August 18, 2024

Sex With Your Therapist: The Ethical Issues

Erotic transference always involves the patient’s desire for the therapist. The complexity jumps when the counselor reciprocates the craving.

It is in the client’s interest to guide the patient in resolving her feelings while the therapist contains his own. When he cannot accomplish the latter, even after consultation and supervision from another professional, the danger of malpractice becomes enormous.

The first principle governing all helping professionals is to “Do no harm,” which includes prohibitions against physical intimacy with clients, present and past.

Today, I will present relevant sections of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association. I’ve added a few comments along the way:*

**10.05 Sexual Intimacies with Current Therapy Clients/Patients

Psychologists do not engage in sexual intimacies with current therapy clients/patients.

Comment: Patients often feel gratitude toward the person helping them through a difficult patch. Sometimes, their psychologist might have been the first to “see” and understand their essence, carry their secrets, and not betray them. Whether accurate or not, these observations and emotions in the client can give the counselor unequal influence in the dyad and the power of one who stands on a pedestal.

**10.06 Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients.

Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard.

Comment: The reasoning is simple. Involvement with other family members can disrupt and injure the client.

For example, imagine the client’s sister becomes the lover of her sibling’s psychoanalyst. Fear of the counselor sharing details of conversations with the relative might occur. Jealousy and friction between the sisters can’t be ruled out. Anger at the doctor and feelings of betrayal in more than one direction might also erupt.

**10.07 Therapy with Former Sexual Partners

Psychologists do not accept as therapy clients/patients with whom they have engaged in sexual intimacies.

Comment: Ex-lovers, where one wants to become the healer’s client, involve two people who might carry a torch for the other. Office counseling sessions can reignite the flame. Everyone knows how many complications occur in the ordinary course of a relationship. In the dual role of lover/therapist, the counselor unintentionally invites harm to the person his profession tells him he must protect.

**10.08 Sexual Intimacies with Former Therapy Clients/Patients.

(a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy.

(b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client’s/patient’s personal history; (5) the client’s/patient’s current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during therapy suggesting or inviting the possibility of a post-termination sexual or romantic relationship with the client/patient. (See also Standard 3.05, Multiple Relationships .)

Comment: The essential point here is more than the time-designated prohibition of an affair. Even when the two-year post-treatment “ban” has elapsed, the ethical guidelines suggest the counselor and client should still not have a carnal liaison.

Imagine an ardor-filled mutual attraction that is unresolved during professional contact.

Perhaps one party suggests waiting for the other until the two-year prohibition has expired. If they agree to start the clock, they might terminate the psychotherapeutic element of their connection and count the days.

The ethical guidelines focus on the professional’s responsibility because of the power imbalance in the relationship and the possibility of harming the now previous patient. They put “the burden of demonstrating that there has been no exploitation” entirely on the psychologist.

Some years ago, I heard the answer to a crucial question in a required educational seminar on professional ethics. The question was obvious but necessary:

Is there ever an adequate legal defense against a malpractice claim due to sexual intimacy occuring after the termination of treatment?

The wise presenter offered an imaginary defensible scenario similar to this:

The doctor and patient, both married to others, concluded a substantial period of psychotherapy. About five years later, they recognized each other on the same flight across the Pacific Ocean. They each traveled alone.

The plane crashes, and the pair find themselves the only survivors on a deserted island. Of course, they both hoped to be rescued and had no sexual contact during this time. After two more years, they gave up the hope of rescue.

Then they began to have sex.

More time went by, and they were rescued and returned to their waiting spouses.

In this hypothetical example, the woman eventually sued for malpractice, and the psychoanalyst had a reasonable chance of acquittal—or so the presenter believed would happen if the story were real.

As you can understand, the seminar leader was saying that only under extreme and unusual conditions might there be an adequate defense for a sexual relationship between the counselor and his previous patient.

Translate that into this implicit guidance within the code of conduct: Never, never, never do it.

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*Therapists who are not psychologists typically follow other, not necessarily identical, guidelines.

The four paintings in order: Man and Woman, Embrace by Egon Schiele, 1917, sourced from Wikimedia Commons. The Lovers by Rene Magritte, 1928. Blue Lovers by Marc Chagall, 1914. Green Lovers, also by Chagall, 1915. The final three images are sourced from Wikiart.org/

August 22, 2021

Love and Where We Find It, Including the Therapist’s Office

Our feelings are attached to places and dates, dates in both senses of the term. People with a good memory can even tell you the room or moment when particular words were spoken — when the mood or lighting altered because a relationship changed.

First meetings, last meetings, and relational drama become almost like a portion of the architecture and appearance of the place where they happened. The spot takes on an emotional resonance out of proportion to what a stranger would notice.

No wonder the counselor’s office becomes part of your alliance with him. Even your time slot in his schedule organizes your life and attaches to the experience of therapy. His consulting room is not just a place where memories are uncovered but where they are made.

If you’ve ever owned a home or lived anywhere for a long while, you may have returned soon after you left. Maybe your route from work put you on the old path without thinking.

Others go back consciously, though not sure what draws them. Some want to revisit an unforgotten ineffable quality associated with this material segment of their history. Or perhaps they still search for the events that happened there or the one or ones with whom they occurred.

The evoked sentiments loom larger than the manufactured creation. They make the edifice small by comparison.

—–

An older woman I know, someone I am close to, visited Chicago decades after leaving for the suburbs, then California, and finally Nebraska. When arriving her first time back, she wanted to see the old neighborhood we both inhabited and the “other house” where her teenage years transpired.

