Preventing Transference Disasters

(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.

Joint Understanding

  1. We understand that patients/clients may develop strong feelings of attachment to their therapist, which may or may not have a sexual component.
  2. We understand that these feelings usually derive their form, energy, and power out of unmet needs and experiences from the past.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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:

  1. For verbalizing any and all feelings, wishes and desires related to the therapist in specific terms so as to allow healing.
  2. 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.
  3. 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.
  4. 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:

  1. 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.
  2. 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.
  3. For maintaining a positive relationship in which the patient’s/client’s strong feelings can be explored in detail and understood empathically.
  4. For understanding that a positive relationship requires communicating and maintaining predictable boundaries.
  5. For using boundaries to protect the therapist’s private life so as to prevent therapist harm and burn-out.
  6. 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.
  7. For not allowing personal gratification to take precedence over the patient’s/client’s care.
  8. 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


  • As a patient/client, reading this pact was very activating for me. I have been working hard at “getting over” my attachment to my therapist and the transference type feelings that have come up since, well, day one. Sometimes I think I am succeeding. Then I read something like this and it’s as if I’m having a cardiac event.

    But that’s not what you’re asking from your readers, so I’ll say this: Thank you.

    The agreements you’ve listed, the wording, the reasons for it, all of it – is precisely what therapists and clients need to be able to put out there to and for one another, and for the therapeutic relationship to develop in whole and healing ways. My therapist and I have been trying for four years to have dialogue pertaining to my issues around attachment and transference to no avail. I mean, we discuss it, but processing and healing it just doesn’t happen. I believe something like this would have been and would be so helpful.

  • My first impression is that you would ABSOLUTELY need to introduce and then discuss all of these concepts to the patient verbally before presenting anything in writing, especially if they have never been in therapy before. Perhaps the level of general knowledge is different these days because of social media and the internet in general, but when I first entered therapy at the age of 33 (over 20 years ago now), transference seemed a quaint Freudian concept which I’d heard about in medical school but didn’t think would ever apply to me. Similarly, I had never heard the term boundary used in this way until my therapist introduced me to the Cloud and Townsend book. Back then, I think I would have felt quite intimidated to have had a document like this put in front of me.

    Some of the wording might be misinterpreted, for example “childlike” could easily be taken as meaning childish/immature in an insulting way rather than simply as a descriptor.

    I am also hesitant about the use of the term “abusive” in #4 of the patient undertakings. I fully understand the intention, but I see potential problems. Speaking from my own experience as a patient, the patient may genuinely not understand (initially) that certain behaviour is abusive if this is how they are used to being spoken to or treated themselves, and using the term will then involve having to confront the painful realisation that their parents or significant other abused them. It also implies a degree of intentionality which may not be present. It seems rather harsh to label something as abusive which may simply be a reflexive lashing out with a dysfunctional learned behaviour in the face of feeling hurt. In particular, if a patient has previously been a victim of narcissistic abuse involving DARVO tactics, applying the word “abusive” to them mimics the actions of their abusers in claiming to be the “real” victims. The situation is very different if the behaviour continues once the therapist has identified and addressed it, but this document is presumably going to be something which will be used right at the start, before any of these problems have emerged and before the patient has developed a rapport and trust in their therapist. There’s a big risk of damaging trust even before you’ve started.

    Sorry if this is rather negative. I think the idea is good but you need to be really careful with the wording and not make any assumptions about the level of understanding of psychological concepts, even ones which may seem simple and obvious to you through your own familiarity.

  • This is absolutely great stuff as has just about everything here. I wish I had even known the word Transference before I started in therapy. As I see it, part of the problem in prevention from a patient standpoint is informing patients of these issues before or early on in therapy. Unfortunately in my case and am guessing in many cases there first encounter with a therapist is during a personal crisis situation and we might not be entuned to “How Therapy Works” or at least should work. So I think just as big of a challenge is getting this in the hands of patients in the early part of starting therapy. I have often thought every therapist waiting room should have many “How To Get The Most Out Of Therapy” information like this.

    Thank you so much for taking a proactive roll in this. I think therapist need to have more of an NTSB mind set on therapy issues. Unfortunately the industry seems to have little to no oversight therefore no one looking what and why things are going wrong and possible fixes. Six months after ending therapy when I finally I figured out about transference and what was going on I went back to my therapist to inform them. Her attitude was “S**t Happens” and it wasn’t her fault as apposed to trying to understand what I had been (and continue) to go through.

    I truly appreciate this website. It has helped me tremendously!

  • Jeffery,
    Thank you for writing this I have seen way too many cases of abandonment by therapists who have told their clients they’ll be there and to open up, only to flee when it gets too intense. It adds another layer of injury to that already there, but even worse makes it that much harder for the client to risk what they have to in order to heal. They choose to risk opening up and moving closer, despite everything in them screaming how dangerous it is to do that, only to have their worst fears confirmed. I have no idea where clients abandoned in this way have the courage to seek out another therapist and continue to heal. So I think education in this area is really important. Therapists need to understand what they’re getting into if they take on a trauma victim, especially if it was long term childhood abuse.

