(Photo: Allison Day, Flickr, CC BY-ND 2.0.)
Dear Readers, I have been witness in these pages to too many stories of therapists failing to handle strong transferential feelings and causing further hurt in the process. I am proposing a possible way to help. The idea is, when strong feelings of attachment begin to emerge, to bring these pages to therapy and to discuss them point by point with your therapist. I have tried to be informative, not legalistic, and to take into account that neither therapists nor patients/clients are perfect.
I am asking all of you readers, patients/clients and therapists, to take a look and if you see omissions or wording that is likely to be misconstrued in harmful ways, please help me improve this draft. For now, I give permission to copy these words, as they are presented here with attribution. Later when the text is firmed up, I will put it under a Creative Commons license.
1/21: 11:05 PM: In response to DV and all who have written early comments, I have seriously softened the language to prevent misreading this as a legalistic document. Also, note the introduction to be explicit that this is not meant to be shoved at a new patient by a legalistic therapist, but should in most cases be used by informed patients to start a real conversation.
So here is the draft text:
Therapy Transference Principles
Jeffery Smith MD
These ideas are meant to give patients/clients a basis for discussion with their therapist about feelings that may have begun to arise in therapy. It is not meant to be a legalistic document and is not meant to be presented by a therapist to a patient/client who is not fully ready to understand the concepts mentioned.
- We understand that patients/clients may develop strong feelings of attachment to their therapist, which may or may not have a sexual component.
- We understand that these feelings usually derive their form, energy, and power out of unmet needs and experiences from the past.
- We understand that patients/clients often come to believe that some action on the part of the therapist, if performed, will relieve their suffering. We understand that this way of resolving a painful feeling represents a way of problem solving natural in relation to a parent, but not a therapist. When children have important needs, their normal solution is to look to the parent to fulfill the need. The therapist’s role is to develop empathic understanding rather than to solve the problem.
- We understand that in therapy, the main means of resolving past unmet needs is to process and heal the painful feelings by sharing them openly in a safe context with an understanding and empathic other.
- We understand that on rare occasions, boundary flexibility may be helpful in confirming the therapist’s humanness and willingness to engage, but can also activate and intensify non-therapeutic wishes, demands, and expectations.
- We understand that patients/clients may experience a powerful resistance to sharing feelings of attachment out of shame, fear of the therapist’s reaction, or sometimes reluctance to accept the therapeutic way of resolving them.
- We understand that the presence of intense feelings in therapy is powerfully challenging for both therapists and patients/clients, and makes specific and serious demands on a therapist doing this kind of work.
Patient/client should feel responsibility:
- For verbalizing any and all feelings, wishes and desires related to the therapist in specific terms so as to allow healing.
- If unable to verbalize feelings, telling the therapist of their existence and that they are not being fully divulged so that both can place their focus on exploring and resolving the difficulty with communication.
- For refraining from acting on feelings of attachment in ways that may force, pressure, or provoke the therapist into boundary crossing, but disclosing impulses to do so.
- For not acting in harmful ways to the therapist or the therapist’s premises and property. Expressing angry feelings is therapeutic, but acting on them or verbally inducing feelings of fear, helplessness, or pain is not therapeutic and is out of bounds.
Therapist should feel responsibility:
- In undertaking this treatment, to have sufficient personal therapy, training, supervision, and outside personal support to deal with powerful patient/client emotions without losing sight of the principles that follow.
- To understands that coldness, avoidance of emotional engagement, or later withdrawal of emotional engagement with the patient/client is hurtful and not appropriate in this type of treatment.
- For maintaining a positive relationship in which the patient’s/client’s strong feelings can be explored in detail and understood empathically.
- For understanding that a positive relationship requires communicating and maintaining predictable boundaries.
- For using boundaries to protect the therapist’s private life so as to prevent therapist harm and burn-out.
- For using boundaries to protect against the human tendency to act on feelings rather than doing the healing work of experiencing and communicating emotions in a safe environment.
- For not allowing personal gratification to take precedence over the patient’s/client’s care.
- In case of therapist failure to follow the above, to commit to honest self examination and to admitting his or her role in the failure.
Version 1.0, 1/31/18
Copyright Jeffery Smith 2018