Countertransference- Coping With Hot Patients

[DoctorLion]

Maybe this has already been talked about, but I was curious to know your thoughts about this and whether or not any of you have experienced the phenomenon during your internships/ practice. Patients falling in love with you. I had a friend who recently fell head over heals with her therapist (who was a Ph.D student at the time). Of course he was not too far off from her in age and he was very lovely to look at (i've seen him a few times). The interesting thing is that she claimed he seemed to be interested in her too. Apparently he was always very professional, but would become visibly upset when she brought up other males or new relationships. Now I know we have to realistically take the possibility of a skewered perception/ wishful thinking complex into account. However the thing is that this girl is very pretty. I would rate her a good 9/10 in terms of looks (I'm really harsh when it comes to ratings). So I wouldn't blame a guy for developing feeling for her. Hearing this story made me do some research on the issue. I actually read a few articles on transference, but there is visibly not enough research on countertransference. I'm betting that this is because not enough Ph.D students/ clinicians would want to open up about their erotic/loving feelings towards patients. How do you guys/gals feel about experiencing this form of transference? Does it happen often?

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[Psychadelic2012]

Besides this being the most common ethical violation (male therapist to female client, mind you), I think it's important to remember that 1) This is an issue for supervision, 2) Therapy is not a dating service, and 3) Countertransference is about more than her looks. There are so many ways to go with this. What exactly are you wanting to explore? I find this a squirrly topic. Personally, I find it disgusting that a therapist would (or that therapists do) talk about their clients in terms of their physical attractiveness. For that I refer to my 3 points above.

 

[Therapist4Chnge]

I actually read a few articles on transference, but there is visibly not enough research on countertransference.

This topic can be covered from a number of angles, though not all are refered to as 'counter-transference.' There has been quite a bit written on counter-transference (classic and more modern non-dynamic focused) and issues related to counter-transference (e.g. supervisor v. supervisee relationship, setting boundaries, power differentials in therapy, etc).

As an aside, I'm somewhat curious about your threads. The first was about "a guy you know", and this is about "a friend" of yours....both involving two very squirrely topics. Something just doesn't sit right with them, like how some of the faculty supposedly responded. Additionally, the title of this thread includes "coping with hot patients", which is a pretty inappropriate way to even reference the topic. This is a professional forum, and these aren't exactly professional threads. Just my 2 cents.

 

[Ya Ya]

This topic can be covered from a number of angles, though not all are refered to as 'counter-transference.' There has been quite a bit written on counter-transference (classic and more modern non-dynamic focused) and issues related to counter-transference (e.g. supervisor v. supervisee relationship, setting boundaries, power differentials in therapy, etc).

As an aside, I'm somewhat curious about your threads. The first was about "a guy you know", and this is about "a friend" of yours....both involving two very squirrely topics. Something just doesn't sit right with them, like how some of the faculty supposedly responded. Additionally, the title of this thread includes "coping with hot patients", which is a pretty inappropriate way to even reference the topic. This is a professional forum, and these aren't exactly professional threads. Just my 2 cents.

👍 this was also my first reaction.

 

[DoctorLion]

This topic can be covered from a number of angles, though not all are refered to as 'counter-transference.' There has been quite a bit written on counter-transference (classic and more modern non-dynamic focused) and issues related to counter-transference (e.g. supervisor v. supervisee relationship, setting boundaries, power differentials in therapy, etc).

As an aside, I'm somewhat curious about your threads. The first was about "a guy you know", and this is about "a friend" of yours....both involving two very squirrely topics. Something just doesn't sit right with them, like how some of the faculty supposedly responded. Additionally, the title of this thread includes "coping with hot patients", which is a pretty inappropriate way to even reference the topic. This is a professional forum, and these aren't exactly professional threads. Just my 2 cents.

lol I was actually thinking of writing a little disclaimer with the question because when I think about it I have had so many interesting experiences one would begin to wonder. For the record: NO, I am not trolling (if that's what you're thinking). I'm reciting my stories to the best of my ability and I find these topics interesting or of concern to me which is why I'm bringing them up. As for the title, well I wanted to make a title that would grab attention in order to increase the likelihood of it being read. I sassed up the words a little, yes, but the content is serious. The story of my friend IS real. I haven't concocted anything. I can't help it if I run into interesting characters. What is so unprofessional about my thread? Isn't countertransference not a serious issue? The only reason why I brought it up is because of the way my friend's therapist was supposedly acting towards her. I became curious about the issue and wanted to pose the question. I find it interesting that I'm being persecuted for bringing up a topic of relevance to the field.

