What is the Negative Transference in Psychotherapy?

In prior articles, I've discussed the positive transference, the erotic transference and the parental transference.  

Today I'm focusing on the negative transference and how it plays out in therapy (see my article: What is Transference in Psychotherapy?).  

What is the Negative Transference in Psychotherapy?

What is the Negative Transference in Psychotherapy?
The most basic explanation for the negative transference, which was first identified by Sigmund Freud when he was developing psychoanalysis, is that it is a term used in psychotherapy for the negative feelings that a client projects onto his therapist.

Just like the other forms of transference, the negative transference is usually an unconscious projection of negative feelings that the client "transfers" from early childhood relationships onto the psychotherapist (see my article: Discovering the Unconscious Emotions At the Root of Your Current Problems).

Although the client might be aware that he has similar hostile feelings towards his therapist as he did for a parent, he might not be aware that he is projecting these feelings onto the therapist.

Also, as I mentioned in earlier articles, transference in general is a normal part of relationships outside of therapy.  It's not just a phenomenon that occurs in therapy.

For instance, spouses can develop negative transferential feelings for each other, especially when one or both of them says something that triggers an emotional response related to a hostile relationship with a parent.

Another example is of an employee who has a negative transference for a boss that's based on a hostile relationship with a parent.

And so on.

Working Through the Negative Transference in Psychotherapy
The negative transference can show up in all kinds of ways in psychotherapy.  It can be a hostile projection that a client feels towards the therapist that is short lived or it can go on for a long time.

The negative transference is a dynamic that clients and their psychotherapist can work through in therapy.

As I mentioned in a prior article, it's important to distinguish transferential feelings from more objective feelings.

In other words, if a client has negative feelings towards his psychotherapist, it's not always about transference.  It's possible that the psychotherapist said or did something that caused the client to develop these negative feelings that is unrelated to transference and, if so, the therapist needs to own up to this and apologize (see my article: How to Talk to Your Psychotherapist About Something That's Bothering You in Your Therapy).

But, assuming that the problem is related to a negative transference, the client and therapist can often work through the hostile projections that the client places on the therapist--although it's not always easy and the working through will depend upon the particular client-therapist relationship.

Let's take a look at a fictional vignette, which is representative of a common situation in therapy where the client starts out with a positive transference for his psychotherapist, develops a negative transference and, ultimately, the therapist and client work through the negative transference.

Fictional Vignette:  Working Through the Negative Transference in Psychotherapy

Ed
Ed began psychotherapy because he was upset about a recent breakup with his girlfriend.

He tried in vain to reconcile with his former girlfriend of four years, but she refused to reconcile.  This left Ed feeling confused and very sad, especially since he didn't understand why his girlfriend broke up with him.

Initially, Ed felt comfortable with his therapist.  He found her to be empathetic and emotionally supportive.  He told his therapist that he was surprised that he actually looked forward to his psychotherapy session each week because he felt understood and cared about.

At that point, Ed had a positive transference for his psychotherapist and the sessions were going well.

When Ed thought about why he liked his therapist so much, he realized that she reminded him of his aunt, who used to take care of him after school until his mother came home from work.  He loved his aunt because, not only was she nurturing, she was also fun to be around.  He preferred being with his aunt to being with his mother, whom he considered cold and highly critical.

One day, during a psychotherapy session, while Ed and his therapist were talking about his confusion as to why his girlfriend left him and why she refused to reconcile, his therapist attempted to explore with Ed if he could think of anything that he might have said or done that might have contributed to the problem.

What is the Negative Transference in Psychotherapy?

Immediately after his psychotherapist asked Ed this question, she could see a shift in Ed.  His face turned white and he looked stricken.  His body became rigid and he sat very straight up in his chair as if he had just been attacked by the therapist (see my article: Shifting Self States).

When she asked the question, the therapist was trying to help Ed to explore his own thoughts and feelings about what might have happened between him and his girlfriend.  But she could see from Ed's intense reaction that he felt stung, so she attempted to address this with Ed, but he was too angry to listen to her.

Before the psychotherapist could talk to Ed about his reaction and explain the reason for her question, he told her that he was shocked that she would ask him such a question, "This is what my mother used to do!  She blamed me for everything!  Now, you're doing it. I thought you were on my side."

