I would be interested to hear what dual-role relationships are ethical.

sonia, from your blog, it often sounds like you have major unresolved transference issues. and in this article in particular, it looks as if you are projecting your own particular issues onto all therapy clients.

“in the very unlikely possibility my therapist and I became equal friends, it would rapidly become unbalanced because I would become very possessive and jealous in a short space of time.”

“your obsessive desire to be friends with your therapist”

Do you mean “your OWN obsessive desire”? Not all clients are this extreme about their therapists. In fact, most probably are not.

This is not to argue for dual relationships. It’s just to say that this post seems like it’s about you and your feelings, which means it’s merely anecdotal. Interesting, but hardly conclusive.

Great post! I love this article and agree with all the points you made! You have such a way with words and I love all your blog posts! I am happy to see you are posting regularly again after what seemed like a little hiatus from the blog world!

I agree very much with your assessment of what is appropriate within a patient-therapist relationship. There should be very clear boundaries that are not to be breached. Fortunately, what occurs inside the therapist’s office is a genuine human relationship–not a friendship of equals but something genuine nonetheless–very nurturing, very powerful. Ordinary friendships pale by comparison. When I have coffee or a beer with a friend, I usually feel depleted and empty afterwards because nothing much has happened. No one has listened to me. No one has offered support or guidance. Therapy is far different.

Sonia, I generally agree with and like what you write in your articles , but this one is a bit overdone. The tone is highly emotional. Patients usually talk like that, not therapists.
I would not be appalled if my therapist would flapped his/her dirty laundry in my direction, once the therapy is over. It is very naive to expect that therapist’s life is any more simplified, compared to my own. I think every therapy, every situation, every therapist and every client are so different, it would be silly to place everyone on one shelf. Let say I know about some major warts of my own therapist, it alone does not make him any less interesting as a person or valuable as a professional, as long as he stays professional during my therapy. Subject of confidentiality is also questionable in post therapy friendship. I don’t see why a friendship would change anything?
I was not even sure what was so disjointing about your post, until I went through it again – sometimes you write from a patient prospective, sometimes from a perspective of a therapist. Seems like you wanted to deliver a reasonable message, but only left a reader with an impression of someone or something terribly ungrounded.
Now I wonder if you write this articles for a fee or get somehow otherwise compensated.

I liked the post overall. I do find myself questioning one premise that pops up quite a bit on this site — that of the power imbalance between client and therapist. I agree there can be one, but why is it assumed that it’s always the therapist who has greater power? Anecdotal evidence (FWIW): my current therapist is talented and overall I think he’s worthwhile, but he has a few blind spots and it’s not impossible that one of these could be a deal breaker. I think of him as my employee, in a way. If he’s not giving me what I want in a way that’s courteous and empathic, I’m ready to toss him out on his ear and find someone else. I just don’t buy it that he has all the power. I definitely have quite a bit. I’m not a zombie in a trance. I see him with clear eyes. Why are you telling me I’m somehow one down because I’m the client?

That’s ok Sonia! I am just glad you are back! I hope you aced your exams!

I took advantage of the link posted above by TPG, and read the entire reseach findings on client / therapist ethics. I found it tremendously interesting, and also helped so much to relieve my sense of being wrong in wanting a post- theraputic freindship with my fabulous therapist. Thank you TPG, wherever you are ! I am a client, and not a clinician. I have been in therapy , intensely for 4 years and prior to that, intermittently for 7 to consult on issues regarding my daughter. I adore my therapist, and she knows that. I long to have a post- therapy freindship with her, and she knows that too. It will never happen, she has made that exceedingly and painfully clear. This causes me much sadness and frustration. I never will really understand why this subject is so taboo, and i appreciate Sonia posting on it, with such humor , insight and personal transparency. Anyone who blogs is brave in my eyes. However, I need to say that if you look at the findings in the APA research, 54 % of therapists polled said that post therapeutic friendships occurred in their practice ” rarely” or ” sometimes”, this is in contrast to only 45 % who said ” never”. So clearly this is a practice that does in fact occur with some regularity. And so if that is the case, why is it that this always seems to carry such a shroud of ” oh that is so wrong , bad, inappropriate…..” Could over 500 therapists ( the sampling was 1000 therapists ) be so terribly stepping outside the bounds of ethics? I have given up trying to change my therapist’s mind, she is quite settled into her very firm boundaries. But I would love to hear from clinicians who have in fact gone that route and are willing to shed light on it, by talking openly about it from ” the other side of the couch”.

I like how my therapist listens to ME, sees MY viewpoint, seeks to make ME more comfortable being who I am and pays attention to everything I say and show her about MY life.I would love to have friends who did that, but that isn’t friendship,that is MY therapy and self expression to the max. If I were friends with my fabulous therapist, I would need to listen to HER struggles and focus at times on HER inadequacies instead of ME. If I truly knew her personally, I probably wouldn’t like her as much because I’d see her as I see everyone else – self focused. As I learn how to be more of ME in therapy, I am a better friend to others outside of the ME focused world of therapy.

When my personal needs are not being met, I find I must be careful when counseling because it is easy to see the respect and adoration from people as a solution to my own unmet needs. Bottom line is therapists must realize they can do the transference to their clients…….Scary thought, eh?

I’m of the belief that transference is pretty much everywhere, in every relationship and even in everyday casual interactions. This stuff is all over the place. I still hate to think of my very best potential (which is what I discovered in my feelings for my former therapist) as something which needs to be “resolved”. I can’t give it to him, but I can give it to others. It’s something which I value greatly and always will. I always knew where the relationship had to stay, but I think considering something such as friendship in fantasy is very human. Maybe we shouldn’t beat ourselves up so much for having human desires. The important thing is respecting the boundaries and understanding that the relationship is what it is. It can still be quite a beautiful thing just as it is.