 

[DoctorLion]

3) Countertransference is about more than her looks. There are so many ways to go with this. What exactly are you wanting to explore? I find this a squirrly topic. Personally, I find it disgusting that a therapist would (or that therapists do) talk about their clients in terms of their physical attractiveness. For that I refer to my 3 points above.

I was reading through some of the threads in psychiatry about countertransference and the people posting there showed no hesitation recounting their experiences with beautiful clients. Some even stated it was normal for "red-blooded males" to have an attraction of that nature to their clients. Reading those posts made me want to ask the question here (since I don't believe psychiatrists get as much training this area.

I'm so sorry if this all sounds crass, but what I wanted to explore are grad-school/ clinician first impressions of countertransference and whether or not it really happens all that often... how does one cope with it. I just want real world input. But judging from the comments I received above I don't believe I will be getting anything...besides resistance.

 

[deleted176373]

Besides this being the most common ethical violation (male therapist to female client, mind you), I think it's important to remember that 1) This is an issue for supervision, 2) Therapy is not a dating service, and 3) Countertransference is about more than her looks. There are so many ways to go with this. What exactly are you wanting to explore? I find this a squirrly topic. Personally, I find it disgusting that a therapist would (or that therapists do) talk about their clients in terms of their physical attractiveness. For that I refer to my 3 points above.

Eh?

Not so sure I agree that it's disgusting to acknowledge that a client is physically attractive to another person. Some things simply are. Failing to acknowledge that a client's physical attractiveness, or lack there of, may be playing a role in their clinical presentation seems a little short sighted. Several times attractiveness, or lack there of, and a clients self-perception of attractiveness and self-esteem has played a role in clinical presentation.

Where I would agree with you is a situation where a therapist sees a client only from the stand point of physical attractiveness and is primarily attending to their attraction to that person while in session. Ya, that's freaking creepy as hell.

Granted, this is really an issue for supervision, therapy is not the place for finding a mate, and counter-transference is about much more than looks. However, I can acknowledge that I have plenty of physically attractive clients both male and female without being disgusting, nothing wrong with stating the clearly obvious. It's the nature of military service, lots of in-shape people, many of which are young and attractive.

Despite having physically attractive clients, I cannot remember ever seeing a client where I saw them anything more than a patient who needed help solving their mental health problems. Counter-transference is always present though, in both attractive and unattractive clients, in both male and female clients, with both male and female therapists.

M

PS - I agree the way the topic is presented by the OP lacks maturity and tact.

 

[Psychadelic2012]

MarkP, I'll clarify that it's not just the fact that a client is attractive, it's the *talking* about it with a "tone". I find it gross when a colleague says "He/she is hot!!". You can disagree with that, but I still feel that way. Discussing it, outside of suprvision, gives me the willies. By the way, it's usually men who do that (in my exprience). I absolutely agree that clients can BE attractive, and talking about it in supervision is a must. Anything else risks objectifying them and taking advantage of their vulnerability when the therapist has this other focus.

 

[wigflip]

As an aside, I'm somewhat curious about your threads. The first was about "a guy you know", and this is about "a friend" of yours....both involving two very squirrely topics. Something just doesn't sit right with them, like how some of the faculty supposedly responded. Additionally, the title of this thread includes "coping with hot patients", which is a pretty inappropriate way to even reference the topic. This is a professional forum, and these aren't exactly professional threads. Just my 2 cents.

Eh?

PS - I agree the way the topic is presented by the OP lacks maturity and tact.

OP = an UG.

 

[FadedC]

In terms of acknowledging the attractiveness of a client, that's something I've always found interesting about Yalom's books, is that he doesn't beat around the bush with that. I'm not sure if he's ever said "she's hot", but he's come pretty close.

I'm sure it has the potential to have a huge effect on people (and Yalom always acknowledged the effect it had on him), and it's probably the reason why ethical violations are so common regarding therapist/client sexual contact. However I'm not really sure how exactly one would go abou studying it in a scientific manner.

 

[Psychadelic2012]

OP = an UG.

:cry: You're not going to enlighten us with your feminist perspective? Well, a lady can dream. 😍

 

[ClinPsychEnthus]

Eh?

Not so sure I agree that it's disgusting to acknowledge that a client is physically attractive to another person. Some things simply are. Failing to acknowledge that a client's physical attractiveness, or lack there of, may be playing a role in their clinical presentation seems a little short sighted. Several times attractiveness, or lack there of, and a clients self-perception of attractiveness and self-esteem has played a role in clinical presentation.

