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Tuesday, November 5, 2019

The Erotic Countertransference: The Therapist's Sexual Attraction to the Client

In an earlier article, Psychotherapy and the Erotic Transference: Falling "In Love" With Your Psychotherapist, I discussed clients' erotic feelings (also known as transference) for the therapist, the struggle that clients often have with these feelings, and how these feelings can be worked through with the therapist in a way that furthers the work in therapy.  As mentioned in the earlier article, a client's erotic feelings for his therapist is a common issue in therapy.  In this article, I'm focusing on the therapist's erotic feelings (also known as countertransference) for the client.

The Erotic Countertransference: The Therapist's Sexual Attraction to the Client

Psychotherapists who have been trained psychoanalytically are aware that they can develop erotic feelings for some clients. Knowing in advance that this will occur at some point and being trained on how to deal with it in an ethical way helps therapists to be prepared for these encounters, and it allows them to handle these issues in a way that isn't harmful to the client or their work together.

Before I go any further, I want to make it clear that psychotherapists know that it would be a serious boundary violation to get sexually/romantically involved with the client whether that involvement occurred during their work together or even after the client terminated therapy.  Unfortunately, although the vast majority of therapists are ethical, there are some therapists who act unethically.  Fortunately, they are in the minority (see my article: Boundary Violations and Sexual Exploitation in Therapy).

A therapist who has in-depth psychoanalytic experience, knows how to attune to what's going on in her internal world, with the client, and in the intersubjective space between the client and therapist.

She is also able to  momentarily dip into her own subjective experience in a way that's useful for the therapy (see my article: Psychotherapy: A Unique Intersubjective Experience).

For instance, as an example having nothing to do with sexual attraction, while she is listening to the client, a particular song might pop into the therapist's head, and she would ask herself if this song has any relevance to the client or the therapy session. She would ask herself if this is a way for her unconscious mind to give her more information that she might not be picking up on consciously? (see my article: Making the Unconscious Conscious).

There can be many reasons why a therapist might feel sexually attracted to a client.  On the most basic level, some people, including clients in therapy, naturally exude a certain sexual magnetism.  Since part of the therapist's job is to be attuned to the client, she could be picking up on this magnetism.

Another common reason is that the client might be flirting with the therapist as part of a defense mechanism to divert the conversation from things that make him uncomfortable in the session. For an experienced therapist, this is usually easy to see and would need to be addressed by the therapist in a tactful way.

Another issue might be that the therapist might be at a point in her personal life where she is not romantically, sexually or emotionally fulfilled.  As a result, she might experience these unfulfilled needs in the therapy room with the client.  This is why it's so important for psychotherapists to be attuned to their own personal needs so that they don't make ethical mistakes.

The Erotic Countertransference:  The Therapist's Erotic Feelings For the Client
The following fictional vignette is based on many different clinical cases.  It illustrates how the therapist attunes to her own internal experience and how she uses this attunement to discover the meaning of her experience and how it relates to the work with the client.

Gina
Gina, who was an experienced psychotherapist, realized that she felt a sexual attraction for Jim, after their first session together.

As a seasoned psychotherapist whose original training was in psychoanalysis, Gina knew that it was common for both clients and therapists to have attractions for each other.

Not only had she learned about the erotic countertransference in her original analytic training and in her extensive supervision, she also experienced this occasionally with other male clients.  She and her colleagues also discussed this phenomenon in their peer supervision group.

Although she was clear that she wouldn't act on her attraction based on ethical and clinical reasons, there was something different about this experience as compared to other earlier experiences that concerned her.

So, rather than ignoring her sexual attraction, she paid attention to it, and after her second session with Jim, she thought about whether there was something familiar about him that might be triggering these feelings.

She also talked to her own psychotherapist about this sexual attraction in her next therapy session.  Since her therapist, Ruth, knew Gina well from having worked with her in her analysis for over 15 years, Ruth listened intently as Gina described the sexual feelings that came over her during the first two sessions with Jim.

As Ruth listened to Gina describe this attraction, she realized that Jim had similar characteristics to Gina's husband, who died several years before.  She knew that even though Gina had gone through a period of grief and mourning, she still missed her husband a lot.  She also knew that Gina had been unable to motivate herself to begin dating again even though several years had passed, which left Gina feeling lonely.

As they talked about the similarities, including appearance, between Jim and Gina's late husband, Gina felt a deep sadness come over her that she had not felt since Jim died unexpectedly.  Although she saw the striking similarities between Jim and her late husband, Gina also saw the differences, and as she began to differentiate the two men and her feelings towards them, she began to feel a little better.