    I would want to add one thing to the therapist side and one thing to the client side but they are related.

    On the therapist side, I would want an understanding that the unmet needs, fears, expectations of abuse/abandonment/punishment/rejection, shame and difficulty expressing feelings and needs of the client are implicit learning, laid down on a fundamental level, based on very real experiences. There experiences need to offset by experiences that teach the truth: you can trust, someone with power will not hurt you, your needs are legitimate, you matter. Because this is not just about what you know but what you need to shift in your unconscious, it is a long slow process. The therapist must be able to not take what is coming from the client personally. I have no doubt, NO doubt, that it is difficult to have a client struggle with trusting you, or getting angry, or being scared that you will hurt them etc., especially when there is nothing the therapist has done to deserve any of those feelings. It’s not about you, its about what the client experienced, You need to deal with enough of your own issues to be secure enough to not be defensive when it takes a really long time for a client to heal, or to trust you. Your patience and understanding is so important. I so vividly remember 10 years into working with my therapist saying to him, after once again reacted to him as if he were my abusive father “I’m so sorry to act as if your an incestuous pedophile, when you have never done anything remotely to deserve it” To which, he gave the incredibly compassionate reply: “No, the sad thing is that even after so much time in a safe relationship, it can still feel so scary.” You cannot tell a client you are trustworthy, they won’t believe you, you must be trustworthy until they learn through experiencing it until they are taught that it is true.

    The reflection of this on the client side is to recognize and accept that the therapeutic relationship is the closest to a parental one, while not being parental. The focus is on the client’s needs, and the therapist attends to the client without their needs intruding, and provides unconditional acceptance. Because of this resemblance, the therapist carries a powerful symbolic weight so that very little of what goes on in therapy is about the here and now. Feelings, fears and unconscious beliefs will be evoked. So the client needs to recognize that some of their feelings, and especially the intensity of their feelings are fed by the past. That they will need to work very hard to get some space between their feelings and reality, to try and discern if their feelings fit their actual experience of their therapist. Often (but NOT all the time) our reactions to our therapists and their behaviors is based in large part on our early experiences and does not have much to do with how our therapist is actually behaving. We have to work hard to sort out where the feelings are coming from. You have to be willing to express your thoughts and feelings and especially your assumptions about how your therapist is feeling and what they are thinking so you can reality check in order to discern the real source of your feelings and reactions. (Side note: This is what makes a therapist who has not dealt with their own issues so problematic. In order for a client to separate out the reactions and feelings of the past, from what is going on in the present, to “own” their own issues, they have to trust that the therapist is being honest about what is really going on in the room. It’s a bit of a tightrope that the client walks between needing to believe and trust the therapist in order to heal, but not just blindly trusting so that they may still protect themselves from incompetent or predatory therapists.)

    Wow, sorry that was much longer than I intended it to be. Probably needs a lot of editing. 🙂 I so appreciate your willingness to listen and learn from everyone.


    • AG Thank you so much for your important thoughts. Having already modified the post to to remove the most problematic aspects of the original, I’ll collect some more ideas before the third edition.


  • This is fantastic Jeffery! What a great idea. It should become part of every book on psychotherapy, in addition to be made available to therapy clients in one way or another.

  • I find this language to be highly technical, however I appreciate what you’re attempting to do. The way to prevent transference disasters is by,
    -placing responsibility on the therapist who is a trained professional
    -therapists doing trauma work must use an approach that is congruent, genuine, and accepting of the client
    -therapists should educate clients in every session regarding their role and clarify expectations
    -therapists should understand that one instance of disapproval or aggressive confrontation may irrevocably break trust
    -therapists must be open and honest about who they are, no blank slates
    -therapists must acknowledge the ‘ here & now’ components of transference. The feelings that the client has towards the therapist are real and triggered/reinforced by the therapist. Denial of therapist contribution recreates the blaming, shaming abusive parent
    -therapists do any less than I am suggesting emotionally abandons the client
    – therapists do make mistakes and should have the humility to accept responsibility instead of blaming the patient and patient transference

    • Dear Anne, Thanks for your comment. I’m afraid that “Therapists should” has been around a long time and has not stopped the alarming number of disasters. The aim of my post has been to help patients/clients initiate a dialog earlier in the process that can help them flesh out the therapist’s willingness and capability of acting in the ways they “should.” I think where the world is going is towards more consumer activism, as opposed to relying on institutions and standards. There was a time you could trust the phone company and your bank, but, sadly, it is no more.