Where I would agree with you is a situation where a therapist sees a client only from the stand point of physical attractiveness and is primarily attending to their attraction to that person while in session. Ya, that's freaking creepy as hell.

Granted, this is really an issue for supervision, therapy is not the place for finding a mate, and counter-transference is about much more than looks. However, I can acknowledge that I have plenty of physically attractive clients both male and female without being disgusting, nothing wrong with stating the clearly obvious. It's the nature of military service, lots of in-shape people, many of which are young and attractive.

Despite having physically attractive clients, I cannot remember ever seeing a client where I saw them anything more than a patient who needed help solving their mental health problems. Counter-transference is always present though, in both attractive and unattractive clients, in both male and female clients, with both male and female therapists..

I'm not sure I could have said it better! 👍

 

[wigflip]

:cry: You're not going to enlighten us with your feminist perspective? Well, a lady can dream. 😍

I couldn't have said it better than you did above in post #8...

 

[weeblewobble]

Eh?

Not so sure I agree that it's disgusting to acknowledge that a client is physically attractive to another person. Some things simply are. Failing to acknowledge that a client's physical attractiveness, or lack there of, may be playing a role in their clinical presentation seems a little short sighted. Several times attractiveness, or lack there of, and a clients self-perception of attractiveness and self-esteem has played a role in clinical presentation.

Where I would agree with you is a situation where a therapist sees a client only from the stand point of physical attractiveness and is primarily attending to their attraction to that person while in session. Ya, that's freaking creepy as hell.

Granted, this is really an issue for supervision, therapy is not the place for finding a mate, and counter-transference is about much more than looks. However, I can acknowledge that I have plenty of physically attractive clients both male and female without being disgusting, nothing wrong with stating the clearly obvious. It's the nature of military service, lots of in-shape people, many of which are young and attractive.

Despite having physically attractive clients, I cannot remember ever seeing a client where I saw them anything more than a patient who needed help solving their mental health problems. Counter-transference is always present though, in both attractive and unattractive clients, in both male and female clients, with both male and female therapists.

M

PS - I agree the way the topic is presented by the OP lacks maturity and tact.

This is a really good take.

The other thing I'd add is that I've always had difficulty understanding how therapists become actually attracted to clients, beyond noticing they are physically attractive. Clients come in and tell us all the worst things about themselves- their worst life experiences, the worst thoughts they have about themselves and other people, and the most difficult things they are dealing with currently. They are (usually) good people with good intentions, but we don't get their "date" face or their "trying to pick up a guy/girl in the bar" face, we get the "crying eyes out over lost parent while facing foreclosure" face. I do not find this attractive, and I can't understand how others do. Seems to me a little bit like preying on the vulnerable, which is yucky.

I'd also say that from a non-wigflip approved feminist standpoint, I think it's really important not to objectify any clients, male or female or otherwise. "Hot" is not a good way to describe your client, even if they are. These are people letting down their defenses in your presence- be respectful and professional.

But- yeah, if someone is distracted or having difficulty acting professionally due to anything about a client or their interactions with a client, that's a supervision issue.

 

[wigflip]

This is a really good take.

The other thing I'd add is that I've always had difficulty understanding how therapists become actually attracted to clients, beyond noticing they are physically attractive. Clients come in and tell us all the worst things about themselves- their worst life experiences, the worst thoughts they have about themselves and other people, and the most difficult things they are dealing with currently. They are (usually) good people with good intentions, but we don't get their "date" face or their "trying to pick up a guy/girl in the bar" face, we get the "crying eyes out over lost parent while facing foreclosure" face. I do not find this attractive, and I can't understand how others do. Seems to me a little bit like preying on the vulnerable, which is yucky.

I feel the same way about grad students dating traditional aged undergrads, particularly their own students. "You read their crappy papers, right? How is functional illiteracy attractive?" 😱

I'd also say that from a non-wigflip approved feminist standpoint, I think it's really important not to objectify any clients, male or female or otherwise. "Hot" is not a good way to describe your client, even if they are. These are people letting down their defenses in your presence- be respectful and professional.

But- yeah, if someone is distracted or having difficulty acting professionally due to anything about a client or their interactions with a client, that's a supervision issue.

Why "non-wigflip approved?" I agree with everything you say above.

