Episode 391: When Patients Fall in Love With Their Therapists
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You're listening to the Sex and Psychology Podcast, the sex ed you never got at school and won't get anywhere else. I am your host, Dr. Justin Leigh Miller. I am a social psychologist and research fellow at the Kinsey Institute and author of the book, Tell Me What You Want, The Science of Sexual Desire and How It Can Help You Improve Your Sex Life. My therapist fired me after I confessed a sexual dream about her. This was the title of a recent advice column in the New York Times. It piqued my curiosity, so I had to see what it was all about.

The short version is that a guy who was in psychotherapy for PTSD, anxiety, and marital problems had a sex dream about his therapist. He disclosed this during a session, not because he was trying to come on to her, but because he was confused about it. The therapist told him that it was totally inappropriate to bring this up and that it's not something a patient should ever tell a therapist. He felt bad for doing it and apologized. But a few days later, the therapist's office reached out to terminate him as a client.

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.

With that said, the idea that a patient might have a sex dream or fantasy about their therapist is definitely an awkward and uncomfortable topic. I get it. But it turns out that it's surprisingly common for things like this to happen. It's actually a phenomenon known as erotic transference, which is a form of projection, and psychologists have recognized that this is a thing since the days of Sigmund Freud. So that's what we're going to be talking about in today's show.

We're going to explore the complex psychology behind why patients sometimes develop sexual and or romantic thoughts and feelings about their therapists. We're going to talk about what this really means, as well as what to do when and if this situation arises, including whether you should tell your therapist and how therapists should respond in a way that's ethical and beneficial to the client's care. I am joined today by Allison McCleary and Jordan Backell.

Allison and Jordan are both registered clinical counselors and podcasters. Together, they co-host the Edge of the Couch podcast, which provides a space to have conversations about what it's actually like to be a therapist, including the conversations that are regularly missed during training programs. Their podcast aims to decrease shame around topics that are often too hard to talk about out loud. Allison and Jordan often say that the Edge of the Couch is the podcast that they wish had existed when they were new therapists.

This is going to be another fascinating conversation. Stick around and we're going to jump in right after the break. Applications are now open for the next Human Sexuality Intensive course at the Kinsey Institute at Indiana University. This course takes an interdisciplinary, evidence-based approach to exploring foundational concepts in the study of human sexuality, as well as recent developments and research in the field. This course is relevant to professionals, academics, and individuals in any field where a foundational understanding of human sexuality is beneficial.

This course is open to both emerging and established professionals looking to specialize their knowledge as well as those seeking new career directions. To learn more, visit KinseyInstitute.org and be sure to follow @KinseyInstitute on the socials. Hi, Jordan and Allison, and welcome to the show. Thanks for having us. We're really excited to be here. Well, it's a pleasure to have both of you here and I'm excited to meet both of you. So we're going to be having a two-part conversation on the subject of erotic transference.

Now, as a starting point, I always like to begin with definitions so that we're all on the same page. So erotic transference is a specific type of transference. But for people who aren't familiar with the term transference at all, what does that even mean? You know, so what is transference at a general level in a therapy context? Transference is when a client misplaces their feelings onto their therapist's.

So this can sometimes include romantic feelings, sexual feelings.

There can be a feeling that the therapist is like a parental figure. And these misplaced feelings can come from past relationships or internal longings, unmet emotional needs. And they can be such rich, juicy topics for self-reflection and healing, but can be sticky and risky and scary to address.

Yeah, a component of the transference is that the client is like projecting something onto the therapist. So there's this real like...

transfer, which fits with the definition of energy or feeling or experience from the client on to the therapist. And it's almost like the therapist becomes like this whiteboard that something is projected. If you think of a projector screen. And so there's like an enactment happening between the therapist and the client that the client has pulled in, like Jordan was saying from previous experiences. Yeah.

Thanks for sharing that. Yeah, so it sounds like projection is kind of like a good way to think of it or redirected feelings, like that you're taking some feelings that you have and you're projecting them onto the therapist. And as you mentioned, transference can take a lot of different forms, but sometimes it's erotic in nature. So for example, I was reading an article before the show that was all about people who have sexual fantasies about their therapists. So tell us a little bit about what erotic transference specifically might look like on the part of a patient who's experiencing it.

Sure. Clients can have a lot. And we use client instead of patient, but patient fits too, but you'll hear us using client. Clients can really slip into projecting a sexual fantasy onto their therapist.

And when I was prepping for the conversation, I was also thinking about how the projections are not kind of like clean and contained. So they can be really multifaceted. Like a client can have a sense that their therapist is like a parent figure and also have these really present and intense sexual fantasies about their therapist at the same time. So it's like the projections are interconnected and that's, you know, there's an intensity to them.

