Erotic Transference in Therapy

It strikes me that I did not elaborate on erotic transference in my recent blog post about transference. It seems to me that sexual feelings towards a therapist are often some of the most uncomfortable and difficult feelings that can emerge within the relationship. Often such feelings come as a complete shock to a client, especially when the therapist is not the client’s ‘usual type’ or even preferred gender.

As I talk about erotic transference, I want to confess some ambivalence about the term. It seems to me that these feelings can extend beyond the erotic, to romantic feelings, infatuation or feeling in love with a therapist. Having said that, a more all-encompassing term does not immediately present itself (answers on a postcard) so for the purposes of this blog post, erotic transference will be assumed to include any feelings of a romantic nature, including feeling in love and any sexual feelings towards the therapist too.

The emergence of erotic transference within the therapeutic relationship

Disclosing erotic feelings to a therapist can be a terrifying proposition. How will the therapist respond? Will they change boundaries? Will they feel disgusted? These are common concerns I hear expressed about the prospect of discussing erotic transference with a therapist.

I think it is important that therapists consider how they might respond to such a disclosure. Do they feel able to be accepting of whatever feelings emerge? To hear details of sexual fantasies, or desire for a romantic relationship, from any client who might express them? And how confident is the therapist in ethically managing erotic countertransference in this scenario? Physical sensations or reciprocal feelings could be very unsettling for a therapist and it is important that the client’s exploration of the emerging material is not undermined by the therapist’s uncertainty in the work. Supervision is vital of course, and an understanding of the nature of transference is very important to working ethically with these feelings and retaining a sense of perspective in the work.

So how are the feelings worked through? Accepting the feelings just as they are is huge. Listening with an open curiosity and without judgement, and crucially, never pushing the client for details which they do not wish to disclose. It’s really important that, as therapists we are examining our motivations for interventions as we work, because a client may feel very vulnerable when discussing erotic transference, and the potential for harm is present.

It is my personal feeling that boundary changes as a result of a disclosure of erotic transference (in fact, disclosure of any feelings towards a therapist) can be received as punitive, and should be avoided. As an example, any sudden changes to boundaries such as out of session contact or therapeutic use of touch because of a disclosure of erotic transference may feel like rejection, and reinforce conditions of worth which would be counterproductive to the therapeutic process.

One foot in the past

Erotic transference, like all other feelings towards the therapist, is likely to be rooted in a mixture of here-and-now feelings and feelings which originate in past relationships. So there may be here-and-now attraction (or not), but if these feelings are characterised by an unusual intensity, I think that this provides a clue that some element of the feelings may be historical. This could be around past romantic relationships, or quite often related to relationships from childhood.

Clients sometimes describe experiencing a mixture of erotic and maternal transference or erotic and paternal transference towards their therapist. It is not surprising that in some cases the emergence of strong attachment feelings last felt in childhood might be associated with eroticism in the adult brain. After all, the passion with which we loved our parents and needed our parents’ love and touch as infants is not usually paralleled in adult life, other than in romantic relationships. I feel it is possible that erotic feelings can sometimes be a way of consciously making sense of powerful unconscious feelings which are stirred from infancy.

I could get carried away with theory at this point, so I am consciously reining myself in. There are lots of useful books offering varied perspectives on erotic transference and love in the therapy room, and I would encourage anybody who is interested to explore the literature.

Why work through it?

I am a firm believer that the therapeutic relationship is a vessel to growth and change. If we ignore the emergence of any feeling, including erotic transference, we are potentially missing opportunities for movement in the relationship and important clues about the client’s process.

It needs to be handled with care and understanding, and the therapist must be aware of the delicacy of the work and attuned to the client’s needs (an in-depth exploration of the past will not be appropriate for a client in crisis, for example). However, feelings around erotic transference are simply feelings, and I feel, should be accepted and valued in the therapeutic process the same as any other.

A Look at Transference and Countertransference

Transference and the Here-and-Now

I’ve often heard people talk about transference as distinct from “real” feelings. I do not like the implication that feelings which originate in transference are not real. They are very real; for many clients they are painfully real.