 

[erg923]

MarkP, I'll clarify that it's not just the fact that a client is attractive, it's the *talking* about it with a "tone". I find it gross when a colleague says "He/she is hot!!". You can disagree with that, but I still feel that way. Discussing it, outside of suprvision, gives me the willies. By the way, it's usually men who do that (in my exprience). I absolutely agree that clients can BE attractive, and talking about it in supervision is a must. Anything else risks objectifying them and taking advantage of their vulnerability when the therapist has this other focus.

I have a lecture in my ethics course that is titled "Sometimes Antonio Banderas will be your client." That means, in no uncertain terms, that yes, some people are "hot"...and these people seek therapy too. 🙂

NOT acknowledging that physical/sexual attraction is initiated by forces outside the psychosocial situation/setting is a good way to deny your way out of things and make yourself blind. We all know that "awareness" is like the best thing ever in sticky clinical situations.

 

[Doctor Eliza]

To me it is a little like noticing an attractive high school student. You can note that they are pretty/handsome, but it wouldn't cross your mind to be attracted to them (well, I guess there are a few of those stories, but that is a whole different bucket of pathology).

When you are working with patients, it is a totally different mindset than being out in the "real world."

Best,
Dr. E

 

[wigflip]

Some even stated it was normal for "red-blooded males" to have an attraction of that nature to their clients.

This "red-blooded males" discourse gives me the heebie-jeebies.

And 9 times out of 10 when people use "male" and "female" as nouns (rather than adjectives) they're evincing an essentialist/backwards/creepy gender ideology.

 

[weeblewobble]

I feel the same way about grad students dating traditional aged undergrads, particularly their own students. "You read their crappy papers, right? How is functional illiteracy attractive?" 😱

...

Why "non-wigflip approved?" I agree with everything you say above.

Well thanks! I'll amend it to "non-wigflip approved YET"


Agreed about dating UGs. After you read enough whiny emails and papers with emoticons (!!!!) it's impossible to see them as feasible dating partners.

 

[wigflip]

Well thanks! I'll amend it to "non-wigflip approved YET"


Agreed about dating UGs. After you read enough whiny emails and papers with emoticons (!!!!) it's impossible to see them as feasible dating partners.

Wow, I've never had that--just papers with texting abbreviations/acronyms. 🙄

 

[Psychadelic2012]

This "red-blooded males" discourse gives me the heebie-jeebies.

And 9 times out of 10 when people use "male" and "female" as nouns (rather than adjectives) they're evincing an essentialist/backwards/creepy gender ideology.

THAT's what I'm talkin' about!!!!

 

[weeblewobble]

Wow, I've never had that--just papers with texting abbreviations/acronyms. 🙄

It's kind of like they're patting themselves on the back- ex: "If you think about it, Freud was TOTALLY trapped in the oral stage! 😎" These are always the times where I need my sarcasm pen 😀

 

[LivingOffLoans]

This "red-blooded males" discourse gives me the heebie-jeebies.

Same. Like, what does that mean? The term, and how it was phrased, seems to conjure up the stereotype that men are reckless sex savages who cannot control themselves. And isn't that how female victims of male perpetrated rape are blamed? E.g. "She shouldn't have worn that low cut dress!" As if an erection could be equated to a psychotic break or something

But, to weigh in on OP's question, my personal take is this: You handle it like a professional with integrity and maturity, the same way you would in working with anyone in any profession who society constructs as 'attractive'. The job is where your focus goes. Of course, I agree with a lot of the above posts that state there is always something deeper at play in countertransference than sexual attraction. It is helpful to remember this, as it is in any countertransference experience. Speaking from my own experiences, I can only say that what I am most attracted to is the idea of helping people and society - 'the greater good', if you will. This both guides and triumphs most serious countertransference experiences (in the case of your question, erotic) and is what maintains my ability to remain objective. I've sure heard of instances where, unfortunately, therapists violate boundaries that inflict some of the most traumatic consequences you could imagine. But I think you could benefit from reframing how you think of these scenarios. Judging by your posts (and listening to my own inner analyst here), me thinksies that you might be experiencing this very phenomena yourself and may be projecting. No?

For those of us who can handle 'stuff', I personally don't see erotic countertransference as differing much from, say, countertransference with a theme to rescue someone the way you could not rescue a parent. In any case, it always has the potential to be informative in some way about the dynamics in the room, and therefore, beneficial to a skilled clinician doing therapy.

I'm sorry if any of that came across as too strong, but I think your initial question makes room for a good conversation worth having.