  • I had a panicked reaction similar to Michelle’s in response to the first patient responsibility, “For verbalizing any and all feelings, wishes and desires related to the therapist in specific terms so as to allow healing,” I like AG’s comments about implicit learning and your comment in the joint understanding section about “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.” I think the juxtaposition of these three ideas reflects some of that reaction (and I should also note that my reaction came from reading the original, about an hour after you posted it). I read this as something like, “we know you are consumed by shame and fear and and have implicitly learned that others will hurt or abandon you if you share your feelings or needs, but it’s your responsibility to do so.” I might think, “He’s saying ‘just do it,’ but I don’t feel confident that I can.” In the whole context it’s clear that this is supposed to be supported, but as the first individual responsibility listed, my reaction was, “right off the bat you are telling me I have a responsibility to do something that goes against every protective instinct I have. This is too hard.” If I got this early in the therapy I think I might run away. Alternately, I might feel it wasn’t an immediate threat because I didn’t have any such feelings, but vow to myself never to allow myself to develop them. I suspect for me, at least, this might interfere with the development of the therapeutic relationship, because it sets out an expectation that feels unsafe before much trust has been developed.

    In patient responsibility #3: “For refraining from acting on feelings of attachment in ways that may force, pressure, or provoke the therapist…” These items seem to make the patient responsible for the therapist’s actions. I think I’m OK with “force” because it reflects professional ethical responsibilities, and “pressure” still allows for therapist responsibility in terms of what he or she does, but “provoke” seems to imply that the patient can’t trust the therapist to control his or her own behavior. Perhaps “attempt to provoke” more accurately reflects the combination of the patient’s and therapist’s responsibilities? “Provoke” or “provocation” seem to be words that are used to lessen the responsibility of the actor for his or her own actions.

    In patient responsibility #4, what are the pros/cons of adding that the patient won’t act in harmful ways toward the self (in addition to not acting in harmful ways toward the therapist and therapist’s property)? I know this takes the discussion into a somewhat different realm, but conceptually it seems to tie in here particularly for patients with trauma histories.

    Finally, there are several comments in the therapist’s responsibility section and in point 7 of the joint understanding that discuss the toll the therapy can take on the therapist. It might be useful to think about/discuss the impact of those statements on patients who have developed caretaking strategies as a way to manage early trauma or attachment disruptions or living with narcissistic parents. Clearly they are things the therapist needs to be willing to agree to. In what cases are they helpful for the patient to know and understand and how might that understanding play out? For patients who lack empathy, this may be really crucial to their development. For other patients this may set up a direct conflict with the expectation to share their own needs. Of course this is exactly what the client and therapist would need to be working on. The question is whether it makes it more or less available to the work.

    • Weatherwax, thanks for your very thoughtful response. Clearly its going to be hard to get the language simple and clear, without unintended effects. It may help a bit that this is supposed to be the basis of a discussion with the therapist early enough in treatment to give some chance to clarify how the work can go in a successful direction and to prevent disasters. I look forward to trying again to get it right so as not to do harm.

  • I wonder if it could be incorporated in “the Scarsdale Psychotherapy Self-Evaluation”, either as a part or maybe as a supplemental to use in therapy? I found SPSE very helpful when I was doubting my perceptions of my therapist. Could this transference issue be adapted in SPSE style? Just a thought.

  • Liking this, more than a lot. I have a couple of comments:
    1. In the introduction you state:
    … it is not meant to be presented by a therapist to a patient/client who is not fully ready to understand the concepts mentioned.
    I am wondering if you are going to give some signs for therapists to look for to know when it is a good idea. Maybe that is something you learn in “therapist school” 🙂 but I think it might be worth thinking about.

    2. Should there be something in the therapist section that s/he should be responsible for gently bringing up the attachment issue, if the patient does not? (of course, if my therapist had given me this document I would probably take the hint).
    Also, there could/should there be another bullet point about continuing to ask about these feelings– especially when the client has divulged the info. The attachment should not be just received, accepted, and then ignored. Not sure if that makes sense the way I worded it, but I know it is important.

    3. For some reason I think the therapist’s responsibilities should be listed before the client’s. (not exactly sure why)

    4. I LOVE the wording in number 2 of client responsibilities:
    “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.”
    I know that I have a form of sorts that I am supposed to fill out before each visit. It states has thing like… I have been feeling anxious this week and then a ranking from like 1-5 to show feelings of anxiety. I could envision a form like that could have a simple box to check if the client is starting to feel any attachment for the therapist. I know this would have saved me great GREAT angst over how to let my therapist know.

    5. Under therapists responsibility #2 there is this verb agreement mistake:
    “To understands that coldness, avoidance of emotional engagement…”


  • I have a lot of trouble with thoughts of transference.
    I thank you Dr Jeffrey for your book on line which I received this week.
    I have read it with great interest. I will read it again this week coming.
    After a lot of consideration I am wondering if the transference is from my Clinical Psychologist’s point of view.
    He is 14 years younger than I am and I am wondering if he is having problems relating to me as I am so much older and somewhat disabled.
    Does he need me to fulfill his problems? Am I his mother figure?
    I like his approach very much as we have crossed so many of my family problems together. Breaking this bond is hard for me but I am wondering if I am supply him with emotional support he needs?
    He has made boundaries which I find unexceptable.
    I see him for 60 min each four weeks, with no reply to my emails or texts or phone calls to his office. I have been told so.
    I try not to be needy but wonder what his role is out of session time.
    Transference is a problem I know, it can work both ways but I feel it is weighted in his benefit.
    I see his this coming week and I have no idea how I should or should not approach my thoughts with him.