This charming lady’s youth and home life were troubled, but not so for the earliest years near my family. Her parents wished to rise in the world, motivating their departure from the north side of the “Windy City.”

The dad, in particular, had been marked by poverty. Adult ambition took them all to a posh Chicago suburb, where parental conflict, poor parenting, debt, and the father’s illness and early death damaged everyone. The best part of her life remained back in the old dwelling on Talman Avenue, the street where I knew her.

The status-driven designer house was supposed to make all their lives better, but when our tour stopped in front of it, the recollections embedded in the place bubbled up. A flood of tears followed. Once she caught her breath, she said, “For this.”

For this?

They’d moved from a location where she had friends and felt accepted and acceptable, where her parents got along with each other: a place where the idea of home meant safety.

The exit from West Rogers Park leading to the family’s new chapter became a loss, not the betterment expected. The ensuing unhappiness tied itself to the new site.

The finer set of walls, rooms, and a circular driveway brought no satisfaction, no lofty place in the world. This was the graveyard of hope, not its fulfillment.

The therapist sometimes enables people to feel they are worthy of love after a lifetime of believing they are broken, ugly, or stupid — “too sensitive,” disturbed, or weak. The fact of being valued can cause outsized affection, transference, perhaps love of the one who assisted in the process.

When the treatment ends, it isn’t uncommon for the client to wish to take something physical — a small piece of its contents, a “thing,” but one containing personal meaning.

This desire is similar to small children holding on to their blanket or a stuffed animal to calm them when the parent isn’t available. But saying goodbye to the counselor is different.

The article given by the clinician is a transitional object and also something more, intended to preserve indescribable emotions indefinitely. Mom and dad return, but from the healer, there is a parting.

Momentos needn’t be beautiful to carry the significance of the people and moments we retrieve from those inanimate creations, the sentiment they offer. We also remember places, sometimes unremarkable, because of those beside us when we were there — the beloved parents, partners, and pals of our lives.

—–

When the Madison and Wabash elevated train platform underwent deconstruction and remodeling, I could not look at it without recalling my dad. He and I stood on the now-discarded wooden planks many times and at many different ages.

I doubt I will ever see that station without thoughts of him, though the boards on which we trod have disappeared.

I imagine there are such locations in your life. They become part of us.

Are the things intended to catch lightning in a bottle — the electric charge of human contact?

The best possible “bottle” evokes emotion in touch with the heart. Perhaps, too, “sessions of sweet silent thought,” as Shakespeare would say.

When you are old and ridding yourself of worn-out objects and stuff of no value, I suspect you will keep those beyond price because they carry this special kind of magic.

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The photo of the old Madison and Wabash “L” (Elevated Train) Station is the work of David Wilson. The image was sourced from Wikimedia Commons.

For those who don’t know the Chicago “Loop,” the term first referred to the area within the “L” train’s loop-like route around the city’s downtown center.

July 12, 2021

Erotic Transference and the Fantasy Lives of Therapists

My father, a man of uncommon decency, kept an issue of Playboy Magazine in the closet he used for his overcoats. I discovered this item while snooping around the house, not expecting that. The featured model was Jayne Mansfield.

This happened in the late 1950s, long before the unending pornographic video flood undercut the thrill of “dirty photos.” US citizens of the time lived in a post-Victorian, white man’s dream world, just prior to birth control pills and the sexual revolution. Then they continued in a non-Victorian, more sexualized version of the same thing.

I was old enough to fathom why a man might be interested in perusing color pictures of the famous blond beauty in all her air-brushed nakedness. I put the magazine back as dad left it, never confessed my discovery, and didn’t try to interrogate.

If my sire had fantasies despite sleeping next to the woman of his dreams every night, I imagined everyone did.

Therapists do, too.

I notice beautiful women still and didn’t close my eyes when they entered the office for psychotherapy. Another psychologist mentioned such beauties energized him, helped him focus his attention on “the person” behind the attractive face and form.

Hmm.

This man maintained an active sex life, by the way. To my knowledge, he didn’t engage in affairs with his patients but acquired a reputation for more than a few of the extramarital variety at one of the hospitals where we both practiced.

Counselors are not eunuchs. Acquiring a license to practice doesn’t require neutering.

We “notice,” and some few do more than take in the visual, feminine glories of the natural world despite ethical codes forbidding the mix of romantic engagement with those who come with personal problems.

Intimacy with a therapist is never the solution to those problems, though some professionals persuade themselves it is a different manner of “helping.” In case you haven’t realized it yet, we homo sapiens can convince ourselves of anything, justifying murder, robbing our kids of their credit cards, and more.

I can’t tell you I never fantasized about the women I treated. I don’t recall doing so, however. But then, we don’t remember every dark night dream of body and soul, do we?

Did I have those fantasies or not? I still can’t be certain. Most of the time, I compartmentalized or separated home from work. What fantasies I do recollect didn’t derive from doctor-patient interaction.

I never overstepped professional limits, despite invitations offered in straightforward confessions of love from female clients. These included one lovely who brought a kit of sex toys and a variety of condoms to a session and proceeded to unload them on my desk.

The topic of sexual transference continues to pull in readers to my blog, as well as the writing of others. The humans alive today, every one of us, are here because the drive to procreate remains in the DNA passed to us and through us.

I heard females, a limited number, mention our sessions stimulated their lubrication.

I recall another dear person I referred to a different psychologist because we couldn’t resolve and move beyond her transference, aka, her obsessive wish to be my lover.

In our final meeting, she asked for a parting hug. Weeks before, she presented a pencil drawing of me holding her. Since I couldn’t predict how far she might take an embrace, I refused. Anger followed.

