Feb

14

2022

The Ethics of Love in Therapy: Erotic Transference and Countertransference
Love can be a great healer in counselling and psychotherapy, but when refused or abused it can be equally harmful. So how can therapists navigate erotic transference and countertransference ethically, while harnessing love’s power?

Ask ten people what ‘love’ means to them, and you’ll probably get ten different answers. Love is so complex that the Ancient Greeks divided the word into 6 different types:

  • Agape is unconditional, charitable love which transcends circumstance, often used to describe the love for our children or spouse.
  • Eros is romantic love, associated with passion and desire.
  • Philautia is self-love, which we need to find inner happiness.
  • Philia is brotherly love for friends, family and the community.
  • Storge is empathetic familial love from parents to children.
  • Xenia is hospitality, welcoming guests, gift-giving and generosity.

Many of these definitions have clear links to a strong therapeutic relationship. Carl Rogers’ core conditions of unconditional positive regard, empathy and congruence relate to many, if not all, the Greek sub-categories.

Ethical love

However, for a therapist to act upon feelings of eros, or sexual attraction, is inappropriate and unethical under any circumstances.

But feelings of erotic attraction are part of being human, and therefore likely to surface in both directions during a therapist’s career.

Psychotherapy is not a place for avoiding or suppressing emotions, but instead a place for intimacy, honesty and exploration. Therapy is also about intimacy, and teaching clients they are capable of loving and being loved. See Intimacy in Counselling (Brighton Therapy Partnership, 2019).

So the question is not whether or not love is appropriate, but instead how we can give and respond to love in the therapy room in a way that promotes the client’s wellbeing.

As Bodenheimer (2010) concludes: “Perhaps the most powerful reason to avoid the complicated presence of love in the therapeutic relationship is the very reason it must be deeply understood and scrutinised: It is an ethical minefield” (p. 39).

Adverse Idealising Transference

Early in the relationship, clients may idealise their therapist. For some, this can feel like romantic attraction – otherwise known as erotic transference. See Erotic Transference and Countertransference – Nine Things All Therapists Need to Know (Brighton Therapy Partnership, 2014).

In cases of erotic transference, there may be an unconscious hope from a client that their love will be met differently than by their caregivers in childhood. Attraction in therapy may therefore be more likely from clients who had unsatisfying attachments  (Devereux, 2016; Kirby, 2019).

For a smaller number of clients, these feelings intensify over time. If these clients are not responded to appropriately, there is an increased risk of adverse idealising transference (AIT) developing.

By definition, AIT ‘impacts on a person so that over a sustained period their ability to function in their usual way is adversely impaired’ (Devereux, 2016). This impact can last for decades.

Deep down, such clients are likely seeking a perfect caregiver rather than a sexual partner, meaning any sexual contact will eventually be experienced as exploitative.

Succumbing to a desire for the therapist to become a ‘perfect protector’ is likely to lead to a repetition of familiar patterns, which could be holding a client back in their wider lives.

In successful therapy, however, the client may realise that idealising and seeking perfection from others, including the therapist, is counter-productive. By sticking with the transference and bringing it to a new conclusion, a new door is opened for the client.

The client’s inner child must also learn to accept the frustration of an imbalanced relationship which has clear boundaries.

Risk factors

The Clinic for Boundaries Studies (CfBS) assists clients who feel they have been harmed in therapy. In analysis of client reports, the CfBS noted five common therapist characteristics, or personality types, which were common in cases of AIT (Devereux, 2016):

  1. Psychopath – The therapist consciously uses transference to foster dependence and intentionally exploits the client.
  2. Opportunist – The therapist does not set out to harm, but cannot resist acting on their countertransference when an opportunity arises. The therapist will then convince themselves the love is real. These therapists typically have poor boundaries, relationship issues and possible narcissism.
  3. Compensators – The therapist feels they can offer love to make up for a deficit in the client’s past to prove that they care.
  4. Ignorer – The therapist denies or ignores the transference, or disapproves when a client reveals their feelings. The client may then hide their feelings, and could leave therapy and never resolve the transference.
  5. Appropriate – In some reported cases of AIT, the CfBS concludes that the therapist dealt with the transference in an ethical manner. In these cases, it is deemed that the client may have a delusional perspective on the therapist’s behaviour, which leads to a complaint.