  • Hmmm, the list seems somewhat formalistic. It’s hard for me to put my concerns into words in a coherent matter, but my gut instinct is that it is too formalistic and I would be afraid that it would have the effect of reducing the therapeutic relationship into a list of principles and responsibilities.

    • Thanks for your comment. I plan to take in all the comments and try for a third edition that responses to them. Being formalistic is a concern for me, too, but balanced with the desire to make things simple, understandable, and clear enough to lead to mutual understanding, or to clarity that the therapist is not equipped. JS

  • I am in trauma/attachment therapy so maybe my therapy situation doesn’t apply, but what if the therapist was attuned instead of empathic?
    I have seen my therapist take more trainings to help me and switch from empathic understanding to attunement with me. It has been much more effective and actually helps me to feel safer with her.

    • Dear Not Sure, Perhaps it would help readers if you would describe more in detail and depth what you see as the difference between attunement and empathy. Many people think of empathy as equivalent to attunement, but attachment therapists may have a specialized concept that differentiates the two. JS

  • I agree with Kayla, I guess. As much as I hated being blind-sighted with my attachment, sometimes the organic way the attachment “just happened” may be have better, at least for me. If I’d have known the attachment could happen I might have totally fought it.
    On the flip side, I also felt so much shame because I did get so attached and I was so embarrassed. Some education beforehand might have alleviated my feelings of deep despair– luckily I found this site, seriously.
    A form like this MIGHT have helped me feel less embarrassed by it all.
    So, for sure presenting it is probably very important and necessary but perhaps the timing of the presentation is the most crucial piece to think through.

  • Hi Jeffery,

    I so appreciate your work on this blog, your books (I own “How we Heal and Grow”!) and ability to articulate the various experiences that can arise as a part of psychotherapy for both the client and the therapist alike. For my comments, I would like to state at the outset, that it’s very possible that I have misinterpreted what you have written which I think can happen a lot on the internet!

    First off, thanks so much for attempting to facilitate better outcomes with regard to managing transference. As an individual who has been on both sides of this equation, I have often felt that this is an area of practice that is very much overlooked within training programs and on-going consultation. I wish all therapists would do their own personal work and take the time to thoughtfully explore how their actions may impact the client.

    With regard to your post, I agree with many of the comments already made and had a few initial reactions.

    I am struggling with the extent of the client’s responsibility with regard to transference. My strong personal bias is that the primary responsibility for transference disasters remains squarely on the shoulders of the therapist. (Because of this I think all of your points for the therapist cannot be reinforced enough. I believe these talking points should be shown to every therapist who enters a training program and who sits down with a client!)

    On the other hand, for the client, other than not acting out by attempting to harm or threaten the therapist or the therapist’s property, it is my opinion that everything else should be on the table. I believe that psychoeducation regarding the here and now feelings and their connection to the past must be explained as many times as needed throughout the work, however because this process is largely unconscious for clients, to be able to really separate the here and now from the past can be very challenging and can be a cause of great confusion, anger and shame. I believe that a client must buy into this largely symbolic process hook, line and sinker in order to be able to get to the deepest and most painful emotions.

    Therefore, for example, I am wondering about these particular points “…problem solving natural in relation to a parent, but not a therapist…” and “pressuring and provoking the therapist”. In my view, depending upon their trauma, conflating the therapist with the parent is precisely what a client needs to experience in order to fully heal. The client may need to intensely want their therapist to fulfill their needs and even believe they may do so (without being led in this direction by the therapist) in order to surface the original and radical pain of not getting these needs fulfilled. Their need may be that intense and their original deprivation so great.

    Here I wonder if a client could clearly discern that what they are doing is pressuring and provoking, and I guess, if not, so what? Maybe I am missing the extremity of what this means, but I have always understood that the therapist’s responsibility is to be able to withstand turbulent events, set proper boundaries, appropriately respond and assert what is really going on, so the client can access deeper and deeper levels of pain associated with their original wound. Meanwhile the therapist does not abandon the client, cross boundaries or retaliate and continues to provide acceptance.

    Finally, I wonder if the statements under the Joint Agreement could take the form of talking points or questions from the client to the therapist rather than a form of agreement. As an example, the client could bring this to the therapist:

    1) I have developed strong feelings of attachment for you/my therapist which I am learning can
    happen in therapy. I am wondering if we can talk about this and what it means to you?

    I hope you will forgive this lengthy response, and I want to thank you for providing a place to discuss these ideas. I think this type of information is essential to begin a valuable dialogue between the client and the therapist. It is such a complex and complicated experience that I have often wondered if there was a way to mitigate the experience on both sides.

    I am also particularly passionate about this subject, because I have seen how incredibly transformational and healing transferential experiences can be in therapy as well as how devastating the consequences when mishandled by therapists.

    All the best with your immensely helpful work in providing insight into the powerful and sometime confusing work of psychotherapy!


