Tales from the Couch

Seeing the patient from psychiatry’s perspective

Sex with a Former Patient

The temptations of the profession

Some years ago when I was single, Eva G began psychotherapy. She was unhappy because she was repeatedly involved in ungratifying relationships with men who were at least 20 years her senior. She was quite attractive, bright, articulate, and wanted to understand her need to date older men.

The psychotherapy continued once-weekly for about seven months. She quickly developed insight into the dynamics of her choices in men, and began making better decisions in her dating life. When it seemed Eva’s goals were reasonably met, the therapy came to an end. When we parted company, she knew the door to my office was open should she want to look deeper into her conflicts.

About seven months later, she called my office.

“I was wondering if I could see you,” she said.

“Sure. Let me look at my appointment book…”

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“No, I mean socially. Could we go out for a drink…?”

I was surprised, but not stunned. Okay, I’ll admit she was attractive and there can always be an undercurrent of sexual allure in a relationship. But I’d been her therapist, and to get involved in any fashion would have been a boundary violation.

“I’m afraid that’s impossible,” I said.

“But you’re not my doctor anymore.”

“That’s not the point. I was your therapist and because of that, I can’t have a social relationship with you…”

“But the therapy is over and I’ve moved on. Isn’t there a…I don’t know…isn’t there a statute of limitations?” she asked with a laugh.

“I’m afraid there isn’t.”

I was aware some therapists believe there can be a “waiting period” or “statute of limitations” (to use Eva’s term) once therapy is over. After that time period passes, they feel it’s acceptable for a social or sexual relationship to develop. Some say the interval should be two years; others say it could be as long as five.

I say: never.

It can be tempting to engage in a relationship with a former patient or client. Any therapist who denies having ever been tempted is either lying or is simply deluded.

That Eva wanted to see me socially was, by itself, evidence she still had unresolved problems. I was more than 15 years her senior. But there was something else, something equally important: transference had developed while she was in treatment. It always remains, never disappears.

By its very nature, transference guarantees a power disparity in any relationship—even if therapy ended long ago. Despite the passage of time, the therapist is not perceived realistically by the former patient. The therapist is viewed unconsciously as some parental or other powerful figure from the former patient’s past. That alone defines any proposed relationship as a parent-child interaction. Or a teacher-student interface. Any possible relationship—six months or six years after therapy is over—is tainted by residual transference.

Even though years have passed, any extra-therapeutic relationship—no matter how tempting—is taboo.

 

 

Mark Rubinstein, M.D., is a former professor of psychiatry at Cornell. His most recent book is the novel Mad Dog House.

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