Episode 392: When Therapists Fall In Love With Their Patients
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You're listening to the Sex and Psychology Podcast, the sex ed you never got in school and won't get anywhere else. I am your host, Dr. Justin Lehmiller. 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. In the last episode, we talked about how it's common for patients in therapy to develop sexual and/or romantic feelings toward their therapists.

This is a phenomenon known as erotic transference, and it's a form of projection in which the patient transfers feelings and needs onto the therapist based on past experiences and relationships. In today's show, we're going to talk about the flip side of things, when therapists start to develop sexual and or romantic feelings toward their patients, which is known as erotic countertransference.

Research suggests that this is surprisingly common, but nobody likes to talk about it, to the point that this is something that is often not addressed at all in clinical training, which leaves therapists totally unprepared in the event that it later happens. The idea that a therapist might develop feelings toward a patient is uncomfortable, and yes, of course, it would be completely wrong and unethical for a therapist to disclose their attraction to a patient or to pursue a relationship with them.

But given that it's such a common experience, it's important for us to understand the psychology behind why this happens in the first place and what to do in situations like this in the interest of pursuing ethical and appropriate care for patients. I am joined once again by Allison McCleary and Jordan Bickell. 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 Edge of the Couch is the podcast they wish had existed when they were new therapists. This is going to be another fascinating conversation that you won't want to miss. Stick around and we're going to jump in right after the break.

Do you want to learn more from me in the form of an online or in-person course? Become sexceptional by getting certified with Sexual Health Alliance, where you can learn from yours truly and a number of top sexuality scholars. Each year with Sexual Health Alliance, I teach courses like fantasies around the world, as well as immersive study abroad classes in several exciting countries. Join these programs and become a certified sexuality professional at the same time.

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Okay, Jordan and Allison, in the previous episode, we talked all about erotic transference in therapy, focusing on when patients develop sexual feelings toward their therapists. So in this show, we're going to flip the script and talk about erotic countertransference. So let's start with the definition. What does the term erotic countertransference mean?

So in the last episode, if you heard it, we talked about transference as in transferring your feelings, the client's feelings onto the therapist that's from outside relationships or their unmet emotional needs. In this way, this is the therapist's emotional responses to the client, towards the client, which may include

attraction, discomfort, protectiveness, kind of this parental energy that comes up. Today, we are going to talk about the romantic or sexual feelings that a therapist has towards their clients, but it can be any feeling on the full spectrum of human feelings can come up from a therapist towards a client.

Yeah, makes sense. Like we can project any feeling onto anybody else. But yes, in this show, we're going to focus on the erotic and romantic feelings. So why does this happen? You know, why is it sometimes the case that therapists will develop attraction or feelings about their patients? You know, what's the psychology behind this?

Therapists are people too, who can project all of their messy own stuff on to clients who are also engaging in this deep intimacy with clients that does feel like we talk a lot at edge of the couch about how

the therapeutic relationship is so unique. It doesn't exist in other spheres. There's like this closeness and this intimacy that facilitates depth of getting to know oneself, but also leaves both clinician and client open to that full expansiveness of feeling like we're saying. And I would also add that lots of our clients are dynamic, fun people.

like outgoing, wonderful people. And, you know, the longer you spend time with someone and the more you get to know them and they reveal parts of themselves, we can be really impacted by that. Like, wow, I see you as this full person and I really like what I see. Like, this is a great, this is a really cool person right here. Yeah. It's such an interesting phenomenon how

And therapists will, sometimes it's at the beginning of a relationship, a therapeutic relationship where there's an instant like, wow, this is a beautiful person. I feel this magnetism towards them.

And then over the course of the therapeutic relationship, there can be like, oh, yep, this person is a person. And actually, I see them very differently now than when we started working together. Or it can be the flip side where there's absolutely no attraction. And then as they show these vulnerable sides of themselves, maybe there's shared interests. There's these imaginings of maybe they're dating in the world. And you go, huh.

