Erotic transfer discussion.

I was reading posts in a discussion about erotic transfer where someone suggested that it would be wholly unethical to continue with therapy sessions once a person discloses their feelings for the therapist, for the following reasons:

1. A possibility of an unintentional leveraging of the client's emotions to elicit compliance.
2. The client wont engage in therapeutic exploration.
3. The client will keep presenting the same problem and not make any change.

Underpinning 2 and 3, it was suggested that the client may be delusional. That the client might be 'deep in the fantasy' and 'their psychosis' might need to be treated by a psychiatrist.

I understand exactly why therapy should end if a client doesn't wish to use the feelings as part of therapy. But ending therapy with nothing in place is cruel. To be honest I'm appalled that anyone would consider it ethical, better by far to negotiate a re-contracting. Regardless of how deep a person is into 'the fantasy', or psychotic! I would shift the contract out of client-therapist, into 'you are welcome to email me whenever about anything, and I will reply whenever'. This is a very SFBT way of working, where 'we' don't see people as forever-clients. We see people as having problems that change when the problem is done differently. Also our more dialogic stance, dissolves the power dynamic to a large extent. Thinking of Steve de Shazer being purposefully stupid in sessions, looking up at the ceiling and saying something like...'and - pause - how did you make that happen'? Highlighting the person's agency, destroying any illusion of the therapist as being all knowing....

This way of engaging with reality dissolves brick walls and straight jackets.

Here was my addition to the discussion with other therapists:

I think a situation in which a therapist is saying that a client is determined to stay stuck in a fantasy about the transference being real, is bit too 'diagnostic' for me. I believe people have reasons, albeit mistaken, for their beliefs. As long as the therapist is certain and sure of their own feelings I would consider self disclosure. A truthful 'I enjoy our sessions too and I feel honoured that you would like to know me more, but I know that I will not feel that way about you too' as only the starting point. 

It could be that the therapist has said something in a way that the client misinterpreted - and that the therapist needs to know this, because they may make a similar mistake with other clients. In my view such mistakes by the therapist can be seen as a 'positive rupture'. As with the more usual, negative ruptures, communication has gone wrong, and the therapist doesn't need to avoid exploring this, quite the opposite!

If you have read my blog, you will understand that my reply comes from experience.

The other thing I didn't write is that if the therapist has reciprocal erotic feelings, this needs to be managed. I'd suggest finding for yourself a set of protocols about what is sensible and compassionate, rather than automatically killing with an ending. 

Client-therapist isn't over if you both wish to negotiate a therapeutic exploration of the underlying feelings, needs, and meanings. 

Therapy is over if talking about the erotic as a symptom of unresolved issues, with the aim of sublimation, is impossible for either of you

I certainly could not do that with Kit - without him being open about his feelings there could never be therapy. Nor could I trust him to be able to negotiate something else that would be sensible and compassionate. What I actually experienced instead of negotiation with Kit was a feeling of having entered a forbidden zone - I was asked to see myself as being out of order! There was a sense of cold water being poured over my hopes, and ultimately the experience of being bulldozed via ‘rational’ arguments...

A part of factor X is the culture of problem-focused therapy, but I think Kit used the cultural norms of problem focused therapy to support his habitual defensive and avoidant reaction. Talking about that might have helped both of us, but I wasn't prepared to pay him £40 a time! 

But ultimately without equal transparency, there could not be any communication worth having.

My final words, inspired by the online discussion - tangential of course - is that people are using the term psychosis way too freely! Doctors tell children who have 'heard voices' that it could be psychosis. The outcome is several weeks on the waiting list and then they come into my room terrified that they have something very, very, wrong with them. It was a total shock to me the first time I heard a twelve year old tell me this. It usually turns out that the child has experienced bereavement, or is suffering from bullying, or the family is going through a crisis, or, remember the film Fire Walk With Me?

Or the other problem, not doing well at school...

Lets just call it psychosis...or ADHD or autism.

To be honest, this is a good way to get a child to therapy and hopefully, in therapy if there is something worse, we will get to hear enough to be able to do something about it. But nevertheless I can't abide diagnosis as a term encapsulating the explanation of causes, or a something fetishized as a term that will predict outcomes, or as the magic word that paves the way to a cure.

Most of us who have seen the impact of diagnosis, understand exactly where it actually leads...