Another woman, paradoxically, could not have been further from capturing my interest. She did refer to her satisfying sex life with her husband, but this wasn’t what prompted her to consult me. Nor was the brief report remarkable.

I found nothing stimulating in her intellect, personality, appearance, or her way of walking or moving, speaking or smiling. She didn’t flirt and didn’t wear revealing clothing. I guess the lady was in her 40s or early 50s.

And yet, I felt drawn to her. By the process of elimination, I can only conclude she produced an oversupply of pheromones.

My boundaries and respect for those who requested guidance stopped me from considering the pursuit of touch outside those limitations, as did my love for my wife and a set of clear principles. I never needed to think about potential public humiliation, financial ruin, and vocational catastrophe.

None of this makes me a saint, in case you wondered. If you can find one, let me know.

But, I heard a few stories from men who did destroy their lives and those of their victims.

Two of my patients, defrocked former ministers, sought my services because they’d taken advantage of their religious authority and charismatic charm with multiple members of their separate congregations. One still retained an imposing presence and a powerful voice, a capacity he’d used to deliver stirring sermons. His shame was almost palpable.

Another man I’m thinking of, a doctor, employed several ex-patients in his office of female employees. Those with whom I spoke all admired him, but people in authority who provide treatment to a person in distress often receive this kind of attachment and appreciation.

This is what erotic transference tends to involve. The transferential object needn’t be Brad Pitt or whoever is the latest heartthrob.

Well, the odd man I’m describing owned lots of “presence,” an indefinable quality of strength or self-assertion, self-confidence, or magnetism setting an individual apart from others. One might describe it as an aura of sorts.

Most of humanity becomes invisible in a crowd, while those with “presence” stand out no matter their size.

Thus, perhaps it should be without surprise to discover the physician I’m describing took one of his employees, a former patient of course, into his office about once a week.

The couch doubled as a foldout bed. If you entered his “castle” after she exited, the scent of sex remained.

Back to me. I confess I sometimes could be a bit too attentive to the faces and bodies seeking psychological assistance. At least my eyes were. As a psychologist, you need to remind yourself of what you are doing, what your duty is and return your attention to the patient’s needs.

This isn’t difficult if your role remains well-defined internally. Most get this right, I suspect. Otherwise, malpractice insurance costs would be closer to those of medical specialists.

Patients test therapists. Not all, but some of those whose life histories included soul-breaking physical and emotional violations.

A few push their new doctor with displays of anger or intimate provocation. They come to the consulting room with memories of people who appeared kind and turned cruel, the ones who offered comfort as an avenue to their own carnal and controlling advantage.

These injured folks don’t want to be hurt again. They plan attire and enticement to assure themselves the kindly and wise Dr. Jekyll won’t become Mr. Hyde. I also encountered a couple of traumatized women who brought small knives into the office in an attempt to menace me.

Safety and testing take many shapes. It can also serve to control the practitioner, rather than submitting to control by him.

I’ve read nothing about erotic transference and countertransference (when the counselor experiences a desire to pursue a client) specific to the new virtual, computer-mediated age of treatment.

It will be interesting if research informs us whether the power of transference can jump over and through the Zoom screen. I imagine it sometimes can.

From a distance of 10 years since retirement, my take on all this is that we psychologists and other helping professionals cannot but bring the whole of our humanity and personality into our vocation. Knowing yourself well as a healer means you should keep your focus and actions in check.

Of course, we are human, and humans do many things they shouldn’t. Be grateful, then, to find those talented professional souls who don’t, no matter their line of work.

======================

The first photo is of Ingrid Bergman and Mathias Wieman in a promotional shot from the 1954 movie Fear. The following image is a screenshot of Eva Marie Saint from On the Waterfront, also of the same year. Finally, a screenshot of Audrey Hepburn in War and Peace, a 1956 movie. All are sourced from Wikimedia Commons.

November 15, 2020

Inside the Patient in Therapy: What’s Going On?

We think of therapy as a conversation between two people.

Dig a bit to find the unspoken thoughts and feelings stirring inside the client. What are they? In what order do they arrive? And why can’t some patients recall the discussion even a few minutes later?

Let’s imagine observing a middle point in a hypothetical session.

The client’s inner world, from a photographer’s perspective, might look this way:

Emotions are brewing. Think of beer or a broth. Visualize the internal concoction as a liquid of at least mild temperature and motion. Active ingredients could include anger, embarrassment, calm, feelings about the therapist, confusion, shame, and sexual arousal.

Don’t forget thoughts.

Where do the stew’s components originate?

the client’s life history and memories
sensitivity to pain or judgment
openness
the world in which he lives
his brain’s capacity to deal with and analyze complex material
the genetic makeup with which he was born

The therapist’s tone of voice, confidence, understanding, and guidance of the process play into the other person’s state. The security associated with the office shouldn’t be discounted as a factor, either.

The specialist’s next comment spins from his lips into the air. Perhaps it is a statement, a question, or an interpretation of what came before.

The client’s ears hear the voice, clearly or not, and understand the words as the counselor intended or not. The language now launched lands in the mixture already present.

The woman or man’s experience is a combination of what he perceives outside of himself and its meeting with what is inside.

More is possible. Patients, if they place a high value on the relationship, sometimes ponder how to respond. They wish to say the “right” thing — to be “good.” Self-consciousness in this setting isn’t unusual.

Consider the chance the listener is not listening and has lost focus. Maybe the language and inflection increase or calm any emotional turmoil.

The unconscious plays an undefined role too. Past events may be evoked.

The patient might not be as attentive and emotionally “present” as he was a few seconds before. Confusion sometimes scrambles his consciousness — bodily sensations, as well.

