By Carlin Flora, published on January 1, 2006 - last reviewed on June 22, 2007
Jacqueline Wren* thought about him quite a lot. When she knew she would see him, she made sure she looked good. She dissected his every comment and studied his face for clues. Could he feel the same way? Though they talked openly for months, she censored herself, at times concealing the less palatable parts of her personality. "I wish I could say it was reciprocated," she says of her longing. Wren had a crush on her psychiatrist.
Therapists are often the objects of their patients' desire. Male or female, a therapist's power and authority lend a certain sexual appeal. The process of transference—in which a patient's emotions for parents and other figures are channeled toward the therapist—leads people to harbor feelings sparked by the therapist's role, not the actual person. And the qualities that make for effective therapy, such as careful listening and unconditional acceptance, are inherently seductive.
The professional boundary is clear: Therapy should never include sexual contact. Such a relationship could cost a therapist his license or even land him in jail, not to mention the emotional harm it could cause the patient. But humans being humans, attraction does play into therapeutic interactions, and not always to bad effect.
"I was just out of college, and he was 40-something," says Wren, a 30-year-old administrator, of her former psychiatrist. "He was not really attractive. Had I met him socially, I don't think I would have liked him. But I was single, and he was the only man who was taking an active interest in me." Her feelings eventually subsided, in part because she caught a glimpse of a family portrait on his desk. "That drove home the inappropriateness of the situation for me."
Transference that includes erotic feelings is less likely to occur in cognitive-behavioral therapy (CBT)—wherein the therapist challenges a patient's irrational beliefs in a structured manner—than within a more psychodynamic variety of treatment, says John Jacobs, New York-based psychiatrist and author. "With CBT, you're not just talking about internal feelings, you are focused on solving a problem." The free-associative outpouring of intimacies and memories that characterize psychodynamic therapy, on the other hand, is in some ways akin to opening up to a loved one.
No matter what techniques a therapist uses, the basic architecture of the one-on-one meeting provides an intimate setting where romantic feelings can grow. Ellen O'Conner*, a 29-year-old banker, has seen three psychiatrists in the past decade. "In a world of Blackberries and text messages, just sitting across from someone for an hour is unique," she says. "It would be hard not to love that time in a quiet room where you can think about your life, and also the person listening to you and looking into your eyes."
Therapists must acknowledge a patient's attraction and learn from it, says Susie Orbach, an author, psychoanalyst and visiting professor at the London School of Economics. "It's very hard when someone tells you they've bought your books and are masturbating over your picture," she says. "But you don't want to deny their feelings, and you want them to know they can trust you to not be sexually inappropriate."
Liza Shaw, a marriage and family therapist based in Hickory, North Carolina, tells of a client who sought her services to save his failing marriage. His wife complained that he was an unconscionable flirt, so Shaw was not suprised when he began teasing her.
"He told me he had a foot fetish and would compliment my shoes," she says. She began pointing out his sexual innuendo. "He was really self-conscious at first, and he denied it."
Eventually, he realized that he used flirtation to avoid discussing other emotions: "When the situation became intense, he would lighten the mood with a joke and then follow with flirtation." Shaw says it was necessary for her to experience his behavior firsthand so that she could help him change.
Sometimes sexual behavior can help the therapist see broader patterns in the way patients relate to others. Barbara Mautner, a New York-based psychoanalyst, once had a patient suddenly attempt to seduce her. "But my gut told me he wasn't really interested," she says. She told him that his come-ons didn't ring true.
He realized that he held an assumption that all patients fall for their therapists—and conjured up a fake crush to fit his preconception. "He was concerned that I would feel hurt if he did not try to seduce me," she says. Mautner was then clued into the man's need to take care of others and sacrifice his own desires for theirs.
Therapists feel a range of emotions toward clients—from disgust to lust. "It's natural for therapists to feel attraction," says Shaw. "We do experience an emotional intimacy with our clients. But it's not reciprocal. I'm not displaying all of my vulnerabilities and weaknesses."
The therapist who takes a shine to a particular patient may see it as the sign of a healthy rapport as well as a cue to carefully monitor himself. "When I feel attracted to a client, what that really means is that there is something appealing about the person; it's a good sign for the patient," says Jacobs, who has been in practice for about 30 years and has been married throughout.
What if soul mates find themselves in a couch and a chair, star-crossed? Some state licensing boards allow for therapists to date clients two full years after the therapy has ended.
Orbach likens a therapist-and-former-patient union to incest, and says the uneven power dynamic makes her doubt that a patient's "true consent" could be possible, "even if the patient is throwing herself at the therapist." One long-time secret liaison between a doctor and his former patient is currently tabloid fodder: Susan Polk, a 47-year-old California housewife, is on trial for killing her prominent psychologist husband, whom she had seen since she was 15 years old.
Even if they harbor no romantic feelings, many clients admit to yearning for a therapist's approval.
Years ago, Helen Kearney*, now a marital therapist in Kentucky, was told that the psychologist she had been seeing
no longer worked at the clinic. She later read in the paper that he was fired for having sexual relations with several clients. But he had never so much as flirted with her. Says Kearney, "I hate to admit it, but my first thought was, 'What's wrong with me?'"
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