    • DBS, I really appreciate yours and everyone’s input. I think your points are well taken. I agree that therapists carry the greatest responsibility, and that will be reflected in the “third edition” of this post. The problem I’m trying to wrestle with is that so many therapists undertake this kind of therapy without being prepared to fulfill their responsibilities. Telling them they “should” doesn’t seem very effective. I’m hoping to help everyone understand their part in the process mostly so that, earlier in treatment, therapists can recognize when they should get help or step aside. JS

  • Hi again Jeffery,

    I think it’s pretty interesting to have the issue of transference in therapy explained like this. I need a lot of things about relationships explained in words. I have written it before, how helpful DBT has been for me in overcoming my severe attachment problem that was due to wanting/thinking that if my therapist did certain specific actions (hold me on his lap, sit beside me and let me lean my head on his shoulder and cry, hug him) (all physical contact) then I would only overcome my childhood longing and pain. It helped me how you have spelled out in this and other articles how clients think/want this but that’s not necessarily what heals. Meeting the feeling of the unmet needs and talking about them with a therapist who can understand and be present is helpful in healing apparently?

    I have the experience of extreme trauma since infancy. My mother was/is probably diagnosable with a mental illness, and was inadvertently sexual and overstinulating to me in childhood. I grew up with no boundaries. This lack of ability to regulate myself by being able to express myself and say NO to my mother, rather than complying with her every whim, was intensely painful and led to aberrant development on my part. DBT helped because it is like written instructions on how to be a “person”, which my mother could not see me as. I felt invisible all throughout childhood and masqueraded as an adult after leaving home. I have seen so many therapists to try to address my pain, but was always trying to manipulate them (get them to do something) into doing what I thought would heal me instead of feeling my feelings and talking about things.

    There are certain sexual traumas I experienced that I have only recently been able to conceive of dealing with by talking in words. I was able to do this because DBT over the last few years has helped me develop a sense of my own boundaries, a sense of self, and an ability to soothe myself if the interaction with the therapist is less than what I hoped for. I still have experiences I have never talked about, but I’m beginning to feel that after being out of therapy for over a year, that I may be able to do this.

    I have been given/received a lot of different therapies and medications, some typical and some alternative. Each has helped in its own small or large way, though sometimes I was angry because the help meant that I had to change my behavior or thoughts.

    Tomorrow I have an appointment to approach talking again to the therapist I tore myself away from over a year ago. It was for me a horrible attachment disaster and lack of empathetic nurturing at the time, but I certainly grew from his response when I told him I was feeling severe pain, even though his “You want me to nurture you” felt like a lack of understanding and empathy and a denial of the soothing I so wanted from him.

    Now that I have learned a better sense of grounding in myself and an ability to soothe myself by practicing DBT (distress tolerance, emotional regulation, mindfulness, and interpersonal skills), I feel better able (stable enough) to approach this therapist and discuss my attachment feelings (whereas I was acting on them before) and see if I can grow to actually trust him enough. If I can maybe I can tell him of my trauma without expecting/needing a specific response from him. I’m going to go slowly. I’m going to test him out by talking about little things first and see if I feel like he’s there, listening. If not, I shall feel grief at his loss but I will keep trying to find someone I can talk to if these experiences.

    I feel like previously I have written as if you should be able to do everything yourself, but here I am feeling stable enough in myself to try to talk about these ripped open and raw parts of myself with another human being. I feel hope but I am prepared that it may not work.

    However the pain of not relating about this is smaller now than the pain of possibly relating. I’m going to try it.

    Thank you Jeffrey for clarifying interactions in therapy so that I have words for issues, and therefore a better understanding, and ability to communicate with myself and others about what goes on in therapy. I am hoping for a better outcome this time. Knowing in words how to take whether there is trust step-by-step and how my wish for specific therapist behavior is part of my problem is really helpful.

    Growth is really possible and I was stuck in my dark ages for so long but I keep trying new things. Thanks for doing the work you do and the chance you give us to express ourselves by thinking and writing this blog.

    • Thank you, Beth, for a very hopeful post, and a clarification of the great things that DBT can do when there are few clear guideposts to go by. Jeffery

  • Hi,
    I’m amazed at your level of interaction with us readers. We all want to be heard and you really work hard to listen and respond. Wow! I respect you for that! I love your articles.

  • Love your words! I’ve been in therapy for 7 years and severely attached to my therapist. But she doesn’t know what to do with it. And I keep going back. She’s ruining me.

    Her words:

    That’s fine to have a therapy break and I agree that it is probably a good idea given that you feel that you love me and this is not healthy. I would strongly recommend that you continue to see Dr *and Dr * on a regular basis in order to work with these issues as simply trying to contain your feelings and not address the ongoing issues with depression will not be helpful and will not allow for progress. I suggest that it would be best to return to therapy with myself once you have discussed and worked through the issues around how you feel about me with Dr * and/or someone else. I think working with someone else for a bit may give you the opportunity to understand those exceptionally strong feelings of needing that feel overwhelming – though we have tried, it does get difficult at times. Otherwise, I think that you might come back to therapy not in order to address your issues relating to depression/emotion regulation/difficulties with relationships, but in order to simply be in contact with me rather than doing therapeutic work. I hope this makes sense to you and that you can see the therapeutic rationale for this and not it read it as rejection.