Therapists must be careful not to overwhelm this soul, amplifying his struggle to process the unstable encounter between external and internal events.

In some cases, the individual cannot “stay” with the flow of ideas, memories, visceral changes, and feelings. In this situation, the client often takes a kind of unseen flight from his fraught condition. His action is like putting a part of himself in another room, away from whatever is troublesome: dissociating portions of the momentary experience and “going away” from it.

He remains in the chair or on the couch, but a segment of his awareness, including access to his complete range of emotion and sensation, is elsewhere.

Treatment would fail if this were to occur in each session.

I’ve created an example of one kind of encounter, not typical of everyone’s experience. Many, if not most meetings, are calmer, less stirring, more laid back.

Assuming this did happen, however, the end of the visit might produce amnesia of some of the material discussed during it.

How do counselors prevent this?

They take in whatever is in front of them: tone of voice, postural alterations, physical evidence of anxiety. Eye movements, changes in the rate and intensity of speech, facial expressions, perspiration, and tears need to be noticed, as well. These and the patient’s comments concerning comfort or discomfort should enable the doctor to know whether to intervene: reduce the client’s tendency to become overwhelmed or dissociate.
Both parties need to converse about how much intense material can be tolerated and how to communicate distress as it occurs.
The health care professional can suggest the patient write a summary of the session’s end, perhaps when he returns to the waiting room. Like dreams, the experience or portions of it are not always recalled otherwise.
Zoom and comparable virtual treatment platforms include recording options. This permits the client to review a video of the session alone or with the counselor during the next appointment.

A sensitive and competent therapist will inquire about what the patient wishes to talk about and recognize what he might not recall from recent sessions.

His job is not to interrogate. Rather, he desires to be attuned to the person who has entrusted him with the responsibility of his care. He hopes the client will join him in a shared enterprise designed to achieve progress on the treatment path.

Obstacles like suppression or dissociation can prevent mastery over the life challenges that brought the individual to psychotherapy.

Psychotherapists aren’t magicians. We have only words, compassion, and understanding of what is required and when. Words in the right order spoken in the right way are often enough.

———

The first image is Picasso’s The Red Armchair, from 1931. Next comes Classical Head, a sculpture by Elie Nadelman, created in 1909/10. The third figure is featured in Stefan Kaegi’s Uncanny Valley. It is followed by the work of an unknown artist of the Fang culture, a Central African ethnic group. It is thought to date from the mid to late 19th century. Finally comes Sleep Muse, a 1910 sculpture by Brancusi. All but the Kaegi are sourced from the Art Institute of Chicago.

January 26, 2020

In Search of a Rescuer: Where Erotic Transference and Politics Intersect

Most of us have hoped, early or late in life, for someone to “make it better.” Children want this when they fall. They need to believe instant magic is possible, and often it is. A smile, a hug, or a kiss can be enough. We are social creatures looking for connection, sensual and emotional.

When illness is serious, medical professionals are asked for their form of hocus pocus. Those people possess specialized knowledge. The name for it is “health care.” A proper physician communicates his expertise, but the care, as well.

Those with injuries to the soul seek a specific category of treatment: psychotherapy. You might be the perfect physical being, beautiful and whole except for the unseen pain of twisting emotion and turbulent thought. But, you ask, how much can another human do when no surgery or potion fixes what isn’t working?

Should the attempt to help succeed, admiration for the one who helped tends to follow. Sometimes before aid occurs.

The idea of a protector is potent and easily sexualized. “Someone to Watch Over Me,” the old Gershwin song goes. There are moments in life when we call out for such a knight or sorceress to summon the daylight.

The problem, though, is that life’s manufacture of dilemmas doesn’t stop. The factory assembly line can be unkind. Joys and sorrows are randomly generated. Nor does love offer a permanent cure-all.

The nourishment given by passionate and abiding affection helps with many problems, within limits. The lover (or potential partner) can offer only one hand when you find yourself in the soup of struggle. The other he needs to keep himself afloat. Lasting sorcery available 24/7 is in short supply.

If the therapy client searches for a deliverer or a romance in the counselor’s office, desire gets in the way of the best the therapist can provide: for the patient to rescue himself with expert and sensitive help.

The doctor’s assistance does not demand his becoming a brawny stretcher-bearer throughout the client’s life. Instead, the latter learns to take on present challenges and get past his past to make his way.

To do so, our wounded hero must allow (in small doses) uncomfortable emotions access to his heart. Similarly, he begins to permit uneasy topics and memories admittance to his thoughts. Taking responsibility for recovery requires behavioral changes, too; actions he hesitates to try. New and more workable ideas will disentangle the ones binding him if he recognizes their mirage of false security and unties them.

Some argue there is a benign supernatural healer in an afterlife, but I don’t know anyone who claims he now walks the earth. Some of us do, however, mistake mortal beings for more than they are. Thus, no matter the gifts of the therapist, he is not, by himself, the answer.

Current politics reflects this problem. Close to half of the United States thinks they’ve found their savior, a sheep in wolf’s clothing. Nothing short of a no-holds-barred holy terror will save them, they believe.

The other 50% hopes a nobler protector is yet to come. The latter group has been disappointed in people with names like Mueller and fears there is no other metaphorical wolf-slayer at hand.

Here, as well, many who wait and dream make the same error as some counseling clients. The hoped-for wizard in the office is like the fictional Wizard of Oz, just another man. The heavy lifting of well-being will require the muscle of those who lift themselves. The psychologist might suggest a path and a pace, display encouragement and understanding, but no more.

