How to manage sexualized transference

November 2023

Amar Davé, a licensed professional counselor in Maryland, sat in his therapist chair puzzled after a client made an indirect romantic pass at him. After discussing the situation with his clinical supervisor, he broached the exchange with the client, who proceeded to confide his feelings for his therapist in an even more direct way. Like Davé, other clinicians may find themselves in the discomforting yet common scenario where clients develop sexualized or erotic transference in the intimate environment of a counseling session. This type of transference occurs when clients develop romantic or sexual feelings for the counselor in the one-on-one relationship. “Erotic transference is taboo for a variety of reasons,” says Davé, a lead clinician at Unbroken Family Counseling in Downers Grove, Illinois. “I would argue that it’s far more present in our therapy sessions than we tend to realize. From a client perspective, it’s an awkward thing to talk about or bring up. And from the clinician perspective, it’s maybe not talked about as much as it should be because of a fear of ethics and needing to protect professional credibility.” Ryan Howes, a licensed clinical psychologist and counselor educator in Pasadena, California, with 20 years of experience in private practice and academic settings, says he has seen an overwhelming number of clinicians abruptly terminate sessions and refer out immediately after clients disclose erotic transference, which leaves clients feeling betrayed or abandoned. Therapists may also shut down the conversation completely. Howes has heard of counselors who respond to clients who admit they have romantic feelings or are fantasizing about a life together with their therapist by saying, “Oh, we can’t talk about that here” or “You can’t have those feelings here.” The situation, he says, can be completely devastating for the client because they feel discarded. “Unfortunately, erotic transference is widely misunderstood by a lot of clinicians,” Howes adds. To overcome this, there needs to be more understanding within the field and training around what to do when erotic transference occurs.

Understanding the why and how

Howes says that for clinicians to understand the nuances of sexualized transference, they first need to grasp how and why it develops during session. “When clients come to therapy, it’s often the first time or experience when they’re in an environment where they’re feeling listened to [and] being paid close attention to,” Howes says. “For some people who may have been neglected or abused throughout their lives, they might think, ‘I’m being cared for and listened to; someone thinks I’m of some value.’ There are natural warm and loving feelings that can emerge from that. They might think, ‘I want to be with this person all the time because this feeling feels so good.’” Howes says any type of therapeutic alliance between a counselor and client is built with the possibility to foster healthy transference — where the client relates the therapist to a life template rather than a professional connection. For clinicians, gently pointing out differences between the template and therapeutic relationship can help a client realize they may be reenacting a past relationship or one they have been longing for in session. “It’s no different with erotic transference,” he adds. “We should understand as therapists that transference happens all the time, and not just in therapy. Your new co-worker might remind you of an old friend or your grandmother. The same thing happens in the therapy room where maybe you remind a client of a brother or a cousin that can help them feel safe. For most therapists, those feelings are manageable.” Sexualized feelings between the client and counselor, however, may also evoke complex emotions for the clinician. “The feelings are more intimate and vulnerable because they may bring up a therapist’s own needs of love, desirability and yearnings for close connection. That’s why it can be fraught with anxiety,” Howes says. Paul Hoard, a licensed mental health counselor in Washington, says clinicians are trained and often equipped for instances of regular transference with clients who project their trauma and feelings onto therapists. But the extra layer of sexualized feelings from a client can often intensify tension between a therapist and client. “There are so many unconscious processes at play in a therapy session, and the dynamic between two people in a room talking about intimate things is far more permeable than what any of us want to think,” Hoard says. “In our Western culture, sex has a way of sucking all the complexity and curiosity out of the room,” he continues. “We’re able to sit with anger as therapists, differentiate the thought of a client being angry at us while not being at risk with our safety. Yet for many therapists, conversations about sex or intimacy can push us into panic mode. Then we’re unable to recognize what may be being played out through sexualized feelings.” Even counselors who have been trained to talk about sex with clients can neglect what sexualized transference may stir up for them internally, says Hoard, an assistant professor of counseling psychology at the Seattle School of Theology & Psychology. If that internal processing is worked through, sexualized transference can have a similar playbook to treating other types of transference. “So many therapists are trained in the simplicity of erotic content,” he adds, noting that clinicians are often trained only in the basics of sexual discussions during graduate school. “That simplicity leaves us vulnerable to where we cannot clearly conceive what’s going on with a client. If therapists are in fight or flight because erotic transference is happening, then they get swept up in the reenactment instead of being more curious and understanding of what’s happening.”