I prefer to make the distinction between transference and “here-and-now” feelings. That is to say, feelings which have their origins in past relationships and attachments, and feelings which are a response to the therapist in the here-and-now. This is not an easy distinction to make; often the lines will be blurred, some feelings will be a mixture of the two, often it will be impossible to determine the origin of a feeling due to the unknown depths of our unconscious. In fact, to a greater or lesser extent, some element of transference, or projective identification is likely to be present in our feelings in all of our relationships.

The Value of Transference

My understanding of the purpose of working with transference in the therapy room is that those powerful feelings can yield important clues about that which is firmly rooted in our unconscious – these could include challenging or painful feelings and experiences, often completely outside of our awareness, which are impacting on the way we relate to others. These unconscious processes may represent barriers to relating, or keep us in unhealthy relational patterns. In exploring them, and experimenting with ways of ‘being’ within the safety of the therapeutic relationship, we hope to bring some of those unconscious processes into awareness and better understand and manage how we relate to others.

The Presence of Countertransference

Countertransference is an interesting thing I think, because it is often used to describe any feeling that the therapist has towards a client. But just as the client has a mixture of here-and-now feelings and feelings with origins in the past towards a therapist, it seems logical to me that there is likely to be similar complexities in the therapist’s feelings towards the client.

Countertransference as an unconscious response to the client’s transference can be useful source of information when brought into awareness because it has the potential to uncover important clues about the client’s process. For example, a therapist who feels an unusually strong desire to direct or rescue a client may explore how the client might unconsciously invite such a response in their relationships. It is my feeling however that this should be approached tentatively and with curiosity rather than misplaced assuredness, because our unconscious can be a complicated realm to decipher, and it takes a great deal of personal reflection to uncover what material belongs to whom in a therapeutic encounter. Indeed, often it is an unsolvable riddle.

So to me the therapist’s feelings towards a client are likely to be more than countertransference – they are likely to be more than an unconscious response to the client’s material. Relational practice means relationship, and relationships are inevitably filled with complex feelings from both parties.

I feel that for those feelings to be useful to the therapy, and to give them the best chance of remaining non-problematic, the therapist needs to model a curiosity and openness to discovering what the feelings are telling us in the context of the relationship, and exploring how that might be useful to the work.

When Transference Hurts

Feelings which emerge in the therapeutic relationship often touch on painful and traumatic past experiences and insecure attachments. The mind and body are often holding a great deal of pain as a result, and in many cases it is inevitable that elements of the transference will be experienced as painful by the client.

In the book Shouldn’t I be Feeling Better by Now?, Yvonne Bates questions whether the means justify the end when working with transference. I think there is a strong case for the idea that working with transference is simply not right for some clients, though I don’t believe there is a simple solution to ensuring that clients are not harmed by the emergence of these difficult feelings in therapy.

Transference and attachment to a therapist may present difficulties such as pain around the time and boundary-limited nature of the relationship, anguish over the sense that the relationship is not “real”, anger that the needs met in the therapeutic relationship were not met in childhood, and many more.

When working with a skilled therapist who understands the nature of transference, these feelings are very likely to shift in time; this work takes a great deal of patience and care from both parties but I believe that it can be of great benefit.

It is possible for a therapist to inadvertently reenact past relational trauma through a lack of awareness of the presence of countertransference, or to take transference feelings too personally (negative transference such as anger, for example) and act defensively or in a way that is received as rejection. I think all therapists can be vulnerable to this, and the key here is an ongoing process of self-reflection and supervision.

As I alluded to earlier, I think transference is ubiquitous in all of our relationships to some degree. Often these feelings will not demand to be addressed in therapy, but when it is clear that transference is directly relevant to the work, I feel that it is of paramount importance that the feelings are explored collaboratively and with an open dialogue about what meaning they hold for the client. It is my belief that the client’s autonomy and understanding of the process are essential components of positive outcomes for clients.

A Therapist in Therapy

I think I am in a fairly unusual position (at least judging by the small sample of my own personal acquaintances) of having a relationship with my own therapist which predates the beginning of my training, so I suppose my experiences of being a therapist in therapy are likely to be atypical.

 

There was no concern, for example, about needing to ‘get my counselling hours in’, no urgency to stick with a therapist and just get the thing done. I feel very lucky to have had an established relationship and to have avoided the frustrating and sometimes futile search for a good relational match in such a limited time.

