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Episode 391: When Patients Fall in Love With Their Therapists
2025/4/25
Sex and Psychology Podcast
A
Allison McCleary
J
Jordan Pickell
J
Justin Lehmiller
Justin Lehmiller: 我对病人对治疗师产生性幻想这一现象感到好奇，并想深入了解其背后的心理学，以及如何处理这种情况。我关注到一个病人因向治疗师坦白性梦而被解雇的案例，这引发了我的思考。
Allison McCleary & Jordan Pickell: 移情是指病人将自己的情感错置到治疗师身上，这可能包括浪漫的或性方面的感情，也可能将治疗师视为父母形象等。移情源于病人过去的经历或未满足的情感需求，是自我反思和治愈的丰富素材，但处理起来也可能棘手、冒险和令人恐惧。性移情是指病人对治疗师产生性幻想，这是一种常见的现象。病人可能会将性幻想投射到治疗师身上，这种投射可能复杂且多方面，例如同时存在父母般的形象和强烈的性幻想。对治疗师的性感受可能从轻微的吸引到强烈的性冲动，涵盖广泛的程度。对治疗师的感受既可以是性方面的，也可以是浪漫方面的，例如迷恋或灵魂伴侣的感觉。病人对治疗师的性感受和浪漫感受可以同时存在，也可以是独立存在的。病人更容易表达浪漫的感情，而性方面的感情可能被掩盖。即使是委婉的表达，也能帮助治疗师和病人进行更深入的对话。
Allison McCleary: 治疗关系中的脆弱和亲密感是病人对治疗师产生性吸引力的一个原因。治疗师可能是病人唯一感受到持续关爱的人，这可能会导致性吸引力的产生。治疗师也可能成为病人过去经历或未满足需求的象征。病人对治疗师产生性吸引力的原因是多方面的，包括治疗关系的亲密性、治疗师对病人的持续关爱，以及治疗师作为病人过去经历或未满足需求的象征。与治疗师的亲密关系可能帮助病人更好地了解自己的性取向。病人可能将深厚的关爱和情感与性联系起来。在性移情中，年龄和性别等因素可能变得不那么重要。病人对治疗师的性吸引力可能与治疗师的实际吸引力无关。性幻想可能是不由自主出现的，这与病人是否真正想与治疗师发生性关系无关。性移情可能包含一种与治疗师融合的渴望。性移情可能是一种渴望与治疗师亲密融合的表达。
Jordan Pickell: 病人对治疗师产生性吸引力的原因可能与性别有关，例如异性恋男性病人对女性治疗师产生性吸引力。病人对治疗师的性吸引力也可能源于他们对权威人物或亲密关系的既有模式。病人可能会通过表现出强烈的性能量来寻求在治疗关系中的价值感和亲密感。治疗师的易于沟通和非评判性可能会导致病人产生性吸引力。病人对治疗师的性吸引力是多种因素共同作用的结果，包括治疗关系中的安全感、亲密感，以及病人过去的经历和关系模式。与男性治疗师的工作可以帮助男性病人理清自己与男性的关系。治疗关系可以作为病人练习和探索人际关系的场所。治疗关系可以帮助病人学习如何在其他关系中更好地展现自己。性移情也可能是一种充满活力的能量，而非单纯的性欲。
supporting_evidences
The short version is that a guy who was in psychotherapy for PTSD, anxiety, and marital problems had a sex dream about his therapist.
Now the client feels abandoned and doesn't think he'll ever be able to trust the therapist again because he thought therapy was a safe space to discuss anything.
We're going to explore the complex psychology behind why patients sometimes develop sexual and or romantic thoughts and feelings about their therapists.
Transference is when a client misplaces their feelings onto their therapist's.
A component of the transference is that the client is like projecting something onto the therapist.
So for example, I was reading an article before the show that was all about people who have sexual fantasies about their therapists.
Sure. Clients can have a lot.
You're definitely hitting the nail on the head that a lot of clients, sometimes their therapist is the first person...
Someone who is 100% attuned and non-judgmental...
Yeah, it totally makes sense, you know, that this is an environment where sometimes people finally...
Right. And some people might think that you could avoid erotic transference entirely just by choosing a therapist of a gender that you're not attracted to.
Well, my theory, I have a couple, which is like maybe part of being in an intimate, close relationship also helps us to know our sexuality differently...
You know, you see it a lot.
Yeah. And the attractiveness piece is interesting too, because when we're talking about fantasy, it may be intrusive that it's not actually something that they're entertaining as much as it's entering their minds...
And like you're saying with the gender piece, there can be maybe an opening up to what my sexuality is and all the expansive forms that it can take.
Yeah, it's so interesting.
I think it happens a lot.
Yeah, I certainly have had many conversations with clients about erotic transference.
Yeah. Oh, for sure. I think it's very common.
with our society's stuff about sex, therapists don't always handle it great.
Or there are other clients saying, I'm I have told my therapist that before and it did not go well.
But that's not for the clients to manage.
So I do encourage people to talk about it, but therapists are human and also can have discomfort or even fear of clients bringing it up.
And so it totally makes sense that you're going to have a lot of therapists who just feel ill prepared for how to deal with this situation when it comes up.
This would violate ethical guidelines and boundaries if you were to actually act on those attractions.
It's such a shame too, because on the other side of conversations about erotic transference is like such juicy, powerful work.
You know, and you can also see how addressing it and for the therapist to explain, like, actually, this is a common thing for people to experience in therapy.
I think that that could help to relieve so much of the anxiety and the shame and the guilt and the embarrassment that people feel about this.
I think it's a mistake when... people, including therapists, see erotic transference as, quote, getting in the way of the work because it is so part of it.
And when we think about therapy as like a meta cosmos for our clients, right?
So I was going to ask, you know, the question of, should you bring this up?
You don't have to bring it up, one.
I would say framing it, since you've heard this conversation, you can frame it as, I know that this happens and I've noticed these feelings coming up.
You might preemptively say, this is going to be really vulnerable, but I do want to have a conversation about something that I've been feeling that is coming up between us.
It's just, again, not client's jobs to manage that therapy.
Like you don't have to show up and then like, you know, share it all.
Sometimes too, I think clients think, or they worry, or they are maybe hoping that the conversation will get like, will feel kind of like tantalizing or like naughty.
Yeah, an ethical therapist will not... talk to you about their reciprocal feelings.
And I also think therapists can get in their heads too.
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