But certainly therapists can imagine what it would be like to have sex with or do other sexual things with their therapist. And I think it's actually a very common experience that clients can have. Yeah, it can, like you're saying, it can have...

So many different layers to it and can feel very different. So when you think about the spectrum of sexual feelings towards a person, of course, there can be this magnetism attraction. There can be like, oh, this is a beautiful person. It can be more of a crush, lighter, flirtatious energy or a deeper longing and wanting to, let's say, jump someone's bones.

and like imagining when you're sitting across from the person. Do I want to snuggle you, kiss you, have sex with you? Those are very different energies. Yeah, and it can also be romantic feelings too, right? Not just sexual in nature, right? Oh, yeah. Yeah, infatuation, soulmate feeling.

And they can present very different, like separately. You can have clients who feel very romantically drawn to a therapist with kind of zero sexual stuff in there. Then you can have clients who really have, yeah, this kind of like animal-y intensity and sexual feeling and pull, but are not thinking in that kind of romantic place. So they can coexist and they can be really distinct and separate as well. I'll say too that...

In my experience as a therapist, more often clients express the romantic side of things because I think it feels less taboo to describe romantic feelings. And I think I would guess that a lot of clients actually cover up

their sexual feelings with, I have a crush on you or I'm noticing attraction. They're kind of tamping it down to maybe the depth of what it actually is. And that's very common. But even using the

The smaller language can help us move towards a deeper conversation. If we both kind of have this idea that there's a stronger energy than what they're describing, but yeah, people are often experiencing that and then not naming it.

Yeah, that totally makes sense to me. And what I want to talk about next is sort of why does this happen in the first place? You know, why is it sometimes the case that patients develop sexual attractions or feelings toward their therapists? You know, my intuitive sense would be it probably has something to do with the fact that in a therapy office, they're being vulnerable and they're

opening up about things that maybe they've never opened up to anyone else in their life about before. And so having that intense vulnerability might create kind of this sense of intimacy, and that might be one of the things that kind of opens the door here. But what do we know about kind of the underlying psychology behind how and why this happens? You're definitely hitting the nail on the head that a lot of clients,

sometimes their therapist is the first person, like genuinely the first person to ever kind of go there with them to talk about their life, to be curious about them, to show them like this consistent affection and care that is sustained. I also think that it is a unique relationship in that we often don't get that kind of sustained care outside of romantic relationships or sexual relationships or friendships.

So there can be like a, oh, this feels so good. This must be something. But I also think, and this goes way back to Freud, like early days, that therapists are real people, but they can also become metaphor for clients. They can also become analogy for clients, which is the whole projection piece. And so,

When big feelings come up and clients are building their capacity to manage them, it's like there's something about kind of like we're moving it between us so that it's more bearable or it's easier to carry. So it can be a lot of factors. What would you add to that, Jor?

Yeah, like you're saying, I think that's right on that therapy is this intimate space where people feel seen and understood. And for some people, it's the only place they've ever felt that way from another person. And there can be a gender component too. So if you're, let's say, a heterosexual man and your therapist is a woman, then maybe you have never had a relationship and certainly an emotionally intimate relationship with a woman before. Someone who is

100% attuned and non-judgmental, or at least on the outside non-judgmental of who you are. That being said, part of the projection is those past relationship dynamics or internal longings. So maybe that's how you relate to authority figures.

Or that's how you feel worthy and close with someone. That's what I think people want from me. So I have this, like, oh, I'm starting to dress up. There can be a trying to find worth within the relationship by showing up with charged sexual energy. Because that's what closeness has felt like in my life, for example.

Yeah, it totally makes sense, you know, that this is an environment where sometimes people finally, like for the first time, have that feeling of safety, you know, where they have that ability to open up to somebody else. And if you're a good therapist, you're also somebody who is easy to talk to, right? And a lot of us, you know, don't have the experience of, you know, opening up with somebody who

who is just easy to talk to and who's also totally nonjudgmental at the same time. And so you can see how that could create some type of magnetic energy that could sometimes be interpreted or misinterpreted as like sexual interest. And, you know, you add in all of the representations of past relationships and layers layered on top of it. You know, there can be a lot that's going on here all at once. Oh, yeah. Yeah.

So you mentioned that there can be a gendered component to this. And, you know, something that I was thinking about before the show is how does transference, erotic transference intersect with gender? And I say this because I read about a few cases of heterosexual male patients who actually started questioning their sexuality because they started to develop an infatuation with their male therapist.

