I am watching the show ‘In Treatment’ on HBO. It follows a Therapist with his many clients. One of his clients professes a deep love for him and carries on with it.
Should a Therapist continue treatment in that scenario?
According to Wikipedia (“transference”)
In a therapy context, transference refers to redirection of a client’s feelings from a significant person to a therapist. Transference is often manifested as an erotic attraction towards a therapist, but can be seen in many other forms such as rage, hatred, mistrust, parentification, extreme dependence, or even placing the therapist in a god-like or guru status. When Freud initially encountered transference in his therapy with clients, he felt it was an obstacle to treatment success. But what he learned was that the analysis of the transference was actually the work that needed to be done.
I didn’t see the show you describe but it could fall under this scenario.
Hmm. I know about transference, even taken a class in it. But, I am curious about the ethics for the therapist in such a scenario. Freud thought that the transference issue was what needed to be worked out. Is that the position that psychiatric ethics takes today? Maybe this is a GQ and not a GD.
As a psychologist - although not the clinical variety - it is up to the individual therapist. There are a lot of variables, by in large if a client shows a sexual interest that goes beyond a theraputic environment the session should be stopped and a referral to another therapist should be given. All therapists are different, and yes there are some who are unethical and will continue to see a client who has a strong sexual desire for them, and in some cases do unethical things…but I’d hope those therapists are few and far between.
As for the ethics of the individual therapist? They should have a sense if the environment has become unsafe, or untheraputic and discuss it openly with the client - and further should refer them out if it is unsafe, or not conducive to a theraputic environment.
The ethics for professionals who provide psychotherapy are that they don’t have sex or romance with clients. The transference (or however you want to describe the client’s emotions) is considered to be a focus of some theories of therapy, but not others. In either event, it’s reasonable for the therapist to discuss the client’s feelings within the therapy. The therapist would do well to clarify that the discussion is intended to understand the client’s interpersonal dynamics and that the therapist is not going to have sex with the client.
Again, I didn’t see the show you referenced and I’m not a shrink in the first place.
I read the wiki thing to mean that Freud is saying that if a client fell in love with him, he would say that meant the patient had love issues and take it from there. Freud would not believe the patient truly loved him…it would be more like the patient seeing a mirage in the desert.
That’s very well put IMHO. Transference is a form of projection and a wellspring of insight, and that’s coming from someone who doesn’t hold a whole lot to psychodynamic therapy. Countertransference, where the clinician struggles with unusually strong feelings towards the client, is also useful as a tool, and not just for personal growth – there is some notion that over time certain types of countertransference can indicate a sensitivity to a diagnostic category or cluster of categories.
Some will feel more confident that they can keep a handle on a strong transference or countertransference and make therapeutic use of it – in experienced hands and in the right doses, strong feelings can point the way to a strong therapeutic alliance. The need to define boundaries and restate roles repeatedly can be tiring, though, so many will avoid this type of work and will pass the person along instead.
Thanks…I get lucky once in awhile 
Continuing the analogy, the patient firmly believes that it’s love (just as they firmly believe the mirage is water) and will/would act on that belief if an opportunity presents itself. An unethical/unenlightened therapist could do some real damage if they took it as genuine instead of seeing it for what it is.
One of their golden rules a prof of mine used to cite a lot: they can’t assume a dual role—lover and therapist, in this case but others (therapist/friend, therapist/business partner) may arise—because some objectives of the two roles will be incompatible.
A more mundane parallel: as a teacher, I have run ins with students from time to time. I’ve grown a thick skin because I know in many cases, they’re reacting to me as an authority figure, not as an individual. Likewise, a few have declared their love for me. Maybe they don’t have a daddy in their lives or maybe they just broke up with a boyfriend…or maybe they just have excellent taste in men. Whatever the case, I ain’t going there, believe me.
I suppose all helping professions deal with similar things, e.g. the Florence Nightingale effect in the medical field.
I am studying to be a massage therapist, and we had to take a few ethics classes regarding transference/counter-transference, dual-relationships, sex with clients etc…
What he said.
(therapist here)
Ultimately, the therapist has to be a “safe place” that you can go to in any kind of crisis. If she or he becomes your lover, what happens if you quarrel or break up?
There is always the possibility that what the patient feels is not transference, but genuine feelings of love. What then? And who’s to determine the difference?
Those who haven’t seen the program can catch up on On Demand. It is so worth the time. Gabriel Byrne is phenomenal as the psychologist.
No wonder my psychiatrist grinned when I told him of my dream that made me a child and him my father. The same is true for the dream that placed him on the throne of England. Ha! That doesn’t mean that I didn’t find him sexy. I just knew to guard against those feelings.
That’s why a therapist doesn’t have sex with a client no matter what. I don’t think it’s necessary or useful to argue with the client about whether the feelings are real or symbolic. The bottom line is that the feelings and their implications can be discussed if that fits the orientation and focus of the therapy, and that discussion is the only thing that happens.
Obviously the therapist shouldn’t be screwing his clients. However, in a more ambiguous situation like the one in the show, is what I’m more interested in. What if the client becomes forceful and insistent about it like Laura does in the show.
I haven’t seen the show. If the client become so insistent that the work of the therapy can’t be done, and is not willing to stop, then the therapist should make a referral and terminate with appropriate explanation to the client.
I am loving this show. Licensed psychologists (not psychiatrists) are bound by a code of ethics, which clearly defines multiple relationships, guidelines for sexual intimacies with patients, and terminating therapy.
Basically, a therapist should never have sex with a current client, and should not terminate therapy unless there are valid reasons, and feeling “icky” about a client professing love for them is not a valid reason.
Therapists also need to have another therapist to bounce ideas and issues off of, to insure that therapist is acting in the best interests of the clients. Thus far, In Treatment is a pretty accurate portrayal of the therapeutic process, with a few dashes of Hollywoodisms.
I agree, with the proviso that if the therapist gets consultation and still feels too icky to be able to perform therapy effectively, that is a matter of competence and the client ought to be referred (and the therapist should work in further consultation to understand why it felt so icky).