Neither a passive role in counseling nor remaining inactive until election day will accomplish a rescue, whether it be from personal despair or a case of national turmoil.

In 1867 John Stuart Mill put the governmental situation this way:

Bad men need nothing more to compass their ends, than that good men should look on and do nothing.

It is often quoted in these words:

The only thing necessary for evil to triumph is for good men to do nothing.

Whether the worthy man or woman is a therapy patient or a nervous citizen in a shaky republic, he is tasked with principled action to effect the change he wants.

Postcard and letter writing, marching and registering voters, phone calls and donations wait for us only for a while. Energy enacted creates its own source of energy, confidence, hope, and a sense of control: steps in the defeat of passivity, dependency, and worry.

Walt Kelly’s old Pogo comic strip told us “We have met the enemy and he is us.”

If the cartoonist were working today he might prefer this, a remedy of which each of us should remind ourselves:

I have met my rescuer and I am he.

October 27, 2019

The Risk of Emotional Openness: Of Therapists and Their Pedestals

Most of us in the West assume a stance of “openness” to a degree my parents and immigrant grandparents thought shameful and dangerous. Yet our casual ease in talking about “the personal” still has limits: lines not to be crossed.

On the dark side of that border, one finds all of us who are not “known.” By this, I refer to the hidden aspects of who and what we are. In Notes from Underground, Dostoevsky wrote about the parts of ourselves kept below the earth:

In every man’s memories there are such things as he will reveal not to everyone, but perhaps only to friends. There are also such as he will reveal not even to friends, but only to himself, and that in secret. Then, finally, there are such as a man is afraid to reveal even to himself, and every decent man will have accumulated quite a few things of this sort.

I had a taste of my mother’s notion of the proper place of privacy in repeated statements like, “What would the neighbors think?” Her family’s advice for what was and wasn’t discussed came from a generation whose education was Eastern European and specifically Jewish.

Amos Oz, the late Israeli novelist, born in 1939, offered this commentary on those who fled Europe for Palestine before the genocidal erasure of their families and friends by the Nazis:

They had no difficulty at all in expressing communal feelings — they were emotional people and they knew how to talk. (But) the moment they tried to give voice to a private feeling, what came out was something tense, dry, even frightened, the result of generation upon generation of repression and negation ... They could never be certain that they would not utter something ridiculous, and ridicule was something they lived in fear of. They were scared to death of it.

Here, perhaps, is a partial answer to why so many of our friendships and romances fail. We want to experience the freedom and comfort of another’s knowing approval, but hesitate to leave more than a trail of breadcrumbs leading to the secrets Doestoevsky mentions.

No signpost to our camouflaged essence directs the curious to know what we want to be known, but dread will be known. The ridicule that terrified Oz’s parents is thus avoided.

Obstructions to external acceptance of our innermost selves are still more numerous. Unlike those mentioned, these come from the deficits in the ones whose respect we crave.

Few potential friends and lovers know how to enter our protected internal spaces or realize they misunderstand us without so doing. Much work is involved in achieving a depth of awareness of another person, time thinking about more than how to win someone’s friendship, or get naked with them.

Our observers see only the surfaces we present. I’m speaking of qualities like our appearance, intellect, or quick wit. We blind people with our externals, intended or not. What is obvious is like the topsoil of a garden, suggesting little of what lies underneath.

Beneath the stereotype applied to their veneers, the beautiful and smart, the handsome and wealthy, are always harder for an observer to see as they wish to be seen.

As amateur analysts of the human condition, we imagine most compatible acquaintances offer no challenges to comprehension. They are thought to be like us in nature, philosophy, and motivation, with perhaps a few variations due to age, gender, race, nationality, and religion.

Not always.

Whatever uniqueness exists in their clandestine attitudes and behaviors often defies stereotypes. The more unique they are, the less likely they will fit our usual classification system.

One group is skillful in lifting the veils of those who might dance away from in-depth exposure of who they are: therapists. With enough talent and experience, they uncover much of the shrouded but exceptional humanity missed by so many.

This quiet recognition astonishes the ones who are now, perhaps for the first time, recognized. The power of the event and the wizardry often attributed to the counselor confers a significant part of the appreciation and, sometimes, the love directed toward him.

The healer’s discovery confers on him a weighty obligation, as well. While he treats many patients and might feel great affection for them, he does not (if playing by the rules) share the same extent of meaningful attachment to them that he receives from them.

Whenever any of us recognizes the inner-truth of an unknown, defended soul, we are placed on a metaphorical pedestal. How do we manage the esteemed position conferred upon us because of our x-ray vision into his heart?

How much care and carefulness, how much gentleness, ought to be given to someone who believes we (and only we) hold the secrets of his universe?

Regardless of whether one is a therapist or not, we now receive a responsibility we did not seek, ownership of a particular station in the life of the one stripped of his mask. Therapists, close friends, parents, or lovers — almost all of us sometimes take on the weight of this — or walk away in disregard.

No simple directions exist for managing the unsought for status. Comments on therapy blogs make clear that the best mental health experts can leave an indelible imprint. The memory of them may long occupy a living space in the minds and hearts of former clients, not quite a first kiss but still on a high shelf of importance.

In such cases, counselors are inclined to believe they have done their job. While they opened the patient to possibilities, that openness comes with the sometimes painful knowledge that much of their future will be lived without visits to the individual who did the unmasking.

Helping professionals think the toll is worth the reward, but only the client can say this with certainty.

I’m convinced not all do.

We live in a world of love and loneliness. Most of us have experienced both. The impact of being known is extraordinary enough to change the life of the one so revealed and accepted — accepted despite revelation of the dark treasure within their confidential, invisible fortress.