These feelings for Jim were also a signal to Gina that she needed to take better care of herself and that her loneliness signaled that she might be ready to explore dating again--even though she had mixed feelings about it.

During her next several sessions with her therapist, Gina explored her ambivalence about dating.  Part of her hesitation was that she continued to feel loyal to her late husband, and she wasn't sure how she would feel dating someone new.

But she agreed with her therapist, Ruth, that she could take it one step at a time, and she was under no obligation to date anyone.  So, she thought of her foray into dating as a way to explore her own feelings and the next step in her mourning process, which included an acceptance that her husband would never come back.

This acceptance that her husband was gone forever brought a new and deeper wave of grief for Gina. She knew from her own training and clinical experience that this was a normal part of grief and mourning as time went on.  So, she continued to talk to her therapist to address her own emotional needs in her therapy and separate out these needs from her work with her client, Jim.

As Gina took care of herself emotionally by talking to her therapist about her emotions and to her friends, who were also colleagues, about her attraction to Jim, she noticed that her attraction began to diminish.  Her work with Jim continued without interruption to his clinical process in sessions, and the therapy was going well.

A few weeks after Gina started seeing Jim as a therapy client, she noticed that she no longer felt an attraction to him.  She could see the resemblance and similarities to her late husband, but she also saw Jim clearly for himself as an individual.

Four months later, Gina began dating again.  She met a man who was also a widower and who understood her mixed feelings about dating.  As she continued to see him, she realized that her feelings for her late husband would never change, and there was room in her heart for both her late husband and for the new man that she was beginning to really like (see my article: A New Relationship: Understanding the Loyalty Dilemma For Someone Whose Spouse Died).

As her emotional needs were met in her therapy, with friends and colleagues and with the new man that she was dating, Gina felt more emotionally fulfilled.  With time, her client, Jim no longer reminded her of her husband because, although there was a physical resemblance, she could now differentiate more clearly that they were two very different men.

She was glad that she took care of herself and used her resources in therapy and among friends and colleagues to deal with the countertransference issues related to her therapy with Jim.  She recognized that, in many ways, it was similar to what occurred occasionally with other clients in the past, but she also saw why her feelings were so heightened with the similarities to her husband.

Conclusion
Both clients and therapists can develop sexual attractions for each other.  It's usually related to transference for the client and countertransference for the therapist.

Therapists have an ethical responsibility to be aware of their feelings and, for the sake of the client and the integrity of the therapy, not to act on their feelings.

Occasionally it happens that a therapist, who sought help in her own therapy, in supervision and among colleagues, is still unable to handle the countertransference, she has a ethical responsibility to refer the client to another therapist rather than act on her feelings or continue to be in conflict about them.

It's of utmost importance that therapists have a strong sense of self awareness and engage in self care so that they don't compromise a client's therapy.  As in the fictional scenario above, this means that the therapist must have the necessary skills and training to self reflect on her own internal process and do what she needs to do to take care of herself.

Although it was not discussed in this article, there are times when both the therapist and the client have a sexual attraction for each other.  In those cases, even if the client behaves in a seductive way, it's the therapist's responsibility not to cross a boundary with a client.  She must analyze her own feelings as well as the clients to understand the root of the issue for each of them and then proceed in an ethical manner to do what's best for the client while taking care of herself.

Getting Help in Therapy
Most well-trained psychotherapists are aware that they will occasionally feel an attraction for a client.      This is a common experience.  Most of them will also know that this probably has less to do with the client than it does with whatever is or isn't going on in their life.

Although sexual boundary violations do occur from time to time, most therapists take their Code of Ethics, which states that therapists cannot be in a dual relationship with a client, seriously.  They know it would be devastating to the client, their work together and it would also jeopardize their professional license if they crossed this ethical boundary.

If you're already in therapy and some of the issues in this article resonate with you, you would probably benefit from discussing them with your therapist or, if you're not comfortable with that, seeking a consultation with a different therapist to discuss what's going on in your therapy.  Most of the time these issues can be worked out, but if you tried and they can't be resolved, you can also seek help from another licensed therapist.

We all need help at some point in our lives.  If you're not in therapy and you're struggling with unresolved issues that are creating obstacles in your life, you deserve to get help from an experience licensed mental health professional.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, Somatic Experiencing and Emotionally Focused therapist, also known as EFT (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

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.