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. But that doesn't necessarily prevent erotic transference from happening. Right. Mm hmm. Totally. What are your theories about that, Allison?

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 and in a more expansive way that sometimes we can like unlock or come into, you know, maybe just like, oh, it turns out that I can have a crush on a man. And I never thought that that was possible. And here I am. And this is a brand new learning. And I think that it also, because there's like this confusion of,

deep care, deep affection must equal something sexual that, you know, when it's like our default, like we're naming or that's what we're used to. And our body kind of goes back to that place. You know, you see it a lot. I mean, a gender, I think age is also an interesting piece of this where people will say like,

I want to have sex with my 65 year old, like, you know, this old woman who's got like three adult children and I'm a 25 year old guy in university. And like, that's not who I typically want to have sex with, but I find myself like really fantasizing because it kind of supersedes and exists outside of,

gender or age. We're specifically talking about working with adult clients, but yeah, it's like those things, they don't matter when you're in it, when transference is happening, even attraction level of attraction. So clients can be very sexually drawn to their therapist who maybe they don't even find particularly attractive or they wouldn't if they pass them on the streets. It's just like this whole other essence and energy.

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 of like, Oh, I'm having these flashes of images of having sex with my therapist, which I think is of course important to acknowledge to ourselves for sure. Maybe bring it up with a therapist. Yeah.

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. And then I do think there can be this metaphorical, I want to merge with my therapist. There's something about sexuality where...

for some people to become one and there's wanting closeness in the ultimate sense. So in that way, I think that can be one layer of erotic transference as well.

Yeah, it's so interesting. And something I was thinking about as you were speaking was how for a lot of heterosexual men in particular, you know, the only source of emotional intimacy in their lives is with their female romantic partner, right? And straight guys often just don't have emotional intimacy in their relationships with other men. And so when you have a guy who's in therapy with a male therapist, and then suddenly they have that emotionally intimate dynamic with another man, you

You can see how that might potentially even be confusing in some cases because they've only ever associated emotional intimacy with sexuality with women. And so, oh, I can have this emotional intimacy with men. What does that mean? You know, you can see how this could lead to some questioning for some people. Definitely. For some of the men that I work with over the course of our work, it becomes clear that there is an essential next step to working with a man therapist.

Because there can be, okay, you have stuff with men, with other men. And working with a male therapist, some of those things can be clarified for you.

experiencing the emotional intimacy, being vulnerable with another man, the therapeutic relationship is practice for our outside life. It's real life. And then we have our real life. And that relationship can be a place of experimentation. So learning about myself in relationship, me as a man, for example, in relationship with another man, that gives me information about how...

how I can show up in these other relationships

And maybe, again, sexuality is expansive. I think there can be erotic transference in the eros sense too, where there's like aliveness and it's not necessarily, I want to have sex with this person as much as there's this zinging magnetic energy between us. And what would it be like to have that in friendship? Wow. Just the possibilities there. Chemistry. Yeah.

Yeah, it's so interesting. Yeah. So do we know like how common it is for erotic transference to happen? I couldn't find any great data points before the show. And I get the sense that this is a topic that isn't researched all that much because it's kind of a taboo thing. And it seems like a lot of people don't even want to acknowledge it because it's uncomfortable. So anecdotally, in your experience, would you say that this is something that happens fairly often or it's pretty rare?

I think it happens a lot. I think Jordan is right when she says the way that I wrote it in my notes is that clients kind of test the waters, you know, and not intentionally to make clinicians uncomfortable, but just to see like, well, you know, like, I think you're pretty. And then that that's, you know, how you respond to that, whether you like open a door or not, as the clinician could then take the client into reviewing more, but yeah.

Yeah, I certainly have had many conversations with clients about erotic transference. And it's too bad that we're not talking about it as a field because I think that shame drives these conversations into the darkness, right? And into like secret. And that's a shame. But I think it's happening a lot. Would you agree with that, Jordan? Yeah.

Oh, for sure. I think it's very common. Yeah.

with our society's stuff about sex, therapists don't always handle it great. So you'll see online conversation about, I have these feelings towards my therapist. Do I tell them or not? And there will be a lot of therapists saying, this is really important. You should definitely talk to your therapist about it. And then other folks saying, don't. As a therapist, it would scare me if you said that. I wouldn't know what to do. Or there are other clients saying, I'm

I have told my therapist that before and it did not go well. It led to the dissolution of our therapeutic relationship and you could potentially lose the relationship with the therapist because not all therapists are great at navigating these conversations because we need to be doing our own work.

