine Ferraro, LCSW said...

Brother Charles, thanks for your comment. I'm glad you found my article useful.

Rowan said...
This comment has been removed by the author.
Josephine Ferraro, LCSW said...

Dear Rowan,
Thanks for your comment. I'm glad you enjoy reading my blog.
I appreciate your comment because I think many clients have similar experiences with regard to the erotic transference as well as the erotic countertransference (the therapist's feelings).
I'm glad to hear that both you and your therapist are clear about boundaries.
I think it's best for you to address your question to your therapist. However, I will say that I think most therapists are honest with their clients and don't try to mislead them with regard to their own feelings.
I hope that by raising this issue with your therapist that it will help clear up your question.
All the Best to You.
Josephine Ferraro, LCSW