Erotic  Transference  and Countertransference

Understanding and managing transference and countertransference is one of the key elements in successful therapy. Transference is the repetition of feelings toward someone in the present which have their origin in past experiences with a significant person in the past. Everyone experiences transference reactions. 

Many studies have shown that some types of countertransference reactions (broadly speaking this can be defined as all the therapist's feelings toward his/her patient) are never adequately covered in psychotherapy training and supervision. Dr. Sehl's published research* in 1998 revealed that the majority of therapists surveyed did not receive adequate training in countertransference. The HBO program "In treatment" is unusual in many aspects. Although the treatment is abreviated for the sake of TV, it attempts to come close to actual experiences of analyst and patient and it does focus on the analyst's countertransference. 

An analyst's empathy and self-understanding is essenttial in conducting good treatment. In 2006 the NY Times carried an article on the importance of the discovery of mirror neurons and part of the article makes the connection with mirror neurons and psychotherapy: "Therapists can use their own mirror system to understand their client's problems and to generate empathy . . . And they can help clients understand that many of their experiences stem from what other people have said or done to them in the past." (NY Times, Jan. 2006). If therapists do not understand their feelings and reactions to their patients they will have difficulty understanding their client's feelings, and they will have difficulty with a patient's transference. 

In the "In Treatment" show Paul, Laura's analyst, is uncomfortable with her. His actions at times seem seductive, yet he claims not to have any feelings for his patient until his supervisor pushes him relentlessly. 

The more experience the therapist has, the more sensitive he or she will be to a patient's revelations of loving and/or sexual feelings. The therapist's reactions must always conform to the guideline of "do no harm" to anyone seeking help. At the same time, he must not do anything that causes damage to the patient's sense of self-esteem. Was Paul's telling Lara that "nothing will happen here" helpful, or meant to reassure himself? Was it successful in establishing boundaries or unnecessarily premature? 

These are questions therapists struggle with; themes that continue in the opening moments of " In Treatment" 2009. The human side of this therapist is unfolding, revealing how tortured he is about his unresolved past. Paul begins to resolve his resistance to talking about what happened at the time of his mother's attempted suicide.

*Sehl, M. (1998). "Erotic countertransference and clinical social work practice: A national survey of psychotherapists' sexual feelings, attitudes, and responses," Journal of Analytic Social Work, 5 (4), 39-55.

Dr. Sehl would be interested in hearing about therapists' and patients' experience around these issues. Contact him today!