But that's not for the clients to manage. So I would encourage people to bring it up. But no, there is risk in bringing it up that the therapist may unwittingly shame the

the client and it may obviously bring up stuff for them. The therapist could get frazzled, may not say the right thing. 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.

Yeah. And I mean, the fact that it is a taboo topic, I think leads a lot of people to pretend like it doesn't exist. And so a lot of people don't get training in like, what do you do and how do you navigate this kind of situation? 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. You know, and in terms of like how common this is, I've spoken with a number of therapists who say, yeah, it is like a super common thing. Like it happens with much more frequency than you might think.

but nobody kind of like wants to acknowledge it because, you know, of course,

societally, we believe you shouldn't be attracted to your therapist and your therapist shouldn't be attracted to you. This would violate ethical guidelines and boundaries if you were to actually act on those attractions. And so, yeah, it's just this tricky, uncomfortable subject. But the fact that we let that discomfort get in the way of us even talking about it just means that people don't know how to navigate it. And then you do have those situations where the therapist's response is,

is actually very damaging to the client and ruins the therapeutic relationship that they had. So, you know, there are risks of us, you know, not acknowledging or pretending that this doesn't happen.

It's such a shame too, because on the other side of conversations about erotic transference is like such juicy, powerful work. Like if you get a client on board for staying in it with you of like, okay, let's talk about what this is and what this means and where it comes from and what it feels like. And what is it like, you know, to tell it to me and to make eye contact with me when you're telling me about this fantasy and,

And then because often it burns hot and fast a lot of the time, right? Once you start talking about it,

it doesn't take up so much space. It's not as shame inducing and it can dissipate. And then it turns into this other, like much more like generative and powerful and charged stuff that is really helpful and useful for clients. But I think the default for clinicians is like, Oh, this might get in the way of the work. So I think I should refer out. And it is such a shame because the work is so good. If you can stay there.

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. Like, let's normalize the fact that this happens, but here's the deeper meaning behind it. And, you know, this is why it happens.

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. Because when people do feel this attraction toward their therapist, if you read social media posts about it, people talk about it in terms like it makes them very uncomfortable and they feel this sense of shame about it and they're not sure what to do about it. So having a safe space to talk about it in therapy, I think is really important for a client who is already in a position where they're already vulnerable

And then, you know, acknowledging this adds an additional layer to that. And then if the therapist shames them on top of that, then, you know, you've taken a very delicate situation and added a lot of fuel to the fire. 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. It's part of the larger picture of both what's happening in the room and the quality of the therapeutic relationship determines the quality of the therapy, but also that place of experimentation. So to be able to talk it through, to

dissipates the intensity of it, but it also reveals important information about the person, what they want in relationships, what's missing.

And I also think that it can deepen trust between the client and the therapist if it's handled well so that the work becomes so much more expansive and bigger and deeper. But it is a shame when that gets cut off prematurely. I think that there is a lot lost when that happens.

And when we think about therapy as like a meta cosmos for our clients, right? It's like where we practice. There's also this like other meta piece around like practicing having vulnerable conversations and what is it like to talk about your sexual fantasies with another person? And, you know, like there's really good learning that can happen just in like revealing parts of yourself in a, in a vulnerable way and having the other person meet you with like love and respect. And like, thank you for sharing that with me, that that is also practice for our clients about how to have challenging conversations. Yeah.

in other areas of their life. Yeah. So I was going to ask, you know, the question of, should you bring this up? You know, should you tell your therapist? And you kind of already answered it in saying that, you know, you encourage people to do it, but also acknowledge that, you know, there are potential risks and rewards of having these conversations because it might be that the therapist that you have is not well-equipped to address this particular issue.

type of situation. So let's say somebody does want to bring it up to their therapist. Do you have any tips on like how you might broach the subject? You know, again, lots of people are going to be feeling ashamed or embarrassed. This can make it hard to talk about. So how do you bring that up in a therapy context?

You don't have to bring it up, one. But what you're saying is that this person wants to bring it up, has the feelings bubbling to the surface and feels safe enough with the therapist, some trust that the therapist will be able to meet them in that place. It's not for clients to manage the therapist's response. So I'll say that up front. And if you're listening and you're wanting how best can I do this?

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. Ideally, you're not framing it as a proposition of some kind, like, oh, well,

I want to ask you out. I'm imagining us having sex. There are ways in which you are framing it within, I want to talk through these feelings because I know that this is part of therapy. And maybe there is a sense that it's going to get in the way of the work if I don't actually talk about it. So you might say that.

