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Falling In Love with the Therapist: Erotic Transference and Psychotherapy

Allan N. Schwartz, LCSW, Ph.D. Updated: Mar 17th 2009 Many E. Mails have been posted on Mental Help.net about the issue feeling love and attraction towards their therapist. Here is a small sample of such posts: E. Mail Samples: 1) "......Erotic transference at first feels like falling in love and has a euphoric quality, but my experience is that it has the potential to be quite emotionally damaging and lingering. For me, after nearly two years, there is still a deep longing, restlessness, and melancholy that will not subside. The pain is also much deeper than a regular crush/unrequited love. Its described as torturous by some of the patients on this website and I think that pretty much sums it up. Also, it seems there are different forms of transference, and my experience is with the most serious eroticized transference. theyve made a wrong move. But I have to say, with all due respect, that many therapists appear to be clueless and have no idea how to deal with this or understand what the patient is going through...... For me, its an experience that is unprecedented in its intensity and will probably stay with me." 2) "...a part of my brain was pricked during therapy and a poison was released and I cant clear it out. Ive also thought about writing about my experience in hopes it would help the pain go away..." 3) "I've been in psychodynamic therapy for over 10 years with a female therapist. I have suffered eroticized transference to her for nearly the whole time. While I have become accustomed to the idea of it, recognizing that it derives from my deficient attachment to my neglecting mother as a young child, for several years this was highly upsetting to me, as I am a heterosexual married female. I have discussed my feelings with my therapist at length. Still we are stuck...... This doctor is committed to my healing. Her boundaries are in tact. She has helped me in rebuilding my life in countless other ways. Yet, the pain of missing her and yearning for her remains."

Discussion: These three are excellent examples of the types of pain some people have experienced in the erotic transference to their therapists. These patients are women but the erotic transference happens to male patients in relation to female therapists or homosexually to male therapist. This is what is called transference. When transference involves sexual feelings it is called erotic transference. Transference: Transference refers a person bringing their past experiences into the relationship with the therapist. The most important types of experiences that are transferred are those carried from earliest infancy but are not remembered. Those early experiences are repressed (forgotten) and, later, become attached to the inappropriate figure of the therapist in the present. The therapist is inappropriate because he cannot gratify wishes coming from the past. In terms of psychoanalytic psychotherapy this is called transference neurosis. In other words, the patient reenacts those experiences from early childhood in the therapeutic relationship. This "transference neurosis becomes the focal point of the therapy and the ultimate cure. Just for clarification, it is important to keep in mind that even though a person has a "forgotten memory" tha is remains stored in the brain where it can interfere with how that person functions. Transference occurs in all types of psychotherapy. Therapists who use cognitive behavioral therapy, brief psychotherapy, family therapy and group therapy, can become the target of transference feelings and wishes. In the other types of therapy, the therapist does not focus on transference. In these cases, there is no need to intensity the therapeutic relationship because that is not the goal of the treatment. Instead, the focus is on the here and now in the life of the patient and not on the past. It is only in psychoanalysis or long term psychoanalytic therapy that the transference is discussed in detail and resolved before the patient is ready to leave treatment. One of the major features of psychoanalytic therapy is that it is very intense. That intensity is fostered by the fact patient and therapist meet three or more times per week. When patient and therapist discuss the transference treatment is further intensified. The therapist must be fully aware of the power of the patients transference feelings and never allow him or herself to be seduced and act upon those feelings. For one thing, patient transference emotions are not realistic. Instead of acting, the therapist must provide a safe and secure environment in which relationship problems can be unraveled, and understood in order that this person can resume their lives in ways that are healthier and more fulfilling than previously. Types of Transference:

