Her psychiatrist knows her inner thoughts and feelings better than anyone. She can say anything to him and he doesn’t judge her, but only seems to understand her better. She feels safe and comforted whenever she sees him. He knows just when to hand her a tissue when she’s about to cry, and they share laughs together because her sense of humor is so like his. She finds herself looking forward to sessions and even wondering what to wear. She daydreams about him and wonders if he feels the same special connection to her. Perhaps she’s become his favorite patient.
She feels guilty when her husband asks how therapy is going, and tells herself that her feelings about her psychiatrist can’t be real. After all, she’s paying for his time and damn it, he’s never late with a bill, and there’s no special discount for these special feelings.
So what if she’s in love with him? It happens. She didn’t plan it that way. And he may even love her back. Jason Robards was a psychologist in Tender is the Night and married his patient, Jennifer Jones. And in Spellbound, Ingrid Bergman fell in love with her patient Gregory Peck. Maybe she should just come out with it and tell him how she really feels, but what if he rejects her?
This patient’s experiences are typical of what occurs in many forms of psychotherapy that focus on exploring and understanding the patient’s inner psychological life. Known as transference, it means that the patient is transferring feelings she has toward a parent or authority figure, onto the therapist. A therapist who can remain neutral by not expressing his own issues and emotional reactions during treatment will allow the patient to fill in what she imagines to be the therapist’s reaction. When the time comes for the therapist to point out the reality of the relationship, the patient will hopefully gain insight into her distortions, and realize how she transfers past distortions onto other relationships in her life. With the psychiatrist’s help, the patient can come to grips with this pattern, put her distortions into perspective, and move on with her life.
This process can be particularly challenging when the patient’s transference is eroticized. And if the therapist is experiencing emotional issues in his own personal life, it can lead to a dangerous romantic liaison as it is often depicted in films. An ethical, well-trained psychiatrist, however, knows how to deal with his own emotional reactions to his patient’s expressions of transference.
Freud used the term countertransference to refer to the therapist’s emotional responses to a patient during psychotherapy. An effective therapist has the capacity for empathy and will experience countertransference feelings, but should not allow them to interfere with the therapy. In fact, for psychiatrists who maintain perspective on these reactions and their distortions, countertransference offers an important opportunity to explore the patient’s inner emotional world. It helps the therapist understand how the patient’s behaviors affect others in her life, and how these distortions can create dysfunctional interpersonal patterns.
Anyone who has positive or negative feelings towards her psychiatrist during therapy should discuss those feelings, no matter how uncomfortable that discussion may be. For many patients, it provides an opportunity to gain greater understanding of themselves, offering a path to emotional health.
However, some patients can’t handle this kind of exploratory insight-oriented psychotherapy. The psychiatrist’s silence or probing questions may stir up so much anxiety that it distorts the patient’s reality and imposes other dangers.
In the “Sexy Stare” incident in my new book, I was still a young psychiatrist-in-training when I first had to deal with a patient who had an eroticized transference towards me. Insight-oriented therapy had pushed her into such a distorted transference state that she believed I had made love to her by staring into her eyes. Once I realized that her transference feelings had morphed into dangerously psychotic romantic desires, I quickly changed my therapy strategy. I stopped probing her past and helped her cope with her current anxieties. I continued to work with this patient for another year or so, and she improved. I tried never to stare into her eyes again.
So falling in love with your psychiatrist can be a normal part of therapy. A few people can’t handle it, and an experienced psychiatrist knows how to spot them and help them deal with their problems in the present. For most patients, talking about those feelings with the therapist and learning how they relate to past relationships often speeds up emotional growth, recovery and health.
See my new book, “The Naked Lady Who Stood on Her Head: A Psychiatrist’s Stories of His Most Bizarre Cases.”
Copyright Gary Small, M.D.
First posted on HuffPost.com