Not everyone you meet risks traveling to this place. Not everyone locates somebody who might hold the key to their closeted existence. No wonder Vincent van Gogh wrote the following in a letter to his brother Theo:

Many a man has a bonfire in his heart and nobody comes to warm himself at it. The passers-by notice only a little smoke from the chimney and go their way ...

The stakes are considerable for the unseen. Their smoke signals disappear in a moment unless repeated. Even then, not all follow the vapor and welcome what they find there.

What else can the undiscovered one do? Will he speak the words and uncover his feelings before a stranger?

The risks echo. Is the hazardous path to “becoming known” a wise adventure or a dangerous one?

Perhaps both.

—–

All of the images above are the work of Mark Rothko. In order, Untitled, 1968; Untitled, (Light Over Grey), 1956; Untitled, (Light Cloud, Dark Cloud, 1957); No. 12, 1960; and No. 17 (Greens and Blue on Blue) 1957. I encourage you to take more than a few seconds to look at any one of these and discover what is beneath the surface impression, a visual analogue to the subject of this essay.

September 22, 2019

Are Therapists Ever Really Irreplaceable?

Counselors offer conventional wisdom to solitary, long term patients who are attached to them: “You have grown, and that growth will enable you to meet new and satisfying people. I’m merely the first person who understands and affirms you. I won’t be the last.”

I shared this with those whose attachment to me was substantial. Some doubted my words. Now, at a distance created by retirement, I’m less sure which of us was right.

For those who said I was wrong, I’m more than a little late in offering an affirming message in response to their concern. The belated acknowledgment is double-edged good news. The confirmation of your fear means you never found another person in your life who understood you enough, saw you clearly, and deemed you worthwhile.

Am I giving myself credit for insightful, redemptive compassion no one else duplicated? It is not as if I didn’t work hard to understand. It is not as if I didn’t recognize qualities that had gone long unseen and unappreciated. Many healers do this, however. I was not unique.

But, I was singular in several lives because I was their psychologist.

Clinician and patient encounter each other at a challenging juncture. The latter’s life is like a coin tossed above the crowd. Will it land heads or tails? If the therapist is a figurative fair wind, he tips the spinning silver for the better in an unrepeatable moment.

To the extent such an instant is a decisive one, perhaps the client will never meet another like him in a similar, poignant, and needful time. Whenever life is fraught after the treatment concludes, he might look back on past psychotherapy as an oasis worthy of an expensive return ticket.

Alternative paths exist. Not every person who enters counseling becomes so attached to the purported wise man sitting opposite him. Even among those who did bond before its conclusion, multiple people perhaps now provide more fulfillment than a therapist. Those relationships extend to meals together, bus rides, weekend evening plans, and physical intimacy. None of these occur in the patient/doctor range of interaction.

Nonetheless, the doc can be a hard act to follow for several reasons.

For a significant number, the healer made an indelible impact, perhaps an imprint. Remember what you learned about imprinting? Some birds and mammals will attach to another creature, not even of their species, who arrives during a critical, brief period: a moment fertile for bonding.

The right counselor at the right time with the right kind of intervention might be a bit like this.

Most patients — if they continue to work on themselves — will encounter new people who evoke as many positive emotions as the old psychotherapist. Still, these relationships are about both people, not so much about the client alone.

Trust develops in different ways inside and outside the clinic. Within the office, it is carefully orchestrated and permitted to be gradual. The room holds the possibility of becoming almost holy because faith (in another mortal, not a deity) enshrines the place.

In contrast, routine contact in the real world provides riskier opportunities to achieve confidence in another. The restaurant, workplace, and movie theater do not resemble sanctuaries. The ethical guardrails of the cloistered healing space are absent.

An impatient civilization puts down hurdles to closeness not everyone can overcome. Moreover, even best friends and mates do not hear all of the secrets some clients hide in the shadows.

Therapists do and, because they do, they double as confessors. They listen to the sins and inadequacies the client believes about himself. By bearing witness and accepting the reported frailties and flaws, the counselor frees him from the weight of the insecurity and doubt he carries.

Regardless of the wonders of a new friend or love, those companions cannot always be so focused on you as a person who gives professional guidance. This is true despite a weekly, clock-governed hour or two of purchased attention.

Indeed, the hour’s brevity and artificiality assists in creating the uniqueness and makes such focus possible. Where else in our busy, routinized adult experience does anyone get this?

There is a potential erotic quality present in the consulting room too, adding another level importance. Secrets are involved. Providers make appointments in advance, like a date.

The eager sufferer thinks ahead to these future engagements, considers what he wants to say, hopes to feel something soothing and enlivening.

Other competitors for the healer’s time exist (families, friends, spouses) as do additional “suitors” (other patients), and the troubled one worries about termination (aka getting dumped) just as we do in romance.

Experiences in the consulting room, as confined as they are by professional borders, remind us of impassioned events in our history. Perhaps the reminders come because we find ourselves talking about such past times and resurrecting dormant feelings. The memory of exposing one’s inner life to a psychologist lingers for many of those who allow this lowering of their defenses.

The ghost of the therapist might reside in the remembering mind as does a first love. Youthful friends, too, occupy a place in the heart to the end of many lifetimes. You passed with them through the same moment in history in the same place, experiencing like challenges and the same people in your shared world.

Wartime buddies, as well, understand things no one else fathoms. Nor should we forget the long-married, aged couples who are so molded to the other that they pass away close in time.

The sharing of something important, formative or reformative, is present in all these intimate contacts.