During the next couple of weeks when Ed came to therapy, he was either outwardly angry or quietly sullen.  It was obvious to the therapist that Ed was now experiencing a negative transference and he was projecting his angry feelings about his mother onto her.  She realized that she asked Ed this question too soon because he wasn't ready to deal with it.

Ed ignored his therapist's initial attempts to address his hostile feelings for her and each week he wavered as to whether he would continue in the therapy with her or not.  He said he was considering trying to find another therapist who would be more empathetic towards him and who would not criticize him.

After a few weeks, Ed calmed down somewhat and he was able to have a discussion about their therapeutic relationship.  Although he acknowledged that, at first, he felt comfortable with her, now he wasn't sure if he trusted her or not.

He felt that by asking him whether he knew of anything that he might have said or done that could  have contributed to the end of the relationship, his therapist was assuming that the breakup was all his fault.  And since he lived with his mother's withering criticism during his childhood, he found it especially hurtful that his therapist would make this "accusation" in therapy, a place where he should feel safe.

By the third week, Ed was more subdued.  He told his therapist that he received an email from his ex, who finally responded to him and gave him the reasons why she ended the relationship.  She told him that, before now, she wasn't ready to address his questions about the breakup, especially since she had been telling him about these problems throughout their relationship.

Ed went on to tell his psychotherapist that his ex gave him many examples of his lack of consideration for her.  When he read her email, he remembered that she had made these same complaints many times before, but he had never taken her complaints seriously.  Now, he realized that he took his ex and their former relationship for granted when they were together, and he also realized that he was at fault.

The email hit him like "a ton of bricks." But after reading it, he knew that he wanted to change this aspect of himself that tended to disregard the other person's feelings when he was in a relationship.  He recognized that he had this problem in his prior relationships, and he didn't want to continue to perpetuate this dynamic in a future relationship.

Then, Ed told his therapist that he now understood why she was attempting to help him explore what he might have done that contributed to the relationship, and he realized that she wasn't criticizing him.  He realized that, in fact, his therapist was trying to help him.

After that, Ed and his therapist were able to talk about the dynamic in his former relationship, including his part in the demise of the relationship.

He was also able to talk about his traumatic relationship with his mother and how he feared her criticism when he was a child.  He discussed how he was never able to talk to his mother about her hostility because she would never acknowledge it, and she always blamed him.  As a result, there was no way to reconcile things between them whenever she berated him.

After he and his therapist talked about what happened between them, Ed realized that he got emotionally triggered when he heard his therapist's question (see my article: Coping With a History of Trauma: Becoming Aware of Emotional Triggers).

With his therapist's help, Ed was able to distinguish his relationship with his mother from his relationship with her.  He could see that they were too very different relationships (see my article: Working Through Emotional Trauma: Learning to Separate "Then" From "Now").

He could see that, whereas he and his mother couldn't repair their relationship whenever she berated him, he and his therapist could work through difficulties between them (see my article: Ruptures and Repairs in Therapy).

Since his mother never admitted to a mistake and his father was mostly absent, Ed never experienced this kind of dyadic repair as a child, and he was moved and grateful to experience this in therapy.

These discussions allowed Ed and his psychotherapist to work through the negative transference.

Over time, Ed and his therapist had other transferential ups and downs in therapy, but they were able to work through these incidents.

His therapist also spoke to Ed about transference and explained transference reactions were a common experience in therapy as well as in other areas of people's lives (see my article: Why It's Important For Psychotherapists to Provide Clients With Psychoeducation in Therapy).

Conclusion
Transference is ubiquitous.  It's not just a phenomenon that occurs in psychotherapy.

When a negative transference develops in psychotherapy, the value of working through the transference, aside from preserving the therapeutic relationship, is that the client can explore his negative projections, own them, and form a more objective relationship with his psychotherapist.

Working through the negative transference can be challenging for both the client and the psychotherapist.

When he is experiencing the negative transference, the client can be in a state of high agitation and might not be able to process his feelings or hear what the therapist has to say.

But as the negative transference gets worked through in therapy, the client gets to experience, possibly for the first time, that these kinds of issues can be worked out.  Like "Ed" in the fictional vignette, it is often a transformative experience.