As I read through the BACP professional conduct hearings, I have often been struck by the high number of cases brought by trainees or qualified therapists. I suspect that prior knowledge of ethical considerations and what constitutes good practice may account for some of this, and it links with the Macaskill and Macaskill statistic that 27% of therapists in training report experiencing harm in therapy, which was highlighted in Philip Cox’s recent article.

Reflecting on my own therapy, I believe there has been some evolution in the way we work – as an example, my therapist recently offered me a reference for a research-related chapter he thought I might find interesting – however I am aware that I like to keep an ongoing conversation in all of my therapeutic work (as a client and a therapist) about therapeutic purpose, and clarity in boundaries which ensures my therapy can retain purpose and direction, and avoid meandering into supervision or collegial chat.

I have learnt a lot about therapeutic practice from my therapist, but much of this has been unconscious learning, and a byproduct of good therapy rather than a conscious effort on my part to take note of the way he practices. This feels organic, and not a primary purpose or outcome of the therapy.

I find myself curious about what it might feel like to counsel a therapist. My sense is that there could be a number of potential difficulties for therapist and client to navigate.

I have heard it said that counselling trainees can be frustrating when the client views the therapy as simply another hurdle in the race to qualification, rather than an opportunity to engage at depth. Impatience on both sides of this type of situation is likely to be a major barrier to psychological contact, and it seems really important to have an ongoing dialogue about therapeutic aims and how the relationship is working. I think it’s also important to avoid falling into a generalisation that any trainee that walks through the door will be motivated by the course requirements rather than a desire and willingness to engage with the process.

As with any client, I think it’s important to be aware of whatever might be lurking in our shadows when working with therapists or trainees. Unconscious competitiveness, sensitivity to one’s work being judged, desire to mentor, desire to identify, underlying resentments about specific training establishments, assumptions about trainees or desire for friendship could all interfere with the effectiveness of the therapy if left unacknowledged and unchecked.

Not only do therapists deserve effective therapy in their own right, but I would argue they need it to be effective therapists themselves. It is my feeling that any potential barriers to the work of therapy need to be brought into the daylight should they emerge in the relationship.

I would also encourage any trainee therapist who does not feel they are getting effective therapy, and has not been able to resolve the issues within the relationship, to find a new therapist. I don’t think there is a more valuable part of the training process than the opportunity to explore oneself at depth. It is not something you want to miss out on.

Awareness and The Counsellor’s Unconscious

We all know that a therapist should possess good self-awareness. But how do we know what good self-awareness looks like? After all, we do not know what we are not aware of. We do not know what lurks in our unconscious until it arises into consciousness. For this reason, I think that self-awareness can never be declared to be achieved. We become increasingly self-aware as we uncover more about ourselves and our experiences, however self-discovery is not something we stumble upon, or even work to one day achieve; it is a lifelong process.

Steve Page looks at elements of the counsellor’s unconscious which may impact on therapeutic work through the lens of the Jungian concept of shadow in his excellent book The Shadow and the Counsellor; one of my takeaways from reading the book is that our unconscious processes as individuals, and also as a profession inevitably influence our work (and indeed our lives) at all levels, and it is our responsibility to manage our own shadow material as it emerges, whilst also acknowledging our unconscious’s ubiquitous, albeit often silent presence.

Countertranference responses in particular might not always be immediately apparent to us. I think that by being non-defensively aware of their potential to emerge, we give ourselves the best opportunity for making the unconscious conscious, and for appropriate reflection.

If we acknowledge the potential of unconscious material to emerge without our awareness or conscious control, it follows that a client may spot unconscious material before the therapist. This is where our capacity for self-reflection is really important.

It may be tempting, for example, in response to a client saying something like “What you said really hurt; I think you are frustrated with me” to respond immediately with a consciously congruent response such as “No! I am not frustrated. You misunderstood my intention.”.

