Tuesday, February 05, 2008

You Don't Have To Say It All

Last night's episode of In Treatment got us thinking about how uncomfortable it is when the patient falls in love with the therapist. LadyAK47 wrote in to say that it's very awkward when clients tell her she's attractive. She says, with an tone that I think conveys a hint of guilt, that sometimes she just ignores them and she hopes she'll learn to deal with it better.

Anonymous wrote in and said:

I just ended eight years with my therapist. I started leaving about two years ago. Five years ago, I told her I was sexually attracted to her. No discussion about it except an "Oh that's natural, it will pass once we work through your transference issues." It was never discussed again. I got a very brief description of transference with the explanation of me being bright and I would understand it. I thought I did except I wanted to f**k my therapist not my mother. I never shared anything significant with her again and did my therapy by writing but I was still silent as I shared it with no one. I thought this episode was so painful to watch but totally unrealistic, or maybe she is just narcissistic. I would never say to my therapist, "I want you to f**k me" because I would worry how uncomfortable that would have made her and myself. I am betting this is true of most people who find themselves in that situation. Of course therapy is supposed to be the place where it is safe to say anything but I really think that after a time with your therapist, you do start monitoring what is said and their comfort level other than your own (the client). -- ** mine.

So we've all heard that therapy is supposed to be uncensored free association, no holds barred. If it pops into your mind, it should be said, and perhaps the psychoanalysts want it that way. But let's be real here: shrinks/therapists are people, and while therapy should be a safe place to share intimate, uncomfortable, and embarrassing thoughts and feelings, and behaviors, there are limits. And as with any relationship, there are consequences. Many people have very successful psychotherapies without sharing their every thought. And if the patient's feelings are expressed in a way that makes the shrink feel threatened, uncomfortable, totally miserable, completely and irrevocably insulted, or sexually vulnerable, then one consequence may be that therapy becomes un-workable.

LadyAk47, sometimes the best, easiest, and least hurtful thing to do is to ignore an uncomfortable comment.

And to anyone who wants have sex with their therapist, maybe it's just fine if it isn't expressed in crass and threatening terms, but caged in gentler and subtler ways.

In real life, if a patient comes on to a therapist as strongly as Laura did to Paul the sequence of events is clear: Paul should document Laura's advances, he should avoid doing anything that she might misread as leading her on, he should seek formal consultation, and he should end the therapy. A psychotherapist can't be alone in a therapy session with a patient who is asking for sex. The risks of real or imagined abuse get too high and the repeated requests for sex get in the way of any real therapeutic work getting done-- instead it becomes a paradigm for frustration, discomfort, and sometimes for inappropriate sexual activity.

Onward to Episode 7