For the therapist, who is obviously human and doesn't want to be disliked, it can be difficult to feel the client's intense dislike or hatred.  But a skilled psychotherapist also knows that she isn't there to be "liked," she's there to be helpful to the client, which can mean tolerating the client's hostility until they can work out these issues.

Getting Help in Therapy
It takes courage to ask for help (see my article: Tips on Overcoming Your Fear of Asking For Help).

The advantage of going to therapy, as opposed to relying solely on family and friends, is that the psychotherapist is a trained, objective person who will give you her undivided attention at a time and in a place that is devoted to you each week (see my article: The Benefits of Psychotherapy).

Many people, who could benefit from psychotherapy, don't come to therapy because they fear being emotionally vulnerable.

This is why it's so important to have an initial consultation to get a sense of the psychotherapist and if you and she would be a good match (see my article How to Choose a Psychotherapist).

If you've been struggling with a problem for a while and you've been unable to resolve it on your own, you could benefit from seeking help from a licensed mental health professional.

Rather than continuing to struggle on your own, you could work through your problems in therapy and then move on to live a more fulfilling life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist. 

I use an integrative approach in therapy to develop the treatment plan that works for each individual client (see my article: The Therapeutic Benefits of Integrated Psychotherapy).

I work with individual adults and couples in an interactive and collaborative way.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

What is Transference in Psychotherapy?

I have discussed transference in prior articles (see my articles: Psychotherapy and the Positive Transference and Psychotherapy and the Erotic Transference).  I wanted to discuss transference in more detail in this article so that clients who are in therapy or thinking about going to therapy will have a better understanding of this concept.

What is Transference in Psychotherapy?

The concept of transference was originally developed by Sigmund Freud when he was developing psychoanalysis.  He described various forms of transference in psychotherapy, including the positive transference, negative transference, erotic transference, parental transference and so on.

Here is a simple explanation of transference for psychotherapy clients who might be curious:  Typically, transference occurs when the client unconsciously "transfers" feelings that s/he had during childhood from her primary caregiver to the current psychotherapist.

Since this phenomenon is unconscious on the client's part, s/he usually isn't aware that these old feelings are being superimposed on the relationship with the psychotherapist.

If the transference is positive, it usually means that the client and psychotherapist have a good therapeutic relationship and, in most cases, the therapy is going well.

If the transference is negative, it means that there is some conflict between the client and the psychotherapist or some obstacle in the therapeutic work, and the client has negative feelings about the therapist.

During the course of therapy, the client's transference can switch back and forth between positive and negative or other forms of transference.

Many clients aren't aware of the term "transference" because the term is a form of psychotherapy jargon, and most therapist would find a more accessible way of talking about the therapeutic relationship with the client without resorting to jargon.

But clients who are interested in psychotherapy and possibly thinking about becoming a psychotherapist will often read this term and wonder what it means.

Transference is not a phenomenon that is exclusive to psychotherapy.  We all experience various forms of transference all the time in our personal and work relationships.

For instance, if you resented your authoritative father as a child, you might unconsciously "transfer" the feelings of resentment from your father to your boss at work and develop a negative transference for your boss--regardless of whether your boss is authoritative or not.

This doesn't mean that you still don't resent your authoritative father.  It just means that your boss is a person who is in authority in your life, and regardless of whether your boss has an authoritative personality or not, on an unconscious level, you have similar feelings towards your boss (and possibly other authority figures) as you did (or do) towards your father (see the vignette in my article: Contemporary Psychotherapy: Redefining the Traditional View of "Resistance" in Therapy).

Similarly, if your boss unconsciously reminds you of your grandfather, who was kind to you, you might develop a positive transference for your boss without even realizing how your feelings for your boss are connected to your grandfather.

Many psychotherapy clients "fall in love" with their psychotherapists.  I put "fall in love" in quotes because they're not actually in love with the therapist.

Most of the time, their feelings are based on a fantasy of what it might be like to have a personal relationship with the therapist.

This fantasy might have nothing to do with what it might actually be like to have a personal relationship with the psychotherapist (see my article: Why Your Psychotherapist Can't Be Your Friend).

