Thank you to everyone who responded to our Clinician's Quandary. Here are some of the top responses! Submit to next month's Clinician's Quandary here.
Quandary: I’m a little embarrassed to admit it, but I find my client Max extremely attractive and charming. I’d never act on these feelings, but I worry about how it might affect our work. More than I would any other client, I’ve found myself thinking about how I look and speak around him, and when we chat at the beginning of sessions, I feel like the conversation sometimes borders on flirtatious. I could refer him out, but feel bad because this isn’t his fault. Even if I did, how would I explain it? What should I do?
1) Openly Explore the Issue with the Client
Before referring this client out, I’d try to take a step back to assess what’s really going on both in the therapy and inside the therapist. Using a mindful approach, we can create distance to observe our thoughts and feelings more objectively. Maybe I’d realize there’s a reason these are coming up at this particular moment in my life.
Then, I’d share my feelings with the client from this detached observer position, but only after restating my professional boundaries clearly. I might say something like, “As you can imagine, I feel uncomfortable because personal feelings can affect the work that we’re doing in therapy.” Or “I wonder if this has happened to you before during a professional relationship? How did you and the other person handle it?” Afterward, I’d ask, “How are you feeling after we’ve talked about this issue?”
Let’s say it becomes clear that the client is exhibiting seductive behavior during sessions. This would be an area for discussion. Is this man seductive with people in general? How and why has he chosen to act with them in this way? Maybe creating an uncomfortable situation like this one is a way for him to gain some sort of control over what he perceives to be a situation in which he has none. These are just a couple of issues that might come up, which might even shift the trajectory of therapy in a positive direction.
Finally, if none of this works, either because I can’t detach from my feelings or sense the client doesn’t want to explore the situation, then I’d consider transferring him to a colleague. Either way, making a decision about where to take the therapy is going to be much easier now that this issue has been addressed.
Sergi Llopart, MA, Clinical Psychologist
2) Referrals Happen
First, I’d like to thank this therapist for sharing this Quandary. In my opinion, making a referral is not about fault or failure, it’s about providing the most therapeutic services available to the client, which are more likely to be provided by someone who sees him differently than this therapist does.
It’s natural to be attracted to some of our clients, but why torture yourself with repressing your feelings and ruminating on all the ways that this could tangle you up? Referring him out will protect you in your most vulnerable moments. Protect yourself, protect your profession, and most of all, protect your client.
If you’re strongly attracted to him, this will be communicated to him on some level during therapy. It will interfere with his experience, and yours, no less. Acknowledge to yourself that your attraction can hamper your insight and intervention, even if you don't intend to let it, and refer this charming gentleman out as soon as possible.
Corrie O'Toole, LCSW
Long Beach, California
3) Stay with Your Discomfort
I think this therapist is already ahead of the game just by admitting these feelings. I believe this step actually puts them at less risk of acting improperly with the client.
However, I’d advise that this therapist give some serious thought to how these feelings are being generated. Assuming the client is leading these flirtatious conversations, I’d explore internally how the client’s flirtatiousness, seductiveness, or charm might serve him, or not serve him, in other aspects of his life. Basically, I’d make use of my countertransference reaction.
Later, if the client does something that could be construed as flirtatious, I might ask something like, “How do you imagine I’m feeling inside about what you just said?” Or ”What were you hoping I’d feel when you just said that?”
I would definitely not refer this client out. Not only would it be difficult to explain, as this therapist mentions, but this client might end up with someone less attuned to his or her own countertransference than the current therapist.
New York, NY
4) This is Countertransference 101
Physical attraction to a client can feel particularly awkward and uncomfortable, but how you navigate it is similar to how you might handle any other kind of countertransference.
Before referring this man out, I’d advise that the therapist consider to what extent the attraction is interfering with their ability to provide effective treatment. The therapist mentions feeling more self-conscious. Does this prevent them from being fully present? Does it inhibit them from using practices that might deepen their work together, like confronting difficult subjects? Does the therapist feel as if the client is similarly restricted?
If I was this therapist, I’d want to further explore and reflect on my own feelings and experiences with this client. What do I feel like in the room with him? What am I getting out of the flirtation? Is there something happening in my life right now that might make him or the feeling of flirtation particularly appealing? Better understanding the source of the feelings may put them into perspective in a way that deflates the attraction and mitigates disruptions.
I think it would also be helpful for this therapist to normalize and accept these feelings, especially the embarrassment at even having them in the first place. I wonder whether the therapist’s shame or guilt surrounding their attraction is just as disruptive as the attraction itself.
Overall, this Quandary is human and relatable. We’ve all experienced countertransference toward our clients, whether it’s anger, frustration, disappointment, or lust. I wonder if the empathic acceptance of these feelings, along with the above actions, would allow this therapist to be more present and comfortable with their client, enough so that they’re able to continue working with him with minimal discomfort.
Rachel Barash, LMSW
New York, USA
5) Keep the Therapeutic Relationship in Check
When you find yourself thinking about a client in a nonprofessional way, it can be a short step to engaging in questionable or unethical behavior. The therapeutic relationship is a crucial part of the therapy itself that requires ongoing monitoring and examining by the therapist.
It’s not uncommon for therapists to have feelings for clients, and vice versa—call it transference, countertransference, or something else. But we have to remember that it’s the therapist’s job to meet the client's therapeutic needs and goals, not the therapist’s own personal or professional wants and needs. That said, if this therapist’s feelings interfere with the therapeutic relationship or therapy goals—and it sounds like they do—he or she should definitely refer the client out.
If these feelings aren’t interfering, they could merit exploration. Maybe the client elicits these same feelings in other important relationships in his life. On the other hand, maybe the client is triggering something in a past or present relationship of the therapist. This is an important reason to seek out professional supervision. And if this therapist goes to therapy, he or she could explore these issues there. After all, therapists are people first, with issues just like everybody else.
Steve Perry, EdD
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.
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Tags: 2020 | boundaries | boundary issues | Clinician's Quandary | code of ethics | Countertransference | ethical | ethical and legal issues | ethical boundaries | ethical issue | ethical issues | ethical professional | ethical therapist | Ethical violation | Ethics | ethics in therapy | healthy boundaries | personal boundaries | professional boundaries | Professional ethics | therapeutic ethics | therapy ethics | Transference | transference and countertransference