I wonder what it would be like to date this person. They're describing their sex life and you're going, I wonder what it would be like to have sex with this person. And that is, for me, I think in this conversation feels much more sticky and taboo to talk about. So we'll see how it goes.

Yeah, you know, I think a lot of people like to think that therapists can just like check all of their emotions at the door and like not bring any of that into the therapy context. Like, sure, in an ideal world, like maybe this wouldn't happen, but it's a reality. It does.

And like we said in the last episode, it's such a taboo thing that people don't want to talk about it, whether the attraction is on the side of the client being attracted to the therapist or the therapist being attracted to the client. It makes everybody uncomfortable when there's some attraction that emerges in the context of some type of therapy office. So, yeah, it is definitely a sticky subject.

Now, do we have any sense as to how common this is? So I looked up one study before the show, which reported that 95% of male therapists and 76% of female therapists who were surveyed said that they had been sexually attracted to a client on at least one occasion. That seemed like very high numbers to me. So what do you think? Does that surprise you? Do you think it's really that common?

I think it might be more common than that. Same. I'm like 70s person. That seems low. What is, what are these numbers? Sexual attractiveness, erotic transference. It can be this energy. It can, we talked about in the last episode, it can be these intrusive images. I think part of it is how you define it, but it can be a fleeting thing. It's a temporary thing. I think maybe in the study,

or maybe for a lot of people because it's taboo, it takes a very high bar for them to acknowledge it. I think it's actually much more common, fluctuates. If you're not scared of it, then it just comes in your mind and leaves. You don't have to latch onto it of, oh no, this means something bad about me as a person. The fact that I'm a therapist with more power and feeling this way towards my client, it's all just grist for the mill. So

This is a therapy phrase where anything that happens in the therapy room, even the therapist's feelings towards a client is information that can be used for the therapist in their own work, in their own life. But also it can be information about what's happening for the client. Do they present with sexual energy in a way or that other people in their lives may

maybe certain genders or just it's pansexual in a way that people have this energy towards this person. I think it can be informative. It can be informative when a therapist feels this. And sometimes it's just a fleeting feeling. We don't have to create a story about it. It's a private thought. It's okay.

Yeah. And you know, for me, I'm a sexual fantasy researcher. You know, I've written extensively about the science of fantasies. And I think part of what makes people uncomfortable about this idea of erotic countertransference is that they're assuming that, let's say, a therapist has a fantasy about a client, that that necessarily means that they have the desire to act on it, or that they would actually do something about that. You know, fantasies are things that can just

spontaneously pop into your head for no explicable reason, right? And sometimes those fantasies are very fleeting. Like it's just like a one-time thing that happens and you never think about it again. And so I think we need to make that distinction between fantasy and desire when we're talking about these things because just because

the attraction might exist on some level or because there was a fantasy, it doesn't mean that it's going to go any further than that or that people have some type of wanting or longing or desire to actually do those things. Oh, yeah. One thousand percent. And ethical therapists will never cross that line or if they notice that

Putting on extra makeup, wearing their cute outfits, maybe batting their eyelashes a little bit. Their voice goes higher pitched. They introduce topics that they wouldn't normally. That's something for the therapist to be aware of and do their own work. But ethical therapists will never, ever, ever cross that line to acting on erotic countertransference.

We didn't say this in the transference episode, but I think it's relevant here too, which is that these are like, we're using the word fantasy. And I think it's a really valuable word because transference

Transference and countertransference, they are real, but they're also like wisps of smoke in the way that like when you try to actually like land on them and make them something concrete. I always say this all the time, like clients might think they want to have sex with their therapist, but then like if they were to actually be in a dynamic with their therapist, all of the fantasy would disappear because your therapist is just a real flawed person who sucks in some ways and is great in some ways and like, you know, is still a person and gets annoying sometimes. So all of it kind of can crumble.