    • Suzuki, some ideas. I have seen situations where an experienced third party can help shine light on a situation where feelings are so strong that it is hard to see anything but, for example, whether the therapist will or won’t fulfill a wish. I did a post once on consultations and how they can be helpful. On the other hand, working things out with the one you are attached to has the advantage of bringing out just those feelings of pain and frustration that were never healed from the original unmet need.

  • I really appreciate this website and want to thank you for this recent post. I am thinking about brining this in to my counseling appointment today. I have a good working relationship with my therapist, and I often draft similar type proposals or asking similar questions to better understand my responsibility and his role. One suggestion under client/patient “responsibility” would be instead of being responsible to share feelings, etc. It might be better word, “freedom”… Or put in language that allows the choice of when and how. Like either encouraged, free, or safety, etc. Does that make sense? So number 1 and 2, in the language of freedom/encouragment whereas number 3 and 4 could remain in the language of responsibility. Thank you so, so much for addressing these important issues and with really great perspective.

    • I agree with your suggestions. I will address the over-emphasis on patient/client responsibility in the third edition. JS

  • I see a need for therapist-patient discussion of transference: a general definition; how some feelings that are very strong or overwhelming may be related to thoughts, emotions, and unmet needs from family-of-origin days (way less threatening language than “childhood”)—here cite an example or two, such as anger or longing; and some how-to guidance in sharing (mention the discomfort). I also see the need for a brief notice that counter transference can occur, and that both therapist and client have boundaries.

    This method was used by my third long-term therapist. It wasn’t hard to be taught that very angry or hurt feelings at work or with a sibling could stem from f-o-o dysfunction—my reactions, for which I am responsible in the present. This understanding could be applied to the therapist-client relationship.

    I do not like the formal nature of this document, and having it handed to me at any time during therapy would have had me out the door. A thoughtful, well-timed, “this can happen in therapy and we can handle it this way” document would be more helpful. Narrative with an example or two. And “Let’s agree you will not leave therapy without a visit to discuss why.”

    You seem like a fine therapist. Write what you’d say! Then add some notes to the therapist.

  • I don’t fully know what to do. I have just started with a therapist. At least to me it seems like
    I just started. It has been three months. I read all sorts of stuff about trauma therapy before
    starting therapy. I did try it once ten years ago but I was less functional then, in my mid twenties
    and living in a boarding house. The therapist yelled at me within ten minutes, told me I was dirty
    and stank (true), and threw me out of his office after getting various soap things from the other room.

    I honestly don’t know why I kept going back to him. On the second meeting he did the full forty
    five minutes. Near the end I told him about the sexual abuse. First person I ever told. He acted
    sad and told me that it was sad and wasn’t my fault, but that he had made an action plan and
    he felt it would improve my life. I went to the six more sessions I was given by the government.

    We spent the first ten or fifteen minutes talking about how I was going out more, bathing more,
    eating more. (kinda true, for his sake, not all that true.) then we just talked. That third session
    he just let me whinge on about politics. I have autism, and was deeply interested in politics
    as regarded military history. By the end of the session he had told me about his experience
    as a soldier in Vietnam. he was old enough. He had been an eighty two millimeter mortarman
    on the eastern coastal boarder on an airbase near the border with North Vietnam.

    So after the ten minutes of confirming my mostly nonsense about bathing more and whatnot,
    we just talked about that. I honestly thought all of this made sense. After reading all that trauma
    therapy literature five months ago until now, I find it is not as normal as I had thought.

    I have never been successful, but I haven’t ever done any harm. I just tried to live as quietly as
    possible on my disability check. But I had never been in any sort of relationship ever. I was in my
    late twenties and it lasted five years living together, and ended slowly and badly. I began drinking
    at that point. I was in my early thirties, after a few years I just started to get worse and worse.
    I wrecked a number of friendships. They could handle the drinking. But though I never talked about the sex stuff, there was plenty trauma stuff I suddenly would not shut up about. I just
    couldn’t when I was drinking. I had grown used to it because before the relationship ended
    and I started drinking, I had told the non sex trauma stories as funny, crazy stories.

    But it wasn’t funny anymore. It has all seemed to get a lot less funny. After three years of
    drinking I jumped off a bridge. Was unharmed, did ten days in hospital. A new one on me.
    Nice people in there, hard to sleep with four other guys in the room and the lights on.
    Came back to the old hometown. Got in with the local addiction service. They set me up
    in an apartment. Nice of them, a lot better than outside. It is a true slum bachelor, but because
    of its small size and place it is safe building.

    I worked for a few months on my own with the addiction service. But I hate AA. I do all the other
    groups and work, they were real happy with my progress. I was sober 33 days. But I still wanted
    to die. I had told myself I would wait a few year till I am forty, but the pain was pretty intense.
    So I thought, well you were spending the money on booze, scraping by. So spend it on therapy
    and if you pay a guy at least he will be less liable to yell at you.