Clients who experience an erotic transference for their therapist often worry and feel ashamed of their feelings, but this is a common experience in therapy.  Usually, the erotic transference dissipates over time as the client gets a better sense of the therapist as a ordinary person, the client develops more objective feelings for the therapist, and the client finds other attainable love interests in the "real world."

Although transference is an important concept in psychotherapy, not all feelings towards your therapist are about transference and it's important to be aware of this.

For instance, if your psychotherapist has said or done something in therapy that bothers you, your feelings shouldn't be dismissed by the therapist as being only about transference.

The real issue between you and the therapist needs to be addressed (see my article: How to Talk to Your Psychotherapist About Something That's Bothering You in Psychotherapy).

In future articles, I'll discuss other forms of transference.

Conclusion
Everyone experiences transference in all kinds of relationships--not just their relationship with their psychotherapist.

Transference usually happens on an unconscious level.

If you're in therapy and you're uncomfortable with your transferential feelings for your psychotherapist, you can talk to your therapist about it.

Psychotherapists are usually open to talking about transference, and you'll probably feel better to get these feelings out in the open.

Getting Help in Therapy
If you're feeling stuck in your life or you're unable to overcome a problem on your own, you could benefit from attending psychotherapy (see my article: The Benefits of Psychotherapy).

Rather than suffering on your own, you owe it to yourself to get help from a licensed mental health professional (see my article: How to Choose a Psychotherapist).

Whether you need emotional support or if you need help overcoming psychological trauma, a skilled psychotherapist can help you overcome the obstacles that are keeping you from living a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist and I use Integrative Psychotherapy (see my article:  The Therapeutic Benefits of 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 (917) 742-2624 or email me.

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

Clients often start psychotherapy with some degree of ambivalence--often a mixture of hope and fear.  The hope is that they will be able to work through their problems in therapy.  When clients come to therapy to deal with unresolved developmental trauma, the fear is that the psychotherapist might fail them, as they were failed in their earliest relationships with their parents, and they will be retraumatized (see my articles: Developmental Trauma: Living in the Present As If It Were the Past, Starting Psychotherapy: It's Not Unusual to Feel Anxious and Ambivalent,  Clients' Fears About Being Abandoned By Their Psychotherapist, Why It's Important For Psychotherapists to Provide Clients With Psychoeducation About Psychotherapy, and Developmental Trauma: Developing the Capacity to Put Words to Feelings and Sensations).

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

As I've mentioned in other articles, it's always important for the psychotherapist to establish a rapport with the client.  This is especially true when clients come to therapy to work through developmental trauma where they might have been neglected, abused or betrayed in some way. These clients often expect to be retraumatized in their personal relationships as well as in their client-therapist relationship.

Even when there seems to be a good therapeutic alliance between the client and the therapist, this rapport can be fragile and subject to sudden changes depending upon how vulnerable the client feels in a particular session, so the therapist needs to be aware that there can be these sudden changes.

If the client develops a positive transference to the psychotherapist and there is some misunderstanding, the client, who is ever vigilant for possible betrayal, can suddenly develop a negative transference when he thinks that the therapist is behaving in a similar way to his parents.

Many times this fear is unconscious on the client's part, and he might not know that he is reacting to the therapist as if the therapist was the parent who abused, neglected and betrayed him (this assumes that the therapist is really not being abusive, neglectful or betraying the client).

These ruptures are usually reparable if the therapist understands what's happening between her and the client and the client allows for the repair (see my article: Ruptures and Repairs in Psychotherapy).

Let's take a look at a fictional vignette that illustrates these dynamics:

Developmental Trauma: The Client's Hopes and Fears in Psychotherapy

Agnes

Agnes was in her early-30s when she began psychotherapy. 

During the consultation, Agnes explained to the therapist that she felt like she was "just drifting" in her life without purpose.  She said she felt "dead" inside.  She had a history of several unhappy romantic relationships and many unsatisfying dead end jobs, including her current job.  

Coming to therapy was her first attempt to explore these issues.  In the past, she considered attending psychotherapy, but each time she would dismiss this idea because she feared being betrayed in therapy.