And it's similar, I think, around this erotic countertransference, which is like, you know, we're allowing the fantasies to come and go. But the reality of actually having sex with a client is this whole other different thing that just doesn't hold water, doesn't have weight. And so I think there's value in speaking the countertransference aloud, whether it's in like supervision relationships or whatever, so that it does come down from the pedestal so that it comes back into the human reality of like, oh, right.

this is what it would actually be like. And there's value in that. Yeah. And reading through the somewhat limited literature that's out there on this topic, it sounds like erotic transference and countertransference are things that we've long known about. You know, it seems like as long as psychotherapy has been a thing going all the way back to the days of Freud, people have been writing about this subject. But it seems like this is a topic that a lot of therapists are just super uncomfortable with to the point where it's sometimes not even addressed at all in training programs.

But if it's such a ubiquitous experience, you know, why aren't we equipping therapists with the tools they need to deal with this? You know, why is the subject avoided in training programs? And do you have any sense as to what percentage of programs actually even cover this information?

Ours didn't. No. I've done three degrees in psychology and it's never come up in any class or anything beyond like people bringing up their personal experiences in with our cohorts type thing. I think it's even taboo to talk about this with a lot of supervisors. So people that therapists are consulting for guidance. So this is, I think one of the takeaways from our conversations are,

getting a therapist who is experienced with relational work, getting a supervisor from the therapist role where you can talk about these things. Allison and I have been friends since grad school and we are each other's space where we can talk through these things. That it is so taboo. It's a reflection of our larger society. People don't talk about sexuality, sexual feelings. And then there's

even more of a taboo where it's a therapist who is in a position of power and it is wrong, wrong, wrong for a therapist to act on those things. So a lot of therapists are going to be scared that things will be misinterpreted or that people might think that I'm going to act on this when I never would. So they are afraid to even speak it aloud. Yeah, there is a conflation for sure of like,

erotic counter-transference and like predatory behavior in our field. And we have the field of therapy has a problem with predatory therapists sleeping with clients. Like it's just a reality and it's sucks to talk about and acknowledge, but when we kind of merge those things together, it's,

then fear is the leader, right? In terms of those conversations where it's like, oh no, if I imagined having sex with my client because my client was telling this like kind of graphic sexual story and I just for a moment imagined myself there, that that must mean something. Like we're saying earlier, like we separate desire from fantasy, right?

But because we're also not talking about the predatory nature of some of the therapists in our field, we are just kind of like, we're throwing the baby out with the bathwater. We're not talking about any of it. And it is a huge disservice, I think, to students and new clinicians to

And we get asked, like I listened to a recent episode where you were talking with a sex therapist about the five questions get asked a lot. We see themes in the questions that we get to run this and, you know, new therapists coming and almost like feeling so bad about their feelings about clients. And then we're just like, Oh yeah, that's totally normal. But like, they've never even heard that once their entire, you know, academic trajectory and in training. And so, um,

I think Jordan is right. It's a societal thing. It's like these programs don't want to get into like the sticky, messy, yucky stuff. They don't want to face what is gross about the field. And so then we're just, no one's talking about it. Well, and those are the bad therapists. We don't do that. We never feel that way. Right. We don't talk about it because...

We're not them. So there's therapists who entertain those things and we don't. And the idea that our professional boundaries mean we don't even talk about it. And that's where we want to introduce nuance that it's actually important we talk about it because as we talk about it takes the energy out and gives us information. I think just like in the transference conversation, um,

counter-transference, erotic counter-transference is information. So when we don't talk about it, we just lose so much. So I'm so grateful to have people in my life, including Alison, where we can talk about these things. A lot of therapists are working in their own private practices and don't have folks to talk about it with. So they just keep it inside. And I think it gathers more energy when you don't talk about it.

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Yeah, and I think that's such a key point about this conflation of sexual predation with erotic countertransference. Those are not the same thing.