    That was when I started reading books on therapy, the first month because I wanted it to work
    if I was paying for it. At least to some extent. The second month because after the first guy wanted
    me to fill out a bunch of forms and I figured i would keep looking. So I found a therapist.
    And this is why I left this post here. Because she is bloody great. I spent the first four sessions crying like a twit. Told the whole story, started just after the worst stuff when I was a kid to now
    then from birth until the worst stuff. Just poured it out. At that point I would have poured it out
    to a fire hydrant. Told the peer support addiction worker enough to feel like bloody burden.

    She just listened, like a nice person would. On the second session I was closed because I
    had been hurt by an observation, she dragged it out of me in two minutes and put her hand
    to her hear, real sincere seeming, said she was so sorry. To tell her if anything else bothered
    me. At the end of the third session she told me about a fund from some nice, rich, dead lady
    who who started a charity through the office she works at. got me ten free sessions. then
    ten more, which was the max. Have paid for three since then so we are on our twenty sixth

    After the third session she bumped me to twice a week. We did that for the twenty and went down to one a week at that point. Seemed to make a lot of sense. I seemed to be moving forward. Her technique seems great. She has let me sob or just complain. She does relational and gestalt
    therapy. We have done chair work and something with a big rubber ball held between us. She will
    laugh with me. Its so hard to feel true laughter, been so hard for years. She challenges me. Will
    just say, I don’t agree. I don’t believe you. but this only about emotions. I think your holding
    something in.

    She has self disclosed what little I have asked her. I know her basic family situation and what she
    did professionally before becoming a therapist. It was important for me to know those things
    but I never needed to know more. She and I are united in a shared hatred for the entire CBT, DBT
    and overall cognitive models. Ever since I read all those books and whatnot, I hated it. Bunch of pseudo scientific, penny pinching, infantilizing nonsense.

    It all most feels like self disclosure on her part. Just how clearly and passionately she agrees with
    me on the topic. Its the only time she doesn’t stay pretty quiet. She seems to enjoy the discussion.
    She also seems like she agrees with my stances on leftist politics. These are pretty far left, based on the use of non violent direct action, after normal channels are tried. I honestly was surprised
    at a professional person being genuinly supportive of that. The non therapist helping professionals I have met before certainly weren’t. They largely had a ‘you do you, dont get in trouble’ vibe.

    But she seems to genuinely like the idea of me staring a protest in my mid sized town. Which
    I intend to do, but I keep thinking rich man’s daughter, to be honest. The only other self disclosure, seemingly by accident, was that her father was a therapist for fifty years. She was
    a more normal professional until she got her therapist credentials two years ago. Based upon
    the sort of more high end, not the sort of thing normal people spend whatever getting a Masters degree in anyway. Also she said the marriage was new and the kids were young when I asked about it the one time. My rich man’s daughter idea I believe makes sense.

    In any case I am screwing it all up. She has taught me, and I have tried to learn about my
    inner child. I have been trying to actually take care of him. I have been cleaning after myself
    instead of letting filth grow in my apartment or rented room until the time came to move and
    a irritated family member helped me out for money. Bathing, for the first time in months. Before
    the drinking it was twice a month whether I needed it or not, but since the drinking it did indeed get bad.

    Actually forcing myself to clean and bathe and eat. Every single day. Because when I can envision
    him as a metaphorical child, I can actually take care of him, as though it were a responsibility. Going to every group besides AA. Taking the anti-depressants every day. Now I will take a new pill,
    the one that creates severe stomach upset if you drink even a little.

    I can take care of him as such because it is an invaluable metaphor if you need to do something as
    vital as take care of your life. If you expect to be treated like an adult you must act as one. And if
    one requires a metaphor for such basic things so be it. Any method that is needed so people do
    not burden their loved ones. But loving or showing compassion to him is a bridge to far. Its a bloody metaphor.

    I believe I also can shove my emotions down so I am no longer an emotional burden to my loved ones. I do believe it and I will succeed. It is needed because three sessions ago, two after I started paying again, one after going to once a week, I had a breakdown. I went on a bender. As always
    being in my apartment, alone as people sensibly leave me when I drink. But benders usually last
    five days and nothing real happens. This time I phoned the crisis line.

    I had never phoned a crisis line until six months ago when I moved back to the hometown. At
    first they were nice, I told them how I simply felt suicidal but I didn’t have any plans. They said
    it was perfectly okay to vent I did go on for nearly an hour. I phoned them some more, about fifteen times in the six months. It was the same call in a sense I guess. They got angrier and angrier. A couple guys always managed to talk me down, but the ten odd times they weren’t on they just got madder and madder.

    At the end they were telling me I was abusing the line. Hanging up. Yelling, I will remember the one social worker girls voice until the day they plant me in the earth. “that’s what trauma is” hysterical, I also sobbing saying the crap from childhood was my fault. Her screaming “is that what I said, is that what I said”. I will never forget that voice until the day I die.