But lately she felt so miserable and her friends were tired of hearing her complain.  Even when they were willing to listen, she didn't find them to be helpful.  She thought they didn't understand what she was going through and their suggestions were simplistic.  So, she decided to try therapy, hoping that she would feel better, but dreading that it would be another bad experience.  

She described her family history as "a nightmare."  Her father was a severe alcoholic, and her mother was in denial about the severity of the father's drinking.  She described her mother as being in her own "fantasy world" where everything was "rosy."  Even when her father lost one job after the next because of his alcoholism, her mother blamed the bosses for firing the father.  

As the older of two children, Agnes felt she had to contain all her worries by herself because her mother was unable to talk to her about Agnes' concerns.  

Her mother would minimize Agnes' fears by telling Agnes that she was being "dramatic" or a "worry wort."  Agnes' brother, who was 10 years younger than her, didn't understand what was going on, so Agnes felt alone and she suffered from terrible anxiety.

From the time she was a child, she worried about things going wrong.  Even when things were going relatively well, she worried that there could be a sudden downturn and she would be devastated.

She was offered jobs that were commensurate with her education and skills, but she never felt confident enough to accept them.  Instead, she took low level, low paying because they didn't cause her to feel such fear and anxiety.

When she recently turned 31, she had a sudden awakening that she didn't want to just "drift" in life any more.  She wanted to get married and have a family, but she was afraid to date because her prior relationships were so awful.  

She also wanted to work in a more interesting job because she was bored at her current job.  Money wasn't an issue because her father left her a trust fund when he died, but she feared that one day when she was older that she would look back on her life and have many regrets because she was too afraid to take risks.

Recently, a family friend, who knew of Agnes' advanced education and skills, offered Agnes what she  considered to be her "dream job."  But she was highly ambivalent about taking it.  She feared that if she didn't do well, she wouldn't be able to face the family friend or her mother and brother.

So, her dilemma was whether she should stay in her current, boring job where she was underemployed or if she should take the risk and accept the family friend's job offer.

Agnes also talked about coming to therapy as being a "risk."  She chose her psychotherapist based on a recommendation from her primary care doctor, but she feared that the therapist would be another disappointment in a long line of disappointments throughout her life.

Given all of Agnes' fears about therapy, she and her therapist decided that they would take it slow.  Agnes' preference was to deal with the career issue first since she had to give her family friend an answer soon.

During their sessions together, Agnes went back and forth as to what she wanted to do about the job offer.  In one session, she said she planned to take the job.  In another session, she changed her mind and said she was too afraid to take the risk.

As they talked about her need to make a decision and how difficult this was for her, Agnes' therapist helped Agnes to see the connection between her early history and her fear of taking what she perceived to be a big risk.

Agnes began to understand how overwhelmed and emotionally neglected she was as a child since neither parent was able to be emotionally supportive.

It was understandable that Agnes, who felt so insecure about most things since she was a child, would also be fearful of making a change in her career.  She had little confidence in her decision making process in part because she was so invalidated as a child (see my article: Growing Up Feeling Invisible and Emotionally Invalidated).

After a few weeks, Agnes expressed feeling comfortable in therapy.  She felt that her therapist understood her and was emotionally supportive.  

Soon after that, Agnes told the family friend that she would accept the job.  At first, she was relieved that she made a decision and she was no longer going back and forth in her mind.  

But shortly afterwards, she was overcome with anxiety and fear:  Was she taking on more than she could do?  Would she disappoint the family friend?  If she didn't succeed, would she feel like a failure in front of family and friends?

Whenever Agnes spoke with her therapist about her decision, she felt better.  She was almost defiant about "showing" her mother that she could do better.  She also knew that she could leave the job if it didn't work out and no one needed to know what happened.  

But she continued to ruminate about her decision, going back and forth in her mind even though she had already told the family friend that she accepted the position.  Her rumination caused her to lose sleep because she was so worried.

One day, Agnes showed up at her psychotherapist's office on the wrong day.  When her therapist saw her in the waiting room, she called Agnes into her office to talk to her for a moment and to let her know that her appointment was for the next day.  She explained that she couldn't see Agnes today because she already had other clients scheduled.

At that point, Agnes became furious.  She insisted that her appointment was for that day, and she blamed the therapist for being confused, "I knew I couldn't trust you.  You're just like my parents--so unreliable.  I knew you would betray me.  I don't think you're the right therapist for me" and with that she stormed out of the office.