And, you know, I can also see how I think in recent years that people might have grown even more uncomfortable with this idea. Like if you think about it in the context of the Me Too movement and all the conversations that we've had in recent years about power differentials and exploitation, like, well, this idea that somebody who's in a position of power over a client has attraction toward them, like that's inherently wrong. And that is equivalent to, you know, these other forms of sexual violence and exploitation.

exploitation. And so, you know, I can see how there's that temptation to want to lump these all into the same camp. But again, it goes back to what we were saying earlier, you know, just because, say, a fantasy pops into your head, an intrusive thought, it doesn't mean that you have any desire to act on it, or that you're going to do anything about it, right?

Definitely. And we don't want to be thought police. Like when we say you can have the full spectrum of feeling that exists for a person, you could have about a client like that can include hatred, that can include pity, that can include like other like kind of yucky feelings to acknowledge. And so we don't want to demean or shame therapists who are speaking about these complicated feelings that they have about clients because it is so much more about what you do with those feelings than the having of them to begin with.

Yeah, I imagine folks who are listening, I think most your audience are people who aren't, they aren't all therapists. I'm sure, you know, the majority of your listeners are not therapists.

And so I can imagine hearing this conversation as someone who is not a therapist and worry, be scared maybe about my therapist, my therapist having sexual feelings towards me. Maybe I view them as this parental figure. And then this idea of them seeing me as a maybe sexual object, even in a fleeting way.

feels like a violation. And that is why we want to differentiate having the feelings, talking to your peers and your supervisors, that therapists who are doing ethical good work are not going to bring those feelings to you. And that as we are not thought police, I hope clients feel the same way where a therapist can have the full spectrum of human feelings and thoughts towards a client. And that it's a private thought that the therapist just trusts

that if they have these feelings, that they're working it out for themselves and it's actually not your business in a way, do not assume that your therapist is attracted to you. Sometimes people do. It's interesting when clients will think that the therapist, they won't acknowledge their attraction to the therapist, but they have this idea that the therapist is attracted to them, which is so interesting. So if your client is,

and you imagine your therapist is attracted to you, there's also ways of bringing that up. The client can bring it up where there's like, hmm, I'm feeling this energy towards you and...

I'm just saying it might be total projection, but that's what I'm thinking about when we're sitting together. It's getting in the way of our conversation because I feel like you're attracted to me. And then there can be a conversation where it's not like, yes, I am, or no, I'm not. Though some therapists might say, yeah, obviously you're an objectively attractive person. That's, you know, I have eyes. We're in the role of therapist and client. It is not...

Completely taboo for me to acknowledge what is here. But a therapist who is doing ethical work is not going to be like, you're right, I have sexual fantasies about you. That is not for the therapy room.

Yeah. Yeah, I mean, I think we all know the wrong response here, right? A therapist who finds themselves sexually attracted to a patient should not start a sexual relationship with that patient, and they should not tell the patient that they have those feelings, right? We do know that that does happen sometimes, and that is a clear ethical violation.

And in one of the studies I read before the show, it seems like it actually used to be not that uncommon for therapists to sleep with their clients. In fact, if you look at some surveys of therapists from the 1970s, as many as 12% of male therapists and 3% of female therapists were

reported having had sex with a client. However, in later years, that dropped to less than 1%, which I think likely reflects a growing recognition in the field that this was wholly inappropriate behavior. You know, I think a lot of people would be surprised to learn that a lot of the ethical guidelines that we have for therapy today are actually pretty recent inventions.

You know, another example of this would be in the 1960s and 70s, you actually had this whole movement where therapists were engaging in nude psychotherapy with their clients. Like people were literally getting naked with their patients, supposedly as a way of tapping into their authentic selves.

And that practice even had the backing of the American Psychological Association's president at the time, who was actually Abraham Maslow, right? So the guy who developed Maslow's hierarchy of needs was a big proponent of nude psychotherapy. And it's interesting because Maslow kind of died prematurely and

And when he was no longer around, that's kind of like when the nude psychotherapy movement lost its steam because it lost its biggest backer, who was somebody who was very influential in the field. Now, today, of course, getting naked with your patients would be a great way to lose your license, right? Again, inappropriate behavior because we have different ethical standards today than we had back in the 1960s and 70s.