Responding to sexualized transference

Caitlin Ziegler, a licensed professional counselor at Bliss Counseling in the greater Milwaukee area, says she’s had clients who have shown signs of developing sexualized transference and notes that many times clients will subconsciously — or consciously — seek out therapists during intake who they’re attracted to as a way to feel safe and heal. “I’ve had clients who have asked to work with a therapist who has my hair color and looks exactly like me,” Ziegler says. “So, from the onset, they’re asking to be in a therapy room with someone they’re [likely] attracted to.” Ziegler says in those types of instances, she respects the client’s emotional autonomy and won’t always bring up sexualized transference right away unless the client mentions it. Instead, after making sure there are no barriers that would prevent them from working together, her main focus is being empathetic. “I always try to lead with empathy. If a client doesn’t have a healthy female relationship in their life and they’re seeking a female therapist, I know there’s a lot of loneliness and isolation that goes into that,” Ziegler explains. “Just scheduling the session can be brave. We can then see what clients are reflecting with emptiness and what they may be wanting in a relationship.” Katie O’Connell, a licensed clinical social worker at AMK Counseling in Chicago, says there are inherent power dynamics at play with female counselors seeing male clients that can complicate matters. She once had a prospective client go on her company’s website and send her a message expressing their feelings for her in a derogatory manner. This exchange left her feeling shaken and unsafe leaving and entering work, so she spoke to her supervisor who initiated new safety guidelines at the practice. “It’s important to make sure you feel comfortable and are the best version of yourself as a counselor to be able to help someone in need,” O’Connell says. So, if a client or situation makes you feel uncomfortable, then it may be necessary to refer out or take other precautions such as having other staff members present at the office during the session, she adds. Hoard says one common misstep clinicians can make, even if they are able to emotionally bracket a client’s erotic transference, is resorting to the power they possess in the room by listing theories and pointing out what erotic transference is defined as in books. “Any time we move to interpret a client’s feelings, without honoring and affirming those feelings, that’s unfair to the client,” Hoard says. “It’s an example of a therapist not tolerating [their] own anxiety or discomfort. It robs the client of the empathy they may need in that moment.” The client’s attraction to their therapist does not have to be a deal breaker, Davé stresses. And he discourages counselors from making snap judgments about needing to terminate treatment because of a potential distraction. “I’ve had clients flat out say, ‘I’m very into you,’” he says. “So, I’ll say, we can terminate our work and I can help you find another clinician, or we can continue our work by going through the erotic transference together [and] mitigate that because what’s happening in our clinical work is a microcosm of what may play out outside of here.” Lauren Lucas, a licensed clinical social worker with Fox Valley Institute in Naperville, Illinois, says she’s experienced a variety of forms of sexualized transference but is intentional about separating those deeper feelings of transference from general attraction and clients who try to flirt to push boundaries. “I’ve had experiences where the client’s perception of my acceptance and support or the way they perceive me due to my appearance or fashion choices develops into erotic transference,” Lucas says. “It’s based on the idea that I could be ‘the type of person’ that they didn’t feel they could connect with in the past, but who is now offering them time and positive regard.” Lucas says it’s important to acknowledge and name the feelings the client is experiencing as soon as possible. “A large majority of the time, discussing the presence of erotic transference is the most effective way to help the client and preserve the therapeutic relationship,” Lucas notes. “Naming it helps develop a deeper understanding and make meaning of the feelings that are arising for the client, while providing evidence that the therapist remains supportive of the client and committed to maintaining the relationship in a securely boundaried way.” But if it’s unclear whether the client’s actions or feelings are romantic or if the client is ready or able to name them as romantic, then Lucas will address her interpretation of the client’s feelings with more inquisitiveness. “When the erotic transference is showing up in ways that are less aggressive, I’ll approach it the way I do with other observations I may make in session: I’ll be curious, share what I’ve wondered and make space for them to consider their own experiences of our time together.” Davé says the barometer he will use to determine if an intervention is needed in discussing sexualized emotions is whether clinical progress is being made. “In one session, a gay male-presenting client was showing signs of erotic transference but there was no self-disclosure, so I brought up that there was no progress being made and asked what that was about,” he recalls. “I also had to ask myself, ‘What was his work and what was my work?’ I realized it was an us thing. A therapist cannot just say, ‘those are your feelings.’ They’re happening because of the relationship and power dynamic in the room.” Lucas says that therapists need to be cognizant of that power dynamic and hold themselves accountable to determine whether it’s possible to foster a corrective emotional experience with a client by working through the transference together or whether they need to refer out because it wouldn’t be in the best interest of healing for the client. “I absolutely think there’s opportunity for a corrective emotional experience,” Lucas says. “Many times, the act of assertively and nonjudgmentally naming emotions and identifying behavioral responses has been unfamiliar for clients with partners or parents, so it’s possible for repair to begin with even just the initial conversation with their therapist.”

