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July Quandary: A male client I’m treating tends to use me in hypothetical examples, which I find inappropriate. Last week, when we were discussing healthy dating habits, he said, “So if you and I went to a movie, would it be okay to hold your hand afterwards?” I didn’t address the comment at the time, but would like to bring it up during our next session since this is pattern behavior. How should I frame it?
1) Use Humor, But Set Boundaries
Good family therapists always encourage people to solve problems and set boundaries without shaming them, whenever possible. My guess is this client is goofing around, or even subtly coming on to the therapist. However, he could also be struggling with low self-esteem and seeking validation.
Since this is a pattern, I’d probably wait for it to happen again, then combine humor with boundary-setting by saying something like, “You wouldn’t want to take your therapist to a movie—my licensing board and my partner would be all over that one. But you’re raising a great question here. What gestures are okay on a date? Let’s talk about this.”
My formula is to normalize the client's behavior as much as possible, then set as firm a boundary as I need to. If the client didn’t find my response humorous, I might say, “I don’t blame you for wanting to know how I would react, since we know each other well. But I want you to start seeing yourself as someone who can build a relationship with any person who’s romantically interested. So, from here, I’m going to challenge you to use the person you’re dating or will be dating as an example. Does that make sense?”
Rich Gallagher, LMFT
2) Explore the Underlying Motivation
Sometimes, clients are just socially awkward; other times, they're just testing our boundaries. In this instance, assuming the latter is the case, I might say something like, “As you know, it’s not appropriate for a client and therapist to spend time together socially or romantically. But I'm wondering, are you asking how you might approach a dating situation with someone else? Do you have any dates coming up, or are you thinking about going on a date?”
I’ve found that this approach keeps the client from focusing on the therapist. However, if this particular client continued to express romantic feelings for me, I’d address the issue directly by having a frank discussion about whether he believes his feelings are interfering with therapy, and if there’s a need to transition him to another therapist.
Andrew Rose, LCSW
I often tell clients that it's important to respond to the process of communication rather than the content. This certainly applies to the hypothetical question posed here. I would say to the client, “By asking me if I would be comfortable holding your hand after a movie, are you wanting to know if you can trust me, find out more about the type of person I am, or access some special wisdom you believe I have?” I never expect my questions to hit the mark, but hopefully they open the door to more fruitful dialogue.
Kate Cohen-Posey, LMHC, LMFT
3) Normalize Transference
First, I’d say to the client, "Since the therapeutic relationship sometimes becomes intense and discussions can become intimate, it’s not uncommon for a transference to occur. Are you aware of what transference is?" If the client said no, I'd explain what it is and that it's pretty normal and common. I’d make sure to add that transference is okay to talk about, and can even lead to new insights and greater self-awareness in therapy.
How the conversation unfolds from there would depend on whether the client views our relationship as something more than strictly professional, in which case I’d need to emphasize professional boundaries. Being helpful but firm, I’d say something like, “The bottom line is if you want to hypothesize about relationship skills, it’s probably best not to use me as part of your scenario. It would be much more realistic and useful for you to think about a real or potential relationship.”
Claudia Dewane, LCSW
4) Check in with Yourself
If I encountered a client who said something like this, I’d first want to check in with myself about my own countertransference feelings and reactions. I’d also keep in mind that this client shouldn’t be shamed by me for having these thoughts or fantasies. In the next session, I’d wait for a hint of the transference idealization to emerge again—which it likely would in some form—and gently ask him to explore how he feels about me since he uses me as a personal example quite a bit. It could be that he feels very safe with me and trusts me as a therapeutic guide. Throughout our talk, I’d show curiosity about what it felt like for him to experience me in this way and disclose these feelings to me. I’d also ask him to share how he felt I might respond to his comments.
In taking this approach, we’d likely not only maintain the therapeutic relationship, but strengthen it. It sounds like this client might be searching for more closeness in life. This could be starting point for us to explore this more.
Pam Hurley, LCSW
5) Don’t Be Afraid to Self-Disclose
What we’re interpreting as an inappropriate comment might not be as inappropriate as we think. If I was in this therapist’s position, I’d first ask myself why I’m reacting the way I am. I’d explore my reaction to see if there’s any insight I can gain about myself based on my thoughts and feelings about the client's statements. As a therapist with a somewhat gestalt slant on things, I’d share my feelings about the client's statements with him, as well as anything I’d learned about my own reaction. Such self-disclosure could have several benefits. It could create a more egalitarian relationship between myself and this client or invite him to do some self-disclosure as well, including telling me why he’s chosen to name me in this hypothetical example.
We'll post a new response to each Clinician's Quandary on the first Tuesday of every month! See how to submit to next month's Quandary here.
August Quandary: My client Jonathan is in his early 30s. He’d like to be in a long-term relationship but struggles with intimacy, which is why he came to me for help. We have a good rapport and he’s generally engaged in sessions, but if there’s ever the slightest pause, he slyly checks his phone for emails or updates, even though I’ve asked him not to on several occasions. The minute the session ends, his phone is out and he’s scrolling through Twitter. I suspect his phone use may be affecting his “real life” relationships and adding to his anxiety, but when I raise this with him, he insists that it’s not a problem and I’m just out of touch with the times. What should I do?
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