Intensity is a determinant in what can seem irreplaceable in such connections, whether with parents, childhood and adolescent friends, lovers, wartime comrades, and counselors. Similar ties are elusive.

I do not wish to understate the chance you will meet people who “get you” after you depart psychotherapy. Still, I now believe the possibility you may not is higher than I did before.

Each of us, no matter the losses we have had, must search to find new people who can become precious to us. Risks are required. The tightrope of homo sapien interaction offers no safety net, but we are a resilient species.

While many candidates for intimacy exist, if the task were comfortable, the patient would have been embraced by numerous such people before entering the mental health clinic.

Happiness is not a constant. Counselors do not erase the demands of living, including the filling of our social sphere. At their best, however, they empower you to identify and enhance the capabilities inside you to surmount them.

Even for those who profited from therapy and still lack fulfilling nearness, that satisfaction may yet occur. Our emotional lives never can be flash frozen. Children and grandchildren grow or move away and make their own families. Friends die or seek work elsewhere. Conflict with those we love is not always avoidable.

The cemetery is full of irreplaceable people who must be replaced.

Aristotle believed a person who did not require human connection was either a god or a beast. Thus, our quest for an essential other is a part of our nature.

You are not alone in your need to take on this challenge.

Many, many are looking.

They may be looking for you.

—–

The paintings reproduced above begin with Man with a Pipe by Joan Miró. It is followed by three works of Edvard Munch: Self-portrait in Bergen, Young Woman on the Beach, and Woman Looking in the Mirror. The final image is The Mask with the Little Flag by Paul Klee.

January 6, 2019

Thinking About Transference in a New Way

Transference — erotic and otherwise — is worth an unconventional look.

What past events push one toward an unconscious like or dislike of his therapist? What previous learning does the patient now misapply to a stranger who offers help?

A child reacts to his parents based on reiterated experience. If the adults are pleasant and welcoming, his sentiments tend toward the benign. If the guardian’s proximity signals rash criticism, irrational outbursts, or inappropriate physical contact, he associates them with troubled, private states of mind and feeling.

The young one’s mood changes even in anticipation of adult attention. Looking forward to mom or dad’s return home from work can trigger joy or fear. Repeated signals of happiness or trouble will be learned. When an alcoholic overseer opens a beer can, the internal stir tells the child what might soon happen.

The scene or place connected to a wound matters. The familiar location informs a sensitive offspring of potential discomfort. A bedroom, for example, causes alarm if sexual abuse tends to occur there. The boy or girl’s emotional alteration becomes automatic. Conscious thought isn’t necessary.

We are thus conditioned by neglectful or abusive parents. The brain is a predictor, foreseeing danger. Our time at home trained us to notice subtle warning signs of mistreatment. High alert occurs in proximity to anyone resembling those who inflicted the injury, as if we are wearing glasses enlarging false positive features of menace. The distorting lenses sometimes govern how we see employers, friends, and lovers. Youthful coping mechanisms kick into gear.

A trauma survivor’s life is one of constant reliving.

What characteristics of the therapist contribute to this? First, counselors are most often older than the patient, just as the mom and dad were senior to him. The treating professional has an advantage of authority and power in the relationship, as guardians do. He also sets rules and requires their fulfillment. Payment is expected, rather like the home stipulation to do your chores, or else.

The doctor creates the schedule and determines the length of the session. If you wanted more intimacy with your parent, you might be frustrated by your provider’s boundaries. If you never felt special in the family, the doctor’s full caseload reminds you of growing up without status. You are one of a crowd, not first in line.

A clinician needn’t do anything remarkable to provoke a facsimile recreation of a historical script he never read. As if by magic, he arranges the set for the client’s long-running drama. The latter’s well of resentment, love, sadness, and yearning reveal themselves act by act.

A considerate and wise healer gives all his attention, looks in your eyes, and accepts you without judging. You know little about his life. His imputed resemblance to the rejecting sire allows you a mirage-like new chance at the love you never won. He assumes the form of the imagined caretaker you didn’t have, now come to life.

Transference is a kind of disguise, a costume the unknowing client applies to his doctor, who is taken for someone else. The apparel designer’s imagination fills him with qualities belonging elsewhere.

A risk exists here: the mistaken identity can overwhelm the therapist’s capacity to interpret it and refer it back to the initial source.

If this sounds like a guarantee of a bad outcome, however, it isn’t.

Once you accept the idea of transference, you may begin to actively catch the triggered emotions as they develop (or soon after) and work on their underlying cause: the ancient shadow of old relationships and the need to grieve them.

An erotic transference must be more tactfully managed. Tender feelings, romantic or not, are problematic even when unmentioned. While their connection to the past is identical to more common transferential moments, the universal hope for a sainted parent or perfect mate adds a layer of complexity to emotional resolution.

In each case, if your counselor does not overreact to your unhappiness, resentments, or thirst for unique closeness, your imbedded responses should lessen: they will be extinguished or unlearned with time. Likewise, the ability to recognize the difference between your doctor and early custodians is a first step toward doing the same with bosses, companions, and suitors.

People will be recognized more as they are, less similar to Halloween characters. Improved life choices and increasing ease of intimacy becomes possible.

Life and therapy offer us endless challenges. Muhammad Ali, a man who knew a bit about contests inside and outside the ring, offered this advice:

I hated every minute of training, but I said,
‘Don’t quit. Suffer now and live the rest of your life as a champion.’

——

The first and last images above are both untitled painting by V.S. Gaitonde, the last from 1953. The middle work is called Painting No. 1, 1962, by the same artist.

December 30, 2018

What Does Erotic Countertransference Look Like?