The trouble with an immediate and non-reflective response such as this, is that it runs the risk of invalidating the client’s experience of the therapist, and presumes an instant understanding of processes which might be outside of the therapist’s awareness. Perhaps the therapist really isn’t feeling frustrated at all, which is perfectly possible, but to jump directly into a rebuttal without first exploring possible unconscious feelings runs the risk of being seen to be defensive or incongruent. Much better to explore this feeling together and work out what is happening in the relationship through here-and-now discussion.

Not all unconscious material will have a negative impact on the relationship, and it is likely that many things emerge from unconscious responses which are never picked up upon by either counsellor or client. In moments where an unconscious action jars with the reality of the relationship or the role, we are more likely to become aware of its presence. I feel that any awareness we can glean of our unconscious is a positive thing, though it’s perfectly feasible that nothing will need to change as a result of bringing something into consciousness, so long as it is not negatively impacting on the work. The positive part of its movement into awareness, is that it may then be monitored and reflected upon moving forward.

Rollo May (1965) makes a distinction between “intention” (conscious motivation) and “intentionality” (unconscious motivation) which I believe is a useful frame through which to view every intervention made in the therapy room. I think it is important to look at what we are doing with clients and ask ourselves not only “What is my intention?” but also “What is my intentionality?”.

So rather than aiming for an unmeasurable level of self-awareness, I am focusing my energy on developing my capacity to self-reflect and be reflexive in my work and my life as a whole. My feeling is that this is the food and sunlight required to allow my awareness to continue to grow.

For me to achieve this, I think I need to continue to accept my unconscious, to welcome it as a part of me and continue to be curious about what it has to teach me. Working with a non-defensive openness to how others, especially clients view me, is a crucial part of that process – both for forming good working alliances with clients, and also nurturing and allowing movement in my own self-development.

Refs

May, R. (1965) Intentionality, The Heart of Human Will. Journal of Humanistic Psychology, 5 (2).

Page, S. (1999) The Shadow and the Counsellor. New York: Routledge.

The Resilient Therapist

Last week, I wrote a blog post titled The Vulnerable Therapist, exploring the inevitability and value of vulnerability in a therapist, and how this is expressed  in the therapeutic encounter.

In this post I would like to explore resilience as a counterbalance to vulnerability. If our vulnerability is to be managed in the counselling room, I believe that our resilience provides us with the strength and courage necessary for the job.

So what is resilience? The BACP describe it as: “the capacity to work with the client’s concerns without being personally diminished.” (BACP, 2016) and as I browse the internet I find it variously defined as the ability to get up after a fall, and the confidence that we have the ability to deal with challenges should they head our way.

I like the latter definition most of all. It seems to me that our vulnerability becomes something we can embrace rather than fear when we trust ourselves to deal with whatever challenges may arise. To develop this inner-confidence, we must of course have adequate support in place for ourselves – a reliable network which we know we can call upon should we need to. In my work as a counsellor, supervision is central to this. I would also count my therapist, university tutors, peers and family among those who contribute to my resilience in different ways.

I do not think resilience can truly be present without self-care. Breaks, creativity, fun, rest and attending to our own needs strengthen and enrich us. If we are approaching burnout we are becoming personally diminished, and therefore our resilience is diminished too.

So while I am celebrating vulnerability, I also want to give a little shout out to resilience. These fraternal twins of wellbeing are essential parts of who we are as therapists, and as people.

Reference:

 BACP Ethical Framework. (2016). [pdf] Leicestershire: BACP. Available at:  https://www.bacp.co.uk/docs/pdf/15595_ethical_framework.pdf. [Accessed 16 Jan. 2018].

The Vulnerable Therapist

Vulnerability is an inevitability in human relationships, and the therapeutic relationship is no exception. If relational depth is to be achieved in therapy, both parties must bring something of themselves to the relationship – to put trust in each other and the process – to become vulnerable.

As well as being a building block of relational depth, therapist vulnerability can also model an acceptance of feelings, and a sense that it is possible to meet one’s own needs. I remember an occasion when my therapist said to me “I felt vulnerable. But that’s okay. I like that I can be vulnerable, and I can take care of myself.”. Here was somebody sitting in front of me expressing vulnerability and I did not have to rescue or protect them – this was a big moment of learning for me and has changed the way I view vulnerability, in myself and others. It was a huge step on my journey towards acceptance of all feelings.