Agnes' therapist called Agnes that evening after she saw her other clients.  When Agnes answered the phone, she sounded calmer.  She told her therapist that she realized afterwards that she was the one who was confused about the day, and she apologized.

During the course of Agnes' therapy, there were several more similar incidents.  Whenever an incident occurred, Agnes was sure that her therapist had betrayed her in some way.  

But when she calmed down and she and her therapist were able to talk calmly, Agnes realized that she had misjudged the situation and that her fear of being betrayed was always just under the surface waiting to erupt.

As Agnes and her therapist were able to repair their relationship after each incident, Agnes became more trusting of her therapist.  As time went on, these incidents decreased and there was more time between each incident.

In the meantime, Agnes was doing well at her new job.  This gave her more confidence, although she was still afraid sometimes that she would fail.  

When Agnes was ready and she felt more stable in her relationship with her therapist, she and her therapist began to work on her developmental trauma using EMDR therapy (see my articles: What is EMDR Therapy? and  How EMDR Therapy Works: EMDR Therapy and the Brain).

Developmental Trauma: The Client's Hopes and Fear in Psychotherapy

Over time, she was able to work through her traumatic childhood so that the trauma didn't continue to get played out in her adult life.

As she felt more comfortable and secure, she also started dating again, and she felt more hopeful about being in a long-term relationship.

Conclusion

People who have experienced developmental trauma often expect to be abused, neglected, disappointed or betrayed in some way in their adult relationships.

Many people, who have unresolved developmental trauma, tend to be vigilant so they won't be caught off guard when the disappointment comes.  Even when things are going relatively well in their life, their fears can dominate their emotions.

Clients with developmental trauma usually come to therapy hoping that they will find relief from their problems, but many of them also dread that their therapist will betray them in some way.  

Even if the client with developmental trauma develops a positive transference with the therapist, even a minor misunderstanding can cause the client to regress to feeling suspicious and fearful again.

Under these circumstances, there can be many incidents of ruptures and repairs between the therapist and the client--if the client will allow the repair.  Some clients just leave therapy precipitously and never allow for the repair (see my article: When Clients Leave Psychotherapy Prematurely).

But if the client and therapist can work on repairing the relationship, this is healing for the client because her childhood experience was usually that there were no repairs, only ruptures, so seeing that ruptures in therapy can be repaired is healing for the client.

Over time, if the client stays in therapy, a consistently positive relationship can develop between the client and the psychotherapist and can create an opening to develop other positive relationships.

Getting Help in Therapy

One of the most difficult things for many clients with developmental trauma to do is to come to therapy (see my article:  The Benefits of Psychotherapy).

For these clients, balancing hope and fear can be challenging.

Clients with developmental trauma often come to therapy when the emotional pain they're experiencing is greater than their fear.

Over time, if the client and the therapist are a good match, these issues can be worked through in therapy and the unresolved developmental trauma can be gradually resolved (see my article: How to Choose a Psychotherapist).

If the issues that I've described in this article resonate with you, you owe it to yourself to find a skilled psychotherapist who has experience working with developmental trauma.

Once you are free from your traumatic history, a huge emotional burden will be lifted from you.  It can improve how you feel about yourself, your outlook for the future, and your relationships.  

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article:  The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients to work through their traumatic experiences so they can live more fulfilling lives.

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

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Why Your Psychotherapist Can't Be Your Friend

Many clients who are new to psychotherapy don't understand why they can't have a personal relationship with their psychotherapist.  To clarify this issue, my goal in this article is to address why psychotherapists can't be friends with their clients.

See my articles: 

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

Boundary Violations and Sexual Exploitation in Psychotherapy

Psychotherapy and the Positive Transference). 

Your Therapist Can't Be Your Friend

Psychotherapists have a code of ethics that they must follow.  One of the items in the code of ethics is that therapists and clients can't become friends outside of the therapy sessions.  The purpose of this stipulation is to protect the client from boundary violations and to protect the therapeutic work that the therapist and client are engaged in.