 

[DoctorLion]

Same. Like, what does that mean? The term, and how it was phrased, seems to conjure up the stereotype that men are reckless sex savages who cannot control themselves. And isn't that how female victims of male perpetrated rape are blamed? E.g. "She shouldn't have worn that low cut dress!" As if an erection could be equated to a psychotic break or something

But, to weigh in on OP's question, my personal take is this: You handle it like a professional with integrity and maturity, the same way you would in working with anyone in any profession who society constructs as 'attractive'. The job is where your focus goes. Of course, I agree with a lot of the above posts that state there is always something deeper at play in countertransference than sexual attraction. It is helpful to remember this, as it is in any countertransference experience. Speaking from my own experiences, I can only say that what I am most attracted to is the idea of helping people and society - 'the greater good', if you will. This both guides and triumphs most serious countertransference experiences (in the case of your question, erotic) and is what maintains my ability to remain objective. I've sure heard of instances where, unfortunately, therapists violate boundaries that inflict some of the most traumatic consequences you could imagine. But I think you could benefit from reframing how you think of these scenarios. Judging by your posts (and listening to my own inner analyst here), me thinksies that you might be experiencing this very phenomena yourself and may be projecting. No?

For those of us who can handle 'stuff', I personally don't see erotic countertransference as differing much from, say, countertransference with a theme to rescue someone the way you could not rescue a parent. In any case, it always has the potential to be informative in some way about the dynamics in the room, and therefore, beneficial to a skilled clinician doing therapy.

I'm sorry if any of that came across as too strong, but I think your initial question makes room for a good conversation worth having.

No, but hearing about my friend's therapist's behaviour freaked me out a little too much. How does one go about reframing how they think of this kind of therapist/ client relationship 😕

 

[deleted176373]

No, but hearing about my friend's therapist's behaviour freaked me out a little too much. How does one go about reframing how they think of this kind of therapist/ client relationship 😕

Not everything needs to be reframed... Sometimes you need to take an Albert Ellis like stance and call people out when they are completely wrong. Sometimes, wrong, is well... just wrong. He needed to distance himself emotionally from the client and was finding it difficult. The therapist has ALL of the responsibility with regards to this... ALL of it.

M

 

[ResearchGirlie]

I feel the same way about grad students dating traditional aged undergrads, particularly their own students. "You read their crappy papers, right? How is functional illiteracy attractive?" 😱

100% Agree. It's something that seems to happen way too much.

 

[deleted176373]

Well thanks! I'll amend it to "non-wigflip approved YET"

Agreed about dating UGs. After you read enough whiny emails and papers with emoticons (!!!!) it's impossible to see them as feasible dating partners.

I feel the same way about grad students dating traditional aged undergrads, particularly their own students. "You read their crappy papers, right? How is functional illiteracy attractive?" 😱

Why "non-wigflip approved?" I agree with everything you say above.

100% Agree. It's something that seems to happen way too much.

Next y'all are gonna complain about doctors and nurses dating!!!

 

[erg923]

100% Agree. It's something that seems to happen way too much.

What are we saying here? That age difference is somehow "wrong" or a sign of pathology? I thought that was typically the norm. My wife is 5 years younger than me and was in undergrad when I was getting my ph,d. This creeps people out?! Why?

PS: I did not initiate dating my wife cause she wrote elegant sentences...know what I am sayin...

 

[ResearchGirlie]

What are we saying here? That age difference is somehow "wrong" or a sign of pathology? I thought that was typically the norm. My wife is 5 years younger than me and was in undergrad when I was getting my ph,d. This creeps people out?! Why?

PS: I did not initiate dating my wife cause she wrote elegant sentences...know what I am sayin...

My response has nothing to do with age and everything to do with graduate students teaching undergrads should not be dating said undergrads. There's a power dynamic that shouldn't be crossed. Grad student should have to follow the same rules as faculty members in regards to teacher/student relationships.

 

[wigflip]

Same. Like, what does that mean? The term, and how it was phrased, seems to conjure up the stereotype that men are reckless sex savages who cannot control themselves. And isn't that how female victims of male perpetrated rape are blamed? E.g. "She shouldn't have worn that low cut dress!" As if an erection could be equated to a psychotic break or something

So glad to see someone else make this connection to rape myths. It's really an insult to men to afford them so little agency. Bravo! 👍

 

[LivingOffLoans]

So glad to see someone else make this connection to rape myths. It's really an insult to men to afford them so little agency. Bravo! 👍

Right on! 😉

PS: What's up with the new avatar? lol Cute cat though.

 

[wigflip]

Right on! 😉

PS: What's up with the new avatar? lol Cute cat though.

Saw it on yelp and I couldn't stop laughing. I need more snicks these days, so I switched for the holidays.