Recently though, I felt jarred by hearing from a tutor “I am a vulnerable practitioner; if the client doesn’t want a vulnerable practitioner, they can find another therapist.”. For me there are a few questionable things about this statement. Primarily, I do not believe there is such a thing as an invulnerable practitioner, and I think this hypothetical client would probably spend the rest of their lives searching for such a person. I believe the tutor was really referring to the means by which he expresses his vulnerability to the client. The statement in question came as part of a debate about self-disclosure, and self-disclosure is one means by which a therapist may express their vulnerability to a client. The tutor did point out that he wouldn’t self-disclose to every client and he would make a judgement in the moment, which seems to me to show a willingness to adapt to the needs of the client. I believe that if the therapist is willing to put the needs of the client first and to express their vulnerabilities in ways which do not unsettle, antagonise or trigger a vulnerable client, then the need to find the mystical invulnerable therapist should never arise.

Some therapeutic relationships may be very delicately balanced, and if copious expression of therapist vulnerability in any way threatens the safety of the relationship from the client’s perspective, I would argue such exploration is better reserved for supervision and personal therapy, at least until the client’s needs have shifted. My first question, as I consider the appropriateness of any intervention, is always: “Who does this serve?”.

But I do want to celebrate vulnerability. It is what makes us human, it is the seed from which empathy and compassion can grow. It nourishes all of our most intimate human relationships. To love vulnerability is to love ourselves – it is a part of myself I would not wish to be without.

Can Effective Supervision Prevent Harm in Therapy?

Philip Cox’s recent article on harm in therapy got me thinking about the value of the supervision I seek, and my relationship with my supervisor. I like the notion that the word supervision literally means “over-view” and I can picture my supervisor in a little helicopter, observing the wider picture as I manage the finer details on the ground.

So what is the purpose of supervision? For me, the supervisory relationship serves several functions.

Firstly, I have a trusted and confidential space to discuss my work with clients, which feels like an essential counterbalance to the isolating nature of the work which is so often talked about in the profession. It is in itself a form of self-care.

Secondly, I find the strength of the relationship provides a solid platform on which I know I can stand when I need to. I feel confident it will not break beneath me. This security gives me the courage to co-create new platforms with my clients, on which they too can stand and experience safety within the relationship. Being part of this solid base for my clients feels possible because I am anchored by my own firm footing in supervision.

Thirdly, the trust I have in my supervisor helps me in a number of ways. Through talking about client work and other areas of my process openly, I have allowed myself to become vulnerable, and at no point have I ever felt judged. This mirrors beautifully the function of the therapeutic relationship and allows me to bring whatever I need to discuss to supervision, even times when I feel I have made mistakes in my work. The transparency allows us to shine a light on areas of my work that we might otherwise miss, and to raise anything to my awareness which might impact on the work. I value my supervisor’s willingness to challenge me, and to be challenged; I find the parts of the work where we each hold different perspectives the most illuminating of all – there is always so much to learn and to take forward into my practice. Parallel process fits nicely into this area of working within the relationship; it is a fascinating phenomenon and, I find, rich with data about myself and my relationships with clients.

Do I disclose all my thoughts and feelings about the work to my supervisor? Well, I try to, but there will always be things outside of my awareness which don’t become immediately apparent. As my supervisor gets to know me better, he becomes even better placed to spot my shadow material as it emerges and bring to my attention anything I might not have seen. I try to make a point of accepting the observations he makes curiously and non-defensively, even if I do not recognise what he is saying. I find this work exciting and engaging.

A good supervisory relationship doesn’t make harm occurring in client work an impossibility. It would be arrogant and naive for any therapist to assume they do not have the potential to do harm for any reason. But I do think that supervision is an important safeguard against harm. When we have a trusted relationship, a space to explore every aspect of ourselves and our actions towards clients, we have a safety net – the opportunity to catch areas of the work which could become problematic before any harm occurs.

I think this is as true for very experienced practitioners as it is for those at the beginning of their career. Certainly the nature of supervision for a practitioner with forty years experience is likely to differ from that of a student or newly qualified therapist, but all therapists require support, and of course, we are all vulnerable to the emergence of shadow material – supervision is an important part of managing this throughout our career.