Forbidden Fruit: Romantic Attraction in Psychotherapy

I was very nervous. I was in my oral Clinical Examination, in a room with the chairperson of the department and two other professors that I admired. It was difficult for me to “read the room” to see if I was passing so far.

The chairperson posed a question: “Is it ever OK to sleep with one of your clients?” 

“An easy one!” I thought to myself triumphantly. “No. It is a violation of our profession’s ethical principles, as well as a violation of the law in this state.”

He complicated the question. “OK, but let’s say it has been 5 years since she was your client. She approaches you in a bar, you start up a conversation, and it ends up in the bedroom. That is legal in Texas. Is it OK then?”

I knew the answer was still “no” but I had to justify it. I had to think on my feet!

“No,” I said. “We still have a relationship. It’s not currently a clinical one, or a financial one. If I’ve done my job, I supported her as an ‘external ego’ years ago, and I may still be internalized within her as a source of emotional support. If I sleep with her, or even flirt with her, I’m damaging that ‘internal relationship’ and undoing all the hard work of therapy. She can start to think “He was just being nice to me as part of a seduction” instead of “He knew me well, platonically, and considered me to be a good person.”

It must have been an adequate answer; we moved on to other topics. But I started thinking: if what I said was true, why do so many films that feature psychotherapy depict this ultimate boundary violation as a part of the plot? Even my favorite films about therapy – Antwone Fisher, Ordinary People, and Goodwill Hunting – feature client-therapist relationships that extend past the appointments. Other films that depict male-female psychotherapy relationships almost always end in romance. 

In real life, too. Despite it being a forbidden fruit, a common reason for a therapist’s loss of license is the discovery of a sexualized psychotherapy relationship. The therapist knows it is a snake when they pick it up… but every day, someone gets bitten.

In Reality... 

I have another source of information about this, harder to talk about.

When I was a practicum student, I developed a strong attraction to a client in a university clinic. All the signs were there–thinking about her between sessions, looking forward to our meetings, etc. I’m glad to say I never acted upon the attraction in any way, but sad to report that my heart hurt when the practicum ended. 

Superficially, it was easy to understand. She was young, attractive, lively, intelligent – the sort of person that anyone would find appealing. It didn’t help that she reported on her sexual encounters with her boyfriend in sessions, and CERTAINLY didn’t help when she flirted with me a bit. 

I had the foresight to do something that I highly recommend. I spoke candidly about it with my clinical supervisor. Talk about it, and it is less likely that you will act upon it; we are only as sick as our secrets.

The Warning Signs & Mining for Motivations

Through that conversation, I learned about a second level of motivation, one that I suspect is a common denominator in many boundary violations in a therapeutic relationship: think about your relationship with clients. They listen attentively when you speak, rarely disagree with you, respect and admire you, and often follow your suggestions. They often dress up to meet you, and never see you when you have morning breath or cow-lick hair. They disclose intimate details of their lives, and speak with you on a deeply emotional level.

O, that all relationships could be so sweet! 

I discovered additional motivations for my attraction in my supervision. I was in transition from the role of student to the role of breadwinner, leaving my cloistered life for the uncertainty of a professional career. “Any port in a storm!” as my supervisor put it. He hypothesized that her own life transition might have been the motivation for her flirtation, too.

So that is my advice: when you see the warning signs in yourself – scheduling the client for the last session of the day, lingering at the end of the session, thinking about them excessively between sessions, paying too much attention to their faces or bodies or movements – then talk about it! It may not be wise to bring it up with your spouse, but hopefully you have a trusted professional colleague that can serve as your confessor. They will probably heave a sigh of relief, since you will have given them permission to do their own emotional unloading about similar obsessions. 

It is not a crime to think about it, just a crime to act upon it.

But if you can stop thinking about it, you are in a much better position to be of real help to your clients. 

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