    Stopped drinking after that for twenty seven days. Didn’t phone again. Then I went on what was supposed to be a five day bender. They had all agreed I could handle it, the therapist and workers and whatnot. I really thought I could make harm reduction work. But an hour into it I started phoning the crisis lines. I phoned every one I could for fifteen or twenty hours. I whinged out the story in pieces to one person and line after the other. I don’t know what I wanted, it didn’t help.
    But I kept phoning, suicidal but with no plan and the same sob story.

    I don’t know what I thought was gonna happen. At the fifteen twenty hour point there were suddenly two cops in my house. They were just there, helping me to my feet as I was very drunk
    and putting the handcuffs on my wrists. I had never been arrested before. They took me to the hospital. On the way I was both mad that they hadn’t knocked or asked me to walk quietly. So to
    cheer myself at the absurdity of the situation and because I truly thought it was funny I made
    a joke that I had heard in the back of the police car.

    The joke was “how many coppers does it take to throw a drunk down a flight of stairs?. None, he fell”. I thought it was very funny but they did not at all. When the lady copper took me in to talk to the nurse, I began to complain about the chains they had just taken off. I doubt I will forget her voice either, she said “be quiet and answer the nurses questions our I will be happy to put the chains back on your wrists”. I was struck by “I will be happy”, then by the odd concept of being quiet and answering questions at the same time. I just mumbled about it hurting my feelings and
    they put me in a quiet room.

    I assumed they would have locked me up for seventy two hours. I figured I would ask though and said I would like to go home after sleeping two hours. They said yes right away, we will get you a
    cab. A nurse from the crisis line, the one who talked me down before, waited with me. He told
    me I looked cold and that I sounded much older on the phone. We were both polite. I went home
    and haven’t and won’t phone a crisis line since.

    I did return to drinking when I got home. I kept at it for an hour then I phoned an old friend. It was morning by now. He talked to me for an hour. Then I phoned the therapist. I had never phoned
    for any reason, just showed up on time before. She talked to me for an hour and encouraged me to get some sleep. When it was clear to her I wouldn’t she encouraged me to go to the local mental health social center, I like the lady who runs it a great deal. She talked to me for half an hour, then she got a supervisor from the addiction service in the same building.

    They talked to me together for a half an hour, then the supervisor for half an hor in her office. She allowed me to leave when I agreed to get some sleep. I agreed, but as the therapist had known, It is a meaningless promise under duress. If you look me in the eye and say you can’t leave unless you say magic words I am going to say magic words. You are literally asking me to lie to you at that point.

    So I continued drinking. I managed to listen to music for an hour, then I phoned the supervisor. She talked to me for half an hour, then I continued drinking an hour, then I passed out. I awoke to the clock I had set after the therapist gave me one extra next day appointment. I went to that and made a fool of myself. I was likely still somewhat drunk nine hours later. I was a cringing mess. I lay on the floor twice. She said it was okay, I got up on my own. She said it was okay when I was sick in the bathroom. She did ask if I had missed the toilet, I hadn’t. She said she couldn’t be with me when I was in this state. That she could be in the room with me and accept me, but that she couldn’t connect.

    We had one more appointment since then. It seemed to go as well as any other before. We are still at once a week but I have agreed to take the drinking sick pill and she has asked to speak
    with my nurse and main worker. She is very gentle about how that will happen, and what information I wan’t shared. She understands that it is very nerve wracking for me. It just made me scared.

    I have always been scared. I don’t know what to do. I can’t love myself. The inner child metaphor goes so far but I am just a guy. I am garbage, this is a fact. I have done nothing, achieved nothing. I will never have family, I will never work a full or likely even proper part time job. Just live alone, having grown strong enough to not put my burdens on anybody. Not physical, financial or emotional ever again. I can do it.

    But I get so damn tired. I will never do therapy again. This is working as well as I could ever have hoped. I hate myself but I am learning to act like an adult. I am learning quickly. Without the booze, now that I know it will wreck being an adult, I will take the pill like clockwork. But I just get so bloody tired.

    I hate myself so much. I can’t imagine ending therapy, like ever. I have a recurring thought that if it ended anytime soon I would immolate myself on the steps of city hall, when her day in my town is. Of course I would in reality just give myself a bad looking cut and cry about like the garbage I am.

    I don’t know what is wrong with me. I don’t wan’t more than therapy. Just normal, boundary set, therapy. But I would go old analytical and do ten hours a week if she would let me. But I will take what’s given. I just don’t know what is wrong with me, not really. I am nearly forty, doesn’t bipolar
    or bpd or whatever start earlier?. I am just so tired.

    PS. I have also become one of those awful people who leaves novels in comments sections. That also happened in the last six months. This was helpful to write. Thanks so much to anybody who reads any of this.

  • Hi Gurney,

    They told me I have Asperger’s (a form of autism) and social interactions are really challenging for me. DBT worked to help me but you say you hate it! Why do you hate DBT???

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