Sexual feelings that occur in the therapy relationship can be a huge problem for therapists, particularly those that are relatively inexperienced.  When the client shows signs of attraction, therapists  frequently  feel uncomfortable and embarrassed and even avoid awareness of the attraction.   Instead of exploring, in a curious, dispassionate way what the attraction means to the client, young therapists frequently are unaware of it or actively avoid signs it’s occurring.  They may feel unworthy of the client’s attraction because they don’t see themselves as particularly attractive or powerful.  And when they do recognize it, and attempt to deal with it therapeutically,  they often  do so by prematurely rigidly “setting limits” and  are then experienced as cold and rejecting.  The result can then be the client withdrawing from the therapist out of a sense of shame.  This is unfortunate because the romantic feelings are often fledgling emotions that could be the occasion of working through fears of attaching to other people. 

Feelings of attachment of client to therapist are a frequent, even desirable event in therapy.  The therapeutic bond can be very intimate, particularly if it’s long term and depth oriented.  Many clients have had very little or no experience with people who are willing to listen to them, are non-judgmental, and caring.  So it’s natural for them to develop warm, even romantic feelings towards their therapists.   My experience, however,  is that these feelings are seldom an expression of a mature, adult  attachment.   They often result in those clients who feel small, worthless and helpless and are an expression of a primitive wish for merger with someone who is viewed as an idealized, perfect being.  This fantasized merger  is actually  the resumption of  a growth process that was interrupted when the client was a very young child because of perceived inadequacies in the parent who was  idealized.

 For example, a long-term female ex-client of mine very early developed an idealized,  sexualized transference tie to me.  When she first started treatment, she was an unemployed, depressed housewife, with few friends and an unfulfilling relationship with her husband.  She had had a very harsh, critical, un-nurturing mother and a father who, although at first doting on her during first 5 years, then  suffered a series of heart attacks, withdrew into depressed isolation and finally died when she was a teenager.  

In treatment she would openly discuss various fantasies that seemed sexual.  In one, we would each take our clothes off and she would lie on top of me. Another fantasy was the idea that she would shrink down to miniature size so that I would have her in my pocket and she could  be with me all the time. I came to realize that these fantasies were really an expression of a wish for merger with me.  She once admitted, far into her therapy,  that I was like God to her and that, if I acted out with her on her fantasies,  she would be horrified.  Another indication that her attachment was not primarily sexual, was that,  although she was a vivacious, creative, intelligent, attractive woman, and I felt very fond of her, I never felt romantically attracted to her. 

How did I work with her on this material?  Firstly, I accepted  her expression of her feelings and  wishes towards me and normalized them as basically non-sexual.  I said that she had made them sexual, partially, because, instead of seeing herself as the intelligent, creative person she was, she thought that her sexuality was all that she had to offer an admired man.  I also said that she obviously saw me as the kind, caring parental person that she had lacked in her life but desperately needed.    I said that the experience of  thinking about me and imagining me with her was an important step in her growth.   She agreed with these interpretations, and let me know that she thought about me a great deal when she was away from me and that her experience of me being with her made her feel more whole, grounded and positive about her life.  Her relationship with her husband improved, she got a job and  began to take writing classes in college.  

Another example of material which seemed, on the surface, to be sexual, but really was an expression of a merger transference, were the fantasies a 17 year old male client.  He began, shortly after he started therapy, telling me about fantasies he was having in which  we were having anal or oral sex, with him as the passive recipient.  He had a rather immature, narcissistic mother and an equally immature but punitive, domineering father.  I soon realized that these fantasies  of his were a wish for a literal merger with a male figure he saw as a source of benevolent power, confidence and strength.  He talked so much about these fantasies and in such graphic detail, that I began to feel uncomfortable.    I said something similar to what I told the female client, i.e., that he saw me as a strong, fatherly male and wanted to get some of that power into himself.  Having anal or oral sex with me would be a concrete way for him to internalize that power, but I didn’t have the sense that he was homosexual.  Over the course of a year of weekly treatment, we talked about his hurt with his self-absorbed mother and his disappointment in his childish father.   He gradually began to grow and develop the resources he needed to succeed in school and afterwards in college.   A few years later he married a young woman and, although I lost contact with him, it seemed like a good marriage.

Although these are situations where clients openly expressed sexual feelings, many times the desire for a sexual/romantic connection is acted out rather than expressed verbally.  A client may suddenly begin to dress provocatively or talk graphically about a sexual encounter with someone else.  The  therapist may begin to feel uncomfortable or even somewhat aroused.  These situations should be addressed,  but in a sensitive, tactful way.  How they should be  addressed is, of course, dependent on the stage of the therapy, how safe the client feels with the therapist and the therapist’s comfort with broaching the topic.