In other types of psychotherapy it is hoped for that the relationship between therapist and patient is a positive one. This is called a "positive transference" and the positive nature of the relationship is what makes the work possible. It is difficult to accomplish cognitive behavioral therapy if the patient has angry feelings towards the therapist. Of course, this can happen but the work is then to look at the patient's thoughts, determine if there is evidence for those thoughts and then look at more realistic ways of thinking. This far different from psychoanalytic psychotherapy. Even if the patient mentions some feelings about the therapist the focus remains on the present time in the life of this individual.
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Sometimes a person may develop a "negative transference" to the therapist, meaning that the therapist has lost the trust of his patient. The angry feelings are so intense that, in most circumstances, the patient leaves the treatment. There are many reasons a patient might develop a negative transference towards the therapist. The very young and childlike feelings of the patient cause him to believe that the therapy charges should be much lower. After all, would mommy or daddy charge money for care? Another reason might be that the therapist takes vacations and this is viewed as unfair. In this case, the wish of the patient might be to go on vacation with the therapist or to feel very abandoned when he leaves for vacation. Then, too, it is common for children to wish they could be the only child in the family. In the context of therapy this can lead to resentment of and jealously towards the therapists other patients. There is something called an "idealizing transference" in which the patient holds the therapist in the highest regard possible. In fact, such a person may identify with and want to become like the therapist. In such cases, the individual may decide to pursue a career in psychology or mental health. Other people with such a transference may wish to emulate the therapist but in the way of pursuing higher educational goals. This idealizing transference is very positive and often leads to the successful completion of many therapies with the patient going on to become quite successful. Erotic transference: Erotic transference is just what it implies. It occurs when the transference begins to include sexual feelings directed to the person of the therapist. Because of the nature of erotic transference, the patient is yearning for and even demanding sexual intercourse. This patient is convinced that only when the therapist satisfies these cravings can real happiness be achieved. The patient explains that only in this way can the love of the therapist be proven. There is a repetitive and compulsive nature to these demands. Frequently, the flip side of the erotic transference is hatred. This hatred is expressed through the endless demands for the love and sexual attentions that is so desired.

Erotic transference does not always occur. In other words, there is nothing inevitable about it. The reason why one patient develops an erotic transference and another does not has a lot to do with the patient's diagnosis and therefore, with the types of things they experienced from their earliest life. A person who may have felt ignored or neglected by their parents may become someone who has endless cravings that are placed onto the therapist. In this type of scenario, the patient actually believes that the therapist has the power to gratify these wishes and that such gratification would be curative. Of course, this is never true. There are times when the erotic transference cannot be resolved and the patient leaves treatment angry and disappointed. I suspect this is what happened in cases #1 and #3. In fact, case #3 went on for ten years and ended unsuccessfully. The fact is that the purpose of all psychotherapy is to help the patient improve their functioning. Therefore, in the context of psychoanalysis, it is the goal to resolve the transference, erotic or not, in order that the patient find appropriate intimate partners in the outside world and live well adjusted lives. This translates into the patient entering into adult relationships in the outside world where they can live fully intimate and satisfying lives with the appropriate type of partner who can gratify adult wishes for love, sexuality and family. Transference, erotic transference and therapist training: One of the pre conditions for those psychiatrists, psychologists and clinical social workers who become psychoanalysts is that they receive many years of their own psychoanalysis. The reason for this is that they come to make conscious and come to understand their individual transference issues. In addition to their own therapy, these types of therapists receive large numbers of hour of supervision for their psychoanalytic cases. The purpose is to help them come to grips with the powerful transference feelings that the patient brings to the office and places in them. In fact, long after their training and supervision are done, psychoanalytic therapists meet either in groups or on an individual basis to receive continued supervision and guidance with the patients presenting especially challenging transference problems. All of this training and supervision and ongoing education is necessary because of the powerful nature of transference, whether it be erotic, negative, idealizing or seemingly absent or blank. Did the therapists seen by case 1 and 3 seek supervision with these difficult cases? There is no way to know but one hopes this was true. It is even respectable and permissible for a therapist to refer the patient to another therapist in order to help the transference move along. The purpose is not to reject the patient, although there is always the risk of a patient feeling rejected. However, it is sometimes necessary to refer to someone with greater skill and ability, if nothing else works. Do all therapist receive this type of training?

The answer to the above question is largely "no" because not all therapists are psychoanalytic. Cognitive behavioral therapists work in a very different way, in which the relationship with the patient is important but looked at in terms of present day thinking that leads to depression or anxiety. In addition, the training that psychiatrists receive today is largely non psychoanalytic as compared to thirty years ago. Psychiatry tends to look at mental illness biologically and neurologically. Therefore, their approach tends to be more medication oriented. Certainly, people trained to become marriage and family therapists do not dwell on transferential issues but on patterns of interaction within the family. None of this implies that these professionals are not excellent. It only means that the way they see mental illness and work with people is quite different and equally if not more effective than psychoanalytic therapy. Who should go for psychoanalytic psychotherapy? If an individual wants to learn more about their inner mind, their unconscious self and their deeper motivations, then psychoanalysis is a good idea. I suspect, and there is some research to support my suspicion, that some people with personality disorders can benefit a lot from psychoanalytic therapy. I have also found that people in the arts, such as musicians, painters, actors and writers, are helped a lot in their personal and professional pursuits because the very nature of psychoanalysis helps them unlock their creativity. This is a complex issue. Therefore, I invite the reader to submit questions, in addition to making comments and sharing experiences. Allan N. Schwartz, PhD