Clients also told CfBS they wished they knew the risks of AIT before starting therapy, likening therapy to a drug which should come with adverse side-effects warnings.

In addition, characteristics indicating a higher likelihood of clients developing AIT include:

  • A history of dependent or idealised relationships.
  • A sense that the client is seeking care rather than insight.
  • Unrealistic expectations of therapy.

If all three are present in assessment, practitioners should consider if the client will benefit from therapy (Devereux, 2016).

Countertransference

Erotic countertransference is when a therapist feels attraction towards a client. It is often a combination of a reaction to client projections, and an expression of the therapist’s inner world (Kirby, 2019).

During erotic countertransference, therapists may feel:

  • Scared and unsettled.
  • Ashamed and guilty.
  • Self-doubt and ungrounded.
  • Isolated and exposed.

They may also be inclined to

  • Avoid discussion of attraction.
  • Reduce interventions.
  • Offer gifts and break boundaries.
  • Panic and fail to reflect on the work.
Countertransference as a problem

Difficulties navigating countertransference can be traced back to Freud, who spoke of a need to ‘dominate countertransference’ in a letter to Jung, describing the phenomenon as ‘a permanent problem for us’.

Despite this awareness, throughout the 20th century erotic countertransference was a largely neglected topic. Many training programmes disregarded the significance of erotic transference, and may have left therapists without the skills to manage issues around attraction (Bodenheimer 2010).

Therapists have also been reluctant to speak about or seek support for erotic transference and countertransference, despite it being common (Stirzaker, 2000).

Useful countertransference

In more recent years, coinciding with the growth of relational psychotherapy, the perspective on countertransference began to shift. Rather than something shameful which should be avoided, a therapist’s feelings are commonly seen as useful information, if used appropriately (Berman, 1997).

As acceptance of countertransference grew, Schamess (1999) and Stirzaker (2000) encouraged the discussion of erotic countertransference in the therapy room, as this can help to reveal a client’s way of relating to others. Herbert Rabin (2003) similarly encouraged discussion of therapeutic love, which he said can be curative. See Learning to Talk About Sex In Therapy And Counselling (Brighton Therapy Partnership, 2018).

When love goes wrong

Despite the potential benefit of discussing love and feelings of attraction, vigilance and deep reflection are vital.

When boundaries are crossed and erotic countertransference is acted upon, this is often due to issues with a therapist’s personal development and blind spots in their self-awareness (van Rijn and Lukac-Greenwood, 2020). Therefore, personal therapy and supervision play a vital role in preventing or managing erotic transference and countertransference.

By integrating our own personal, professional and sexual selves, we may be able to more easily normalise attraction in therapy. We can focus on exploring love’s meaning and how we respond to it, rather than feeling ashamed and avoiding the area.

Action plan

Timely action should also be taken if a boundary is crossed, particularly as most clients will only hint at attraction (Kirby, 2019).

The BACP fact sheet Recognising and managing attraction in the counselling professions (2021) suggests guidelines to follow when attraction arises:

  • Acknowledgement to self.
  • Noting characteristics and impact.
  • Strengthening of self-control.
  • Gently reinforcing boundaries in a tentative, non-rejecting way.
  • Inviting collaboration rather than imposing meaning.
  • Managing outward displays of discomfort, distaste, or anxiety.
  • Temporarily shutting off/compartmentalising where necessary.
  • Ensuring consistent behaviour towards the client compared with others.
  • Not steering discussion away from topics of attraction.

If a therapist wishes to disclose their own feelings of attraction, this must be discussed and reflected on in supervision.