While it's understandable that clients might have a desire to become friends with their therapist, it's up to the therapist to explore this desire, try to understand how it's connected to the client's problems and history, help the client work through this issue, and maintain a professional boundary.

There are times when psychotherapists get caught up in enactments with their clients.  Enactments are usually unconscious on the part of the client and the therapist and often related to prior personal history that gets played out in the therapy.

Mutual enactments are common and exploration and resolution of these enactments can deepen and enhance the work.

The following fictional vignette is about a case where these issues come up in therapy:

Fictional Vignette: Why Your Psychotherapist Can't Be Your Friend and Understanding Mutual Enactments in Therapy

Jane
Jane moved to New York City to start a new job after she completed graduate school.  Although she loved her new job and New York, she felt very lonely on weekends because she didn't know anyone other than her coworkers and they were all married and led busy lives.

She tried various social groups and participated in local events, but she had no luck in forming friendships among the people that she met.  This reinforced a longstanding feeling that she had about herself that she wasn't lovable or good enough for people to want to care about her.

After several months of feeling increasingly lonely, Jane began therapy at a psychotherapy center where they offered sliding scale fees.

After her intake, Jane was assigned to a new woman therapist who was part of the center's training institute, and Jane began attending therapy twice a week.

Jane liked her therapist, Susan, from their first session, which was unusual for Jane.  Usually, she felt shy and awkward when she met someone new, but Susan had a way of helping Jane to be at ease.

Jane looked forward to her therapy sessions on Mondays and Wednesdays.  She liked talking to Susan and felt better afterwards.  But between sessions, Jane still felt lonely.

A few months later, a friend from graduate school, Dee, moved to New York and reconnected with Jane.

Jane and Dee were friends in graduate school and they usually enjoyed each other's company, but now whenever they got together, Jane found her mind wandering back to Susan.  She noticed that she was comparing Dee to Susan and Dee would always fall short.

As time went on and Jane continued to compare Dee unfavorably to Susan in her mind, she spoke to Susan about it in one of their therapy sessions.

Susan was already aware from the way Jane complimented her and how much Jane said she enjoyed their sessions that Jane was idealizing her.  So, she wasn't surprised when Jane told her that she was comparing Dee unfavorably to Susan.

Jane told Susan that she would really like it if they could be friends outside the therapy sessions.  She told Susan that, after all, they were close in age and she suspected that they probably had a lot in common.

Susan listened attentively and then normalized Jane's wish.  She told her that many clients feel this way about their therapists and this was part of an idealizing transference.  She also explained why it was important that they maintain their therapeutic relationship, as opposed to a personal relationship, in order not to cross boundaries and sacrifice their work together. On some level, Jane knew that she and Susan couldn't be friends, but she felt hurt and rejected when she heard Susan tell her this.  She told Susan that she didn't think their therapeutic work would be compromised in any way and, in fact, she thought the work might be enhanced if they became friends.

As Jane and Susan continued to explore these issues, Susan talked to her training supervisor about this issue.  Susan was clear that she wasn't going to violate an ethical boundary, but she felt herself defensively pulling away emotionally from Jane, and she was afraid that this would ruin their work together.

Susan and her training supervisor talked about how Susan could remain balanced in her approach with Jane--neither too friendly nor too distant--to maintain a therapeutic rapport with Jane.

During this time, Jane missed a therapy session.  She was aware that the psychotherapy center's policy was to give at least 48 hours notice (unless there was an emergency) and that she would be responsible for the fee if she gave less than 48 hours notice.  But she left a message for Susan an hour before their appointed session time saying that she wasn't feeling up to going to their session that day.

When Jane returned to her next session, Susan asked Jane about the missed session, and Jane responded that she just didn't feel like coming to therapy that day.  She offered no other explanation.

When Susan reminded her about the center's policy about broken appointments, Jane told her that she didn't feel she should be charged for the appointment because she had come to all her other appointments and this was the first appointment that she missed.

Susan sensed that something had gone awry between Jane and her and that it was probably related to their talk about why she and Jane couldn't be friends.

But when she tried to explore this with Jane, Jane said that her missed session had nothing to do with their discussion and she would rather that they "move on" and talk about more important things than continue to talk about her missed session.

