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I am sure I have never experienced any textbook transference issues. I do believe my relationship with my therapist that spanned nearly 19 years wasnt appropriate in the sense that we were acting more like friends and knew things about each others' families that only friends would know. I had long ago came to a point of relative stability and was really dealing with life's issues which occasionally had small fires I needed help putting out. And I was very lucky. I met him fresh out of grad and business school working at an agency that also assisted people with sliding scale payments.
But each time he moved offices It was always in my area and ins network. He eventually became well known with his own practice in bougie towns. He is also in AA and has been sober 20 years. He was integral to my sobriety because he would meet me at certain meetings-I joined his homegroup. We parted ways after I had a couple of years sobriety because years of therapy that turned into "scheduled hanging out" and sobriety put me in a place of real safety and contentment. Anyway:
For "fun" Ive always been interested in the mechanics of mental health treatment, I will often have discussions with friends and family who work in various mental health, human services fields and healthcare industries.
One therapist acknowleged to me that he felt he has experienced countertransference more than he thought he would and what he considers the "standard" for dealing with that happening doesnt always apply, work, relate, or work for him
I want to also note that not all therapists and other mental health workers are well-at least not well enough to be doing their jobs objectively.
I dont know if others agree but I sometimes heard "only a crazy person can treat crazy" And I have seen a disproportionate amount of unhealthy or emotionally immature/inappropriate "professionals" when looking for doctors for my family. My son was first evaluated for ADHD and a "midline issue" at age three. He is 25 now and starting law school. You do the math but I'm talking 22 years of laymans experience- not county myself and others I have had to help.
I am just sharing that because I do not want people to feel I am anti-therapy or just some fool who read a little on webmd and thinks she is an expert. I feel very informed but I am no professional or expert.
My feelings about Transference:
If it is coming from the therapist (counter transferrence) I believe it should be talked about openly in session ASAP in order to determine if the patient feels that way, if the I feel like if the patient has transference feelings and the therapist does too on his end. I feel like that relationship should be paused and then ended. I dont see how two people who are in an emotionally jumbled relationship be expected to work on themselves and the patient with both having the same problem. I expect to have someone say that they "have a cousin who knows a guy that was a therapist, and he had feelings for his 22 year old patient he worked it out with her and she is a patient.
If transference is coming from the client it needs to be addressed asap and the entire therapist/client relationship should be re-evaluated to see how this can move forward while not contaminating the work or disturbing the process.
In particular it should be addressed with certain things in mind:
Does the client have a long term history with this type of attraction/inappropriate fixation with other people either in a personal friendship/family relationship or romantically.
Those two things make a difference. A long term history of emeshed, obssesive, and inappropriate relationships with friends and family are a lot different than a client who has these issues with their own romantic life and creates an exstensive fake relationship that is deep and one sided .Romantic and sexual feelings are strong and intoxicating and can easily support a client who wants to live in a fantasy.
if a person gets infatuated or feels romantic with their therapists it is important to see the pattern and IMO set a plan in place immediately establishing an end date and a "step down/out" plan between the therapist and client so that the therapist is owning the responsibility of preventing further harm, preventing any possibility of impropriety.
The therapist HAS to own it to change it. The client cant and more importantly wont change it- it fills whatever void they are filling and they should be considered impaired or almost incapable and unqualified to do anything THEY are the patients that have conditions that make them almost "numb " to perceiving harm and near impossible.
More importantly it is ETHICAL sets a good example, and it will ultimately spare the patient pain.
I believe in identifying the issue(transference).
I believe in prepping for the long hard conversation- ending therapy with him by knowing what treatment facility has beds open if it gets bad, Having the new therapist present and completely willing to offer help. What PHP or IOP's are full/available just in case. I would have a list of local services if your patient needs more supportive help. Its a shame you cant slowly weave yourself into her orbit even perhaps observing her routine. Decide ahead of time what you will allow. Hugs? Or do you never want physical contact.? Therapists debate the validity/effectiveness of hugging or patting patients vs never allowing any physical contact in order to establish a boundary that can never be crossed. A therapist must remain calm and neutral to make sure that the discussion is direct, equal and without shame. Remember you are still the therapist while making an exit plan without triggering any more tears, and setting up some of her services. If she ends needing some hospitalized care you will have to do the referal for her.
The patient will not like this at all. And it makes sense. And it will hurt the patient. And you can help with that pain by Picking a last day with the patient and writing it on the calendar because its important. Helping to make a plan with regular reminders and check in's that other patients can see.
i take so many things personal- when they are not.
Even if you end the treatment it went well you may experience some minor sadness .
I know this seems unfair and ridculous but its better to address something and move on.
Something else about counter transference: I think that if the therapist has feelings for the patient and you address it in therapy I dont think that the therapist is off the hook. I think the therapist should be required to have some therapy and emotional healing. i also think its fair to say that the therapist should have regular weekly meetings with a supervisor to discuss his cases with the supervisor and receive feedback or suggestions. The supervisor should be given enough information to be really familiar with that patient and their circumstances. i look at it as simple protocol updates.
That's it for now. it started out strong yesterday and I went 24 hours without sleep. if its not making sense i want to hear what you think.
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"I carried a watermelon?"
President of the no F's given society.
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