So yeah, we know the wrong response here. You know, it's not getting naked with your client and not acknowledging that you have attractions to them to the patient themselves. So what should you do if you're a therapist and, you know, you experience this erotic countertransference and you're like, just not sure what to do with it?

take it to supervision, like any type, I mean, acknowledge it to yourself first. I think that that is a huge first step. Like, wow. When so-and-so was talking, I imagined myself as part of that fantasy or, I mean, dreams are also a big thing here, which sometimes therapists even feel bad for having sexual dreams about clients, which we have no control over. So I think naming it first and acknowledging it and then taking it, whether it's

that you are as part of a training, whether it's supervision that you're paying for, like consultation, whether it's peer supervision, like Jordan and I are naming, there is something about supervision

turning to someone and saying like, I think this way that I genuinely believe prevents these other incidences from happening because then we have someone there to kind of gently hold us accountable and say like, yeah, are you showing up differently with this client? Have you been texting them outside of session? Are you noticing that you wish they would linger and hang out in the waiting room for a minute? And so there's someone there to be your teammate in if they are coming up in a big way.

Would you add anything to that or what would you add? Yeah, just that you and I have done that for each other before. And asking, going through that, maybe tree, those conversations, those questions, which are so important. And I think it's easier to do with a peer than it is to do with a supervisor because there is that power differential and there can be less trust.

And more, are you going to report me? What's sussing out? Can I trust you for me to bring up these feelings that are coming up with my clients? So developing a trusting relationship with supervisors, developing a trusting relationship with therapist peers. And then I also want to speak to the client side based on what you were sharing about Maslow and naked therapy. As a client, when you're looking for a therapist,

for their license because as someone who has done some training in psychedelic assisted therapy, there are a lot of unlicensed folks who are say doing MDMA assisted therapy with their clients. So there are people on the margins who are still seeing it as therapeutic. Like I'm going to give, maybe I won't have sex with my clients, though there are people, there's like a big scandal right now that has happened where people

Therapists have had sex with their clients who are asking for it while they're under medicine. Oh, boy. And I think being able to bring those things into the light are very important so that people can be accountable for that.

the harm that is enacted on clients. But even outside of that, there are therapists who do hugs and there can be a sexual energy to a hug and then there can be a purely platonic hug. And how does a client interpret that? How does this therapist feel during that? So there's also something about touch,

that is really tricky. So it's important for therapists to have their own spaces to talk it through because it is so multi-layered and the way that clients interpret it can be very different than the feelings that we're having as therapists.

Boy, so many layers to this conversation. And if you add MDMA-assisted therapy on top of this, it creates even more potential for erotic transference and things like that to happen because that's just a very different context and situation. So yeah, oh boy, lots of stuff that we could discuss there.

Now, I wanted to ask a somewhat provocative question that's kind of related to this idea of therapists and clients who are attracted to each other. And that's whether there are ever any circumstances under which it's ethical for a patient and a therapist to start a relationship. And specifically, people often wonder, would it be okay for us to start a relationship if we just end our therapeutic relationship first before starting a sexual or romantic relationship?

So what do you think? What's the answer here? Is it always unethical because there will be a power imbalance? Curious about what you think. We have a hard line. We're laughing just because it is so 1000%. It is never okay. It is never okay. To the point where we're like laughing a little bit because there is no room there. And I also want to acknowledge that in the field, there are people who do have ideas about...

if I end the therapeutic relation, oh, we didn't see each other that many sessions. Yeah, we only did five sessions. Yep, I'll end the therapeutic relationship and then two years have passed and so now it's okay or there are some who are radical therapists

You know, you see this. I come from an anti-oppressive approach, but there are some people, queer therapists, anti-oppressive therapists who can, from a political stance, get this idea that we are two humans and people are adults and they can make their decisions for themselves. But from Allison and my perspective, there is never...

a equalizing of power, no matter how much conversation you do, how much therapeutic work you do as the therapist, it's just never okay.