Disclosure should only be made if the therapist and supervisor are sure the disclosure is with the client’s best interest at heart, which must be accompanied with a clear therapeutic rationale for the disclosure (BACP, Good Practice in Action 117: Self disclosure within the counselling professions).

Professionalism vs Rejection

When attraction arises, many therapists are fearful of a complaint and tend to withdraw. Avoiding engagement with attraction is often rationalised by therapists as a way to remain professional and avoid conflict or client disappointment.

But this goes against the BACP’s Ethical Framework for the Counselling Profession (2018), which requires therapists to aim to alleviate client suffering, improve their clients’ quality of relationships, and to uphold moral qualities of self-respect, resilience and courage.

In addition, avoiding or ignoring feelings of attraction is a common trait of therapists whose clients go on to develop AIT (Devereux, 2016).

Here-and-now

For many clients, disclosing attraction is the expression of a ‘here-and-now’ desire to be lovable. If this is dismissed as a product of the past alone, then relational patterns are likely to have been missed. Therefore, practitioners should not limit discussion of sex in therapy simply due to the abuse that takes place, or the fear of judgement (van Rijn and Lukac-Greenwood, 2020).

Relationalist Daniel Shaw (2003) highlighted the contradiction in therapy that we are attempting to enable a client to love, but that we may avoid the acknowledgement of love in the room. He urged therapists to use precise language when talking about feelings of love and attraction, to help a client distinguish between transference from their history, and genuine feelings.

Delicate balance

Managing erotic transference is a delicate balance between acknowledging feelings and being open to exploration, while avoiding defensive or rejecting behaviour and maintaining boundaries.

Attraction is a natural human experience, and to navigate it effectively in the therapeutic relationship takes bravery. It is vital to use our support networks and resources to ensure erotic transference is dealt with ethically, and to ensure clients are free to explore a natural part of themselves.

 

If you found this article interesting, perhaps you might like a further exploration into the aspects of *Love in Psychotherapy* by attending our online conference on Saturday 5th March 2022. Click here for more information and to book your place.

We always welcome your feedback, so please leave a comment below or share this article with your fellow therapists.

References

BACP (2018) Ethical Framework for the Counselling Professions. Lutterworth: BACP

BACP (2021) Good Practice in Action 117. Fact Sheet: Practitioner self disclosure within the counselling professions. Lutterworth: BACP

BACP (2021)  Good Practice in Action 119 Fact Sheet: Recognising and managing attraction within the counselling professions.  Lutterworth: BACP

Berman, E. (1997). Relational psychoanalysis: A historical background. American Journal of Psychotherapy, 51(2), 185-204.

Bodenheimer, D. (2011). An examination of the historical and current perceptions of love in the psychotherapeutic dyad. https://repository.upenn.edu/cgi/viewcontent.cgi?article=1005&context=edissertations_sp2 (accessed 31 January 2022) Clinical Social Work Journal, 39(1),

Devereux, D. (2016) Transference love and harm. www.bacp.co.uk/bacp-journals/therapy-today/2016/september-2016/transference-love-and-harm (accessed 31 January 2022) Lutterworth: BACP.

Kirby, V. (2019) Seduction in the counselling room. Therapy Today June: Vol 30 (5) Lutterworth: BACP.

Rabin, H. (2003). Love in the countertransference: Controversies and questions. Psychoanalytic Psychotherapy, 20(4), 20-33.

Schamess, G. (1999). Therapeutic love and its permutations. Clinical Social Work Journal, 27(1), 9-26.

Shaw, D. (2003). On the therapeutic action of analytic love. Contemporary Psychoanalysis, 39(2), 251-278.

Stirzaker, A. (2000). The taboo which silences: Is erotic transference a help or a hindrance in the counseling relationship? Psychodynamic Counseling, 6(2), 197- 213.

van Rijn, B. Lukac-Greenwood, J. (2020) Working with Sexual Attraction in Psychotherapy Practice and Supervision. Abingdon: Routledge.

 

 

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