The nuance of boundaries

Howes has noticed that therapists often falter with clients experiencing sexualized transference because they struggle to understand the nuance of boundary setting. “I think it’s important for therapists to know that just because a client is experiencing feelings toward a therapist, it doesn’t mean that a boundary is necessarily crossed,” Howes says. “It’s when clients begin to act on feelings that it becomes a problem. That’s when a therapist needs to be clear about what the boundaries are and not avoid that conflict in a conversation.” Howes recalls clients who have told him something to the effect of “I’m fantasizing riding off into the sunset with you.” He clarified the client-counselor relationship by saying, “I just need to reiterate to you that our relationship is based on me helping you, not based on meeting all of these unmet needs. But I’d like us to understand together where those feelings are coming from.” Establishing and clarifying these professional boundaries with the client helps the therapist show unconditional positive regard toward the client while still also acknowledging what’s being experienced in the room. “We have to leave room for a grieving process to begin after the boundaries are regularly set because they [clients] will slowly have to let go of the idea they had in their head,” Howes adds. This means that counselors also need to allow clients the space and freedom to discuss all their feelings and thoughts in session. “If we come in suggesting we’re that safe container, then they spill their guts and a therapist says you cannot have romantic feelings here, they can feel shame on a deep level because they’ll believe they crossed a line with their feelings,” Howes says. “So knowing the difference between a client crossing the line and having feelings about crossing the line is important.” Setting and maintaining boundaries can be an ongoing process that often needs to be repeatedly reinforced, Lucas adds. “If I have expressed the boundaries and expectations of the therapeutic relationship, and a client continues to push them through flirtation, insinuation, observations about my appearance [or] questions about my personal life, I will have a conversation about the fact that this dynamic is now a barrier to the therapeutic process,” he says. O’Connell admits that setting boundaries is not always easy because clients can push those boundaries. “The feelings a client expresses can have a vulnerable motive, but they also can have a more aggressive motive,” she says. “I’ll always try to honor a client’s feelings, but when they start to bend boundaries on a regular basis, then it may call for a more permanent change in the best interest of the client and therapist.”

The importance of self-awareness and supervision

Hoard, who has presented professionally on the need for sexual education for therapists, says clinicians’ own stigma of sexuality and unresolved romantic emotions in their personal lives can work as a barrier to clinical progress and indicate the need for self-awareness. As a result, he says that the best treatment approach for sexualized transference starts with strong supervision so that the therapist can better understand what’s happening internally in response to the client’s emotions. That can be a challenge, however, because of the supervisees’ fears and concerns related to ethics and their own stigma and reluctance to discuss sexualized and romantic emotions in supervisory sessions. “The more isolated a therapist is, the more vulnerable they are,” Hoard says. “A key aspect in our work is being able to look at ourselves as clinicians and question whether our gut [feeling] in a given moment with a client is a useful guide or whether it’s leading us in the wrong direction. If we don’t talk about sex in other aspects of our lives, particularly in supervision, we can have a defensive retreat and it can be hard to stay in that therapeutic space.” “If there is no space to go to a supervisor and make sense of this, then we’re more likely to go into a reenactment with the client and less positioned to work through it with them,” he adds. Howes says that’s why it’s integral for supervisors to foster an environment for therapists and supervisees to comfortably talk about erotic transference. “Supervisors need to really create a safe space where they can let the therapist explore their own feelings so that whenever erotic transference arises, it’s not the first time they’ve talked about romantic emotions,” he explains. Processing romantic feelings in supervision or therapy can help counselors discover their own feelings and needs about the situation and prepare for any potential dangerous or unethical issues such as developing feelings for the client, Howes says. Ziegler considers the self-awareness she gets through her own personal therapy and supervision as a form of preventive treatment. “The most important thing we can do as therapists is know these emotional pieces about ourselves through self-reflection,” she stresses. “It’s an essential part of our learning and we have to have a consistent amount of reflecting so that we’re ready for instances that could challenge us like erotic transference.” Davé has a good relationship with his supervisor, which helps him unpack areas of discomfort. He says that having this strong relationship allowed him to feel comfortable enough to mention when he once had a gut feeling that erotic transference was happening with a client. In supervision, they discussed what he thought he was feeling from the client, how the client’s feelings manifested and what he needed for support before he could provide support to the client. “If I didn’t have that relationship with my supervisor, I could easily see where I maybe wouldn’t have brought it up,” he adds. Lucas says that counselors owe it to their clients to process their own emotional responses before and after they enter the therapy room. “Just as we’ll support our clients as they process these emotions, it’s important for therapists to have a colleague or supervisor to process the emotional impact on them too,” he explains. “I think a large piece is that as therapists we make a serious commitment to maintain firm boundaries with our clients, so when there’s an indication of a sexual or romantic feeling coming from a client, that can elicit discomfort and uncertainty from the therapist.”  

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Scott Gleeson is a licensed clinical professional counselor in the Chicago suburbs, specializing in trauma and relational dynamics. He spent over a decade writing for USA Today, where he won national writing awards from the Associated Press and NLGJA: The Association of LGBTQ+ Journalists. He’s collaborating on a book about fighting cancer with legendary broadcaster Dick Vitale, which is set to hit bookshelves in March 2024. His debut young adult fiction novel, The Walls of Color, comes out the following year.

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