And what we see time and time again, like constantly, is that people believe that they are the exception for a temporary amount of time. Therapists can convince themselves like, no, no, no, I'm actually in love with my client. We're actually in love. And that those relationships don't last. And then the client comes out the other side and through doing their own healing, understands that what happened was wrong. And then they are traumatized.

and they have healing to do and they feel that they were mistreated and they were and so it's like yeah sometimes it might work for a while and so there can be therapists and clients who are dating or in married have children and are saying like it worked for us but I think those situations are so few and far between because I think what happens more commonly much more commonly is that

The therapist violates a boundary, whether that is sexual texting, sexual touch, maybe actually having sex, and then they freak out. So they pull back all of the care from the client and they say, actually, I can't be your therapist anymore. And then they have to lie. It gets so bad and twisted and warped and messy. And so Jordan and I both an edge of the couch as like a brand draw a very hard line there of like, no, it is always predatory. It is always harmful.

even if it temporarily looks like it's not. And there are some clinicians, like we're talking about this naked therapy, great example. There are some clinicians out there in the world in the year 2025 who believe that having sex with a client can be healing and transformational for that client and beneficial in some way. And the client can feel the same way in the moment. The client can be like, this is therapeutic for me. You loving me in return is

is soothing something like a wound in me that has never felt addressed in any other way. And we're on this higher plane. We transcend the roles of therapist and client therapist

And like Allison is saying, it's only much later that they have a deep, deep, deep sense of violation of like not only sexual violation, but psychic violation that the therapist, maybe there's a feeling of grooming. Like the therapist was pulling all these bits of information, using their power, making it seem like it's something that I wanted to do and chose to do.

So it is really tricky because as the therapist, I mean, it's against our ethical guidelines. It's not good practice. I think it's morally wrong because it's an abuse of power.

But also a client, because of the power dynamic, the client can't consent. And even when a client says, I'm completely on board, we can't because of the power difference and because of what we know about clients and what they don't know about us, they may feel very differently later on. And that is on us, not on the client.

Yeah, I appreciate the thoughtful answer. And you know, this is why we have the ethical guidelines in place. It is interesting, you know, a lot of people, as you said, do believe that they're the exception to the rule and that they can handle it, they can make it work. And if they just wait a certain amount of time, or if it has only been a certain number of sessions, like then, you know, people can find a rationale or justification for anything.

But yeah, there are a lot of risks of somebody who is in a position of power like that being a therapist and then acting on those attractions toward a client. So definitely something not to do. We believe like do anything, do anything else.

Bring that energy home, that Eros feeling. Discharge it somewhere else. Yeah, there can be this question about, okay, what does this mean about me and my sexuality? Maybe I have this, I want to feel powerful over someone else.

For me, as a, you know, I grew up with sister, very strong, a lot of women, strong women in my family. And then to see men in this vulnerable position was very new to me when I first became a therapist. Like, wow. And so anything that comes up is worth bringing to your, not just your friends and your supervisor, but also to your own therapy because these are ways that our feelings are pushing us for our own growth and healing.

Yeah. And when in doubt, if you're a therapist and you're struggling with something, talk to a supervisor or go into therapy yourself, right? You know, I know a lot of therapists who have therapists. And in part, that's because doing the work of a therapist can be very emotionally draining and it can be hard to not bring your work home with you in a lot of ways. And so there are lots of resources and support.

out there. I know that so many people never learn about these topics like erotic transference and countertransference in their training. And so it's important to go out and find your own sources of support in terms of learning how to navigate and deal with issues like this. So thank you so much for this amazing conversation, Jordan and Allison. It was a pleasure to have you here. 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, sexandpsychology at sexandpsychology.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 $3.99 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.