Susan knew that Jane's idealizing transference wouldn't last forever and that an idealizing transference often changes to a negative transference since no therapist could live up to the idealization and remain on a pedestal indefinitely.  But she was surprised that this change happened so quickly.

Susan was also concerned that if there was a negative transference that it would interfere with the work, which she wanted to avoid.

As a new therapist and without the benefit of being able to speak with her supervisor beforehand, Susan told Jane that she would overlook the broken appointment fee this time, but if Jane had another broken appointment, she would have to pay the fee.

When Jane left another message the following week indicating that she wasn't coming to their appointment on the same day as the appointment, Susan spoke with her supervisor about it.

During their supervisory session, Susan and her supervisor talked about "enactments" between clients and therapists.  She explained to Susan that, like many therapists, Susan got caught up in an enactment with Jane when she agreed not to charge her for the missed appointment despite the fact that Jane was well aware of the center's policy and had signed an agreement about broken appointments.

Susan's supervisor told Susan that it appeared that Jane wanted to feel "special" in Susan's eyes and if she couldn't be friends with Susan, she might have unconsciously created this situation where she could feel that she was a special client to Susan where Susan would break the rules for her.

The supervisor encouraged Susan to address and explore this issue with Jane and to explain Susan's role in getting caught up in this enactment.  She also told Susan that, based on the center's policy, Susan would have to collect the fees from Jane.

Jane felt embarrassed about her role in the enactment, but she also understood that she was a new therapist, she was still learning, and that even experienced psychotherapists unconsciously get caught up in mutual enactments with therapy clients.

When Jane returned for her next session, she didn't offer a reason for the last cancellation, so Susan brought up the issue and suggested they talk about it.

Initially, Jane was defensive and told Susan that she didn't want to waste her time talking about this when she had other more important things to talk about it, "And, anyway, isn't it my session to talk about anything that I want to talk about?"

Susan explained why they needed to talk about the cancellations and the unpaid fees.  She started by acknowledging that, as a new therapist who wanted their work to go smoothly, she made a mistake allowing Jane to break the rules.

When Jane heard Susan admit to making a mistake, she softened somewhat.  She still liked Susan and she was concerned that she might have gotten Susan "in trouble" with the center (see my article: Ruptures and Repairs in Psychotherapy).

Susan explained that she wasn't in trouble with the center, but she needed to address the mutual enactment that occurred between them so they could understand the meaning of it.

Reluctantly, Jane admitted that she felt hurt and angry when Susan told her that they couldn't be friends, even though Jane was already aware of the rules.  She also admitted that she could have come in for her therapy sessions, but she was annoyed and decided to skip those sessions.

This discussion led to Jane talking about how she always wanted to feel special with her mother, but she was aware that her younger sister was her mother's favorite, which left Jane feeling that she wasn't good enough or lovable enough to be her mother's favorite.

This lead to their talking about why Jane wanted to feel special to Susan.

Although, as a new therapist, Susan initially feared that what started as a negative transference would lead to the demise of the therapy, she now saw that discussing it was key to getting Jane to open up and get to more core issues.

Jane agreed to pay for the missed sessions, and they continued to work on the core issues of her feelings of being unlovable and not good enough (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

Conclusion
The therapeutic relationship is a unique relationship unlike any other because it's focused on you.

It's common for clients to wish to have a personal relationship with their therapist--either a romantic/sexual relationship or a friendship.

It's the therapist's job to recognize these transferential issues, address them in therapy, and maintain a professional boundary.

It's not unusual for clients' transferential experience to change from an idealized transference to a negative transference, especially since no therapist remains on a pedestal indefinitely.

Addressing transference issues and mutual enactments, if handled well by the therapist, can enhance the therapy by helping the client to address the core underlying issues.

Getting Help in Therapy
If you're feeling stuck in your life, you could benefit from working with a skilled psychotherapist who can help you to overcome your problems (see my article: The Benefits of Psychotherapy).

There are also times when you and your therapist can get stuck in mutual enactments, including boundary violations, when you could benefit from a consultation with another therapist.

Rather than struggling on your own, you could work through your problems with an experienced therapist who has the skills and knowledge to help you overcome your obstacles (see my article: Choosing a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist with over 20 years of experience who works 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 (917) 742-2624 during business hours or email me.