You might say, I have a sense that this is about something else, or I'm confused by these feelings. 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. And even just that, I think, can frame the conversation so that the therapist understands

Is clued in like, okay, this is within the context of the therapeutic work. It's just, again, not client's jobs to manage that therapy.

I think I would add to that too, that you can go like at whatever pace is comfortable for you. So you can in one session say to your therapist, there's something that I really want to talk to you about. I'm not quite ready to talk yet. And then, you know, three sessions later, you can say that thing I wanted to talk about is sexual in nature, but I'm not ready to talk about it yet. Like you don't have to show up and then like, you know, share it all. You can, of course, if you want to, and if that feels better, but it's also okay if it's paced and like scaffolded a bit, but

I would say too, if you're going to bring it up, then I think you have to be prepared for the fact that like, you're going to have a conversation about it again, maybe not right away, but you know, we can't just kind of throw a grenade and then be like, but I never want us to ever talk about it ever again. So I think there is like a bit of knowledge that like, if you bring it up, there's going to be exploration. Yeah.

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.

And if you have a therapist who is handling it really well, it won't. It's going to feel like how they handle everything that they handle with you, hopefully, which is like with care and respect, but also like in this tone of like, hmm, that's so interesting. Let's talk about that. And I think that that's how...

therapists can kind of clue into like if they're handling it well is that they are staying in that in that register of curiosity and a desire to know better and to know more about what the client is talking about but not in a like shared sexy secret that's typically not what we want to see happen when a client brings up their sexual fantasies about their therapist and I think sometimes I have a

witnessed or wondered if my clients are kind of disappointed by that when they like put something out that is a bit like you know I imagine this with you and then I'm kind of like okay let's talk about it and I don't go into like oh you know like that energy that it can kind of feel like a lead balloon falls a bit for clients so and that that's again a space for exploration but um can be

a bit of like a emotional roller coaster to travel on together as client and clinician. Yeah, an ethical therapist will not...

talk to you about their reciprocal feelings. Yes. Let's say if they do and you're hoping for that, even if there's a real sense of there's mutual attraction here, don't expect them, even if it's true, for them to acknowledge that. And it's also okay, this is from my perspective, but from a client, it might be different. A therapist might be frazzled by it. They might turn bright red. They might trip over their words a little bit. And I would hope that

that people have space for that and aren't reading into it because it is a taboo topic that therapists might not be super experienced in how to handle it and that we can kind of fumble through it together. I realize that that's not ideal, but just because a therapist is blushing doesn't mean that they share feelings.

Yeah, I think you're so right that sometimes people over-interpret and read too much into other people's reactions. Another form of projection that can happen. Oh, especially when erotic transference is on the table because then like,

every like lingering look, every hand that could have touched, every opening of a door can be interpreted as like, Ooh, are they into this? Are they not into this? And I also think therapists can get in their heads too. Once they know erotic transference is there, is that there can be fear about showing up authentically out of worry that it's going to like fuel the erotic feelings. And so there can also be

a fear from, I think, the client for revealing it and also from the clinician of ensuring that it's handled really delicately. Yeah, such an important point. Thank you so much for sharing all of this information, Jordan and Allison. I'm really looking forward to continuing our conversation in the next episode and talking about the other side of the coin, which is when therapists start to develop attraction toward their patients. Can you please tell my listeners where they can go to learn more about you and your work and listen to your podcast?

You can find Edge of the Couch in a couple of different places. So we are over on Instagram at edgeofthecouchpod. We do have a Patreon community where we have bonus episodes. So patreon.com slash edgeofthecouch. And if you want to email us and let us know what you think or thought about our conversation, you can get us at connect at edgeofthecouch.com.

Yeah. And then maybe if you're, so our podcast is meant for therapists, but a lot of clients who, people who aren't therapists listen to it so that they can get a bit of a peek behind the curtain about what are their therapists maybe thinking and feeling. And so those are ways in which you can work through some of those imaginings through maybe, yeah, listening to Alison and my conversations. Yeah.

Well, thank you again so much for your time. I really appreciate having you here and I'll be sure to include links to your show in the show notes. Thank you so much. Thank you for listening to keep up with new episodes of this podcast. Visit my website, sex and psychology at sex and psychology.com or subscribe on your favorite platform where I hope you'll take a moment to rate and review the show. If you listen on Apple podcasts, please consider becoming a sex and psychology premium subscriber to enjoy ad free listening for just three 99 a month.

You can also follow me on social media for daily sex research updates. I'm on Blue Sky and X at Justin Laymiller and Instagram at Justin J. Laymiller. Also, be sure to check out my book, Tell Me What You Want. Thanks again for listening. Until next time. ♪