(Photo: Allison Day, Flickr, CC BY-ND 2.0.)
Revised 2/28/187: 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 have since posted a new version, which may not prevent disasters, but will, I hope help everyone to be more aware of what is involved, both for patients and for therapists.
Since original post, many readers pointed out that my words put responsibility on the patient when it is really the therapist’s job to understand and guide the patient. I had imagined that by trying to be “even-handed,” the paper would be easier for therapists to accept. In fact, my original use of the word “responsibility” was not appropriate, so I have removed it.
It has also been pointed out to me that the therapists who really need to get these messages are the least likely to be open to them, and that the patients who most need to enter into a frank discussion, are among the most likely to be blocked by shame and intimidation.
My Better Answer: See the new post of 2/18/18, and the extended narrative that is presented in the hope that it might be useful in some cases to both patients and therapists.
I’ll leave this post because of the 40 comments to it, which I don’t want to delete. Otherwise, I believe the new post is more useful and realistic.
So here is the draft text, revised again 2/28/18 to put responsibility where it belongs.
Therapy Transference Principles
Jeffery Smith MD
These ideas were an early draft that I hoped would help patients and therapists. These revised summary notes may be of use, and the comments are enlightening, but please refer to the more recent and much more complete “Primer on Attachment to Your Therapist” in the subsequent post.
- Patients/clients may develop strong feelings of attachment to their therapist, which may or may not have a sexual component.
- These feelings usually derive their form, energy, and power out of unmet needs and experiences from the past.
- Patients/clients often come to believe that some action on the part of the therapist, if performed, will relieve their suffering. 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.
- 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.
- 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.
- 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.
- 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 will benefit from:
- Verbalizing 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.
- Refraining from acting on feelings, impulses, and wishes, but putting them into words.
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