Words are hard labor. Let’s therefore add some pictures. The moving kind in matters of the therapist’s heart.

Much is written about erotic transference, but this is countertransference. Ladson and Wilton (2007) report:

The intense emotional experience of countertransference in psychotherapy … is not rare. Some studies have reported 95 percent of male therapists and 76 percent of female therapists admit they felt sexual feelings toward their patients.

The above video, from the HBO series In Treatment, offers you a glimpse. Enough to know — if you are open to knowing — how a therapist’s erotic countertransference can divert psychotherapy from its intended aim.

—

Observe TV’s portrayed counselor (Paul). His discomfort is evident in his speech, his body, his silences. The grip on his role is slipping.

The first and last two minutes of the nine-minute excerpt offer the session and the words. The center segment is given over to silent film.

Do you believe their relationship will turn out well? Do you think office hours will remedy the problems for which Laura booked her first appointment?

The second clip begins with Paul looking for guidance from his analyst Gina. He has lost himself to a mutating agenda. Laura came to him to improve her psychological state. This man was sought as an expert healer, not a man soon to be in love.

The pair now struggle with a different goal. Doc Paul is like a person hanging from the wet window ledge of a twenty-story building. The strength and clarity of the woman who is his client will overpower his ambivalence. The flashing EXIT sign makes no difference.

The most remarkable moment in these two fragments opens at 7:47 of the first one. Paul is told who he is, what his weaknesses are, by his perceptive patient … and that she loves him just as he is. No wonder the ledge is slippery. To be known and accepted — here is the ultimate aphrodisiac.

—

You might be stirred or troubled by your own transferential emotions if you are in treatment yourself. Perhaps you hope for physicality, but should the professional’s self-control crumble, the collapse renders impotent all his education and ethical resolve; and your safety with it.

A therapist must draw a line never to be crossed.

Lower your eyes to his office floor. The indelible mark was present long before your meeting.

Any other barrier, more movable or less precise and clear to him, risks injury to both of you.
STOP signs help only if you recognize where to look, and the brakes still work.

May 26, 2018

What Does Emotional Infidelity Consist of?

You tell yourself you are faithful. You love your spouse. You pray every day, attend religious services once a week. You believe in the strength of your will — the ability to resist temptation, the perfumed heat emanating from a delicate hand.

Ah, how we fool ourselves. All around are enticements. They are the banana peels you don’t notice, the black ice waiting to skid the vehicle of your soul into dyscontrol, the quicksand but a step ahead. Springtime and flowers and a glass of wine. A comely presence attached to a sympathetic listener (a therapist, maybe) when you are unhappy about something.

There can be so much in a smile and a tilted head. And those eyes!

How do you know when you are unfaithful, even a little? Or heading for it?

A few questions:

Do you sometimes think about the “other” when talking to your spouse?
Do you, even a bit, wish your mate were more like someone else?
Do you imagine what you’d do if free to pursue something elsewhere?
Does your present lover know the stranger exists?

The ice is getting thin, no?

What do you imagine your mate would think if he/she overheard you talking with this special person or read your email?
Does the arrival of a new message give you a rush?
Can you sense the “sex of things” even if you haven’t acted on it?
Do you lie to disguise any aspect of the new relationship?
Is the mental and emotional space devoted to the stranger enlarging?

None of the above necessarily includes any sexual contact, not even a kiss.

Do you engage in secret phone calls with the other?
Have you arranged meetings in a park, coffee shop, restaurant or the like?
Do you share confidences not offered to your spouse?
Is your sexual desire for your mate now much smaller or larger than before you became otherwise preoccupied?
Are photo exchanges part of your new, hidden life?

Many of these actions can be rationalized. The new friend perhaps is a co-worker or someone you met on a commuter train. Each step seems small enough and might be something you minimize. Flirtation is enlivening. Sympathetic listeners are necessary in any life. A new person is fresh by definition and the glare from the unwrapped cellophane hides whatever imperfections reside in the package.

At some point the frail self is caught in a wave, swept away, young again. The experience moves you from underneath a pedestal to the top of one. Routine breaks. Your spouse knows you too well, but the fresh friend is dazzled. Your life goes from static to ecstatic. You assume your mate will not find out. You don’t face what your friends or kids or parents might think. No one will be hurt, you say to yourself. STDs? You laugh thinking they can’t happen to you and nothing will pass to your mate.

You are a fool in love. The early stages of love make us all fools. I do not disparage amour here, but surely you recall muttering (in the past, of course), “What was I thinking?” The question comes too late.

Some argue you should simply enjoy the ride, ignoring that you are not encased in protective bubble wrap. Better, ask yourself what is of ultimate importance in your life. What are the reasons you chose your spouse? Consider the gratitude you feel still toward him or her; all you share and have shared. How can you enliven the relationship to make it better? Who are you really, your best self? Who do you want to be?

An emotional affair is still an affair of sorts, even if not yet so dreadfully complicated. The new romance will almost make you believe the other is Christopher Columbus and you are the America he discovered. And vice versa. All this while you are upside down and so much the plaything of your emotions that you will not even recognize you are drowning. Your stable life was built of blocks made of prose (and prose is essential to sustain any lasting relationship), but the weights pulling you under are full of poetry.

Perhaps you can find some of the old poetry back at home, too.

You have my best wishes and deepest condolences. No judgement here: these things happen even without seeking them. Friends and therapists are waiting to help.

Just remember:

The brakes on your being are balky. The steering wheel is unresponsive. You’re heading for a cliff at high-speed.

Think about it.

Oh, but wait!

I forgot your brain no longer works.