@m re: “sonia, from your blog, it often sounds like you have major unresolved transference issues. and in this article in particular, it looks as if you are projecting your own particular issues onto all therapy clients.”

I really have to take issue with the phrase “major transference issues.” I wish people would think about the meaning of the words they use.

Have you ever considered the phrase “near miss”? “Those planes had a ‘near miss,’ it could have been a disaster.”

I think what you mean is, “near hit.” Plans have near and far misses 99% of the time. It’s when they nearly hit that we should be concerned.

That’s the problem I have with “major transference issues.” When you examine the words, they don’t mean what you I think you intend to say.

“Major” connotes a serious problem, as if the person who has a major problem is somehow unable to carry out the requirements of being a therapist.

Saying someone has a major problem in their perspective about their work is practically accusing them of being incompetent. It is a word that should be reserved for an accusation, or not used at all.

Imagine your boss arriving at your work area declaring, “@m? You have a major problem.” You’re not expecting a raise after that remark, are you? “Major” is a loaded word. Keep it in reserve for serious, career-threatening problems.

“Unresolved” implies that the conflict can — and should — be resolved. Sometimes unrequited passion remains that way — unresolved. In the case of unmet needs, they may forever remain unmet.

The needs can be conscious, acknowledged, in control and contained. Nevertheless, they exist. They are a fact. Not only do they do not decrease competence, they increase an understanding of others who also have unmet needs.

“Transference” continues to be a word that makes no sense. I know we’re using it for convenience, but in reply to @m, becoming attached to a therapist is not necessarily transference.

Transference is when you project a relationship with one person onto your experience with another. The relationship occurring between two people in therapy can include transference. That transference might be worth examining.

However, the passionate attachment a client might develop to a therapist is not a projection. It’s a real-time human response to a current relationship.

Because I relate so utterly with Sonia’s experiences I take it personally when I read that she has a major transference problem.

If you don’t have the abandonment or attachment issues she describes than you are not the subject of her blog posts.

What she describes is only true for some of us. That doesn’t mean she’s projecting her issues onto all possible therapeutic subjects. That means she understands abandonment and attachment well enough to describe them.

She might not be describing you, but she’s certainly accurate in describing some of us. It would be absurd to expect any post to describe everyone.

@poo – “I was not even sure what was so disjointing about your post, until I went through it again – sometimes you write from a patient prospective, sometimes from a perspective of a therapist.”

Precisely. No one is one thing. Every adult was once a child. One can only hope that every therapist was once a client. A therapist having a client’s perspective is is not a flaw; it’s an asset.

Therapists are going to have their own issues. I’m thrilled that as Sonia becomes a therapist she doesn’t forget what it’s like to to be a client.

My otherwise helpful therapist interpreted my attachment to her as a threatening sexual situation. She couldn’t discuss it with me. It looked like homophobia, but you know what it was? American Puritan Catholic training. She didn’t acknowledge her fears and shame. She pushed me into the Transference Closet.

My only hope was to travel the wilderness of Amazon and Barnes & Noble. Kenneth Pope was helpful, but only to a degree. You won’t find the phrase “urge to merge” in his works.

One excellent book about therapy is In Session, but it’s just a great description of therapy, not of what to do with the unrequited passion that a client can develop for a therapist.

Several authors made it worse. Two suggested that therapy should be open to exploring love in the name of helping clients. Let your unmet needs duke it out with that suggestion.

So Sonia’s ability to describe both the client’s and therapist’s experience of attachment has been a tremendous help to me in my relationship with my therapist. When you give her a hard time for expressing herself as a client, you’re asking her to stop writing about my experience as a client.

You guys who have a problem with Sonia’s attachment to her therapist have two choices. You can have a world in which therapists acknowledge their needy, dark, shamed, painful and crazy sides, or one in which therapists have needy, dark, shamed, painful and crazy sides, but won’t admit it.

psychreader, my point was – both therapist and a client sounding a bit hysterical regarding transference issue. In any case, as a client, I would wanted to know about level of mental stability my psychologist possess. 14 years of therapy by a therapist is highly questionable.

@poo – “14 years of therapy by a therapist is highly questionable.”

I’m sorry my friend but that is completely backwards.

The worst therapists are going to be closed-minded about the never-ending quest to know oneself.

Therapists are human. They’re carrying around the same crazy crap that you and I are carrying around. The ones who acknowledge this and work on it are safer and more stable than those who deny it and assume their own perfection.

Stability happens when the therapist responds in human ways to clients and then acknowledges and examines the affect the client has on the therapist.

Stability can’t happen when the therapist doesn’t admit her own frailties. That’s not stability. That’s holding your breath and acting like a totem pole.

@beth -

“psychreader: ‘Transference is when you project a relationship with one person onto your experience with another.’

I think it’s WAY more complicated than that.”

So do I.

The problem is we’re using one word to mean two things.

I would prefer that we use “transference” to mean projecting the past onto the present.

We need a different word for “this person is having a profound affect on me, I would like to be in their presence as much as possible.”

My therapist and I are having a personal relationship (now called “multiple” relationship)….it happens. As for the power differential……there are power differentials in lots of relationships, teachers, attorneys, bosses, etc…….

I wouldn’t be able to unload this awful stuff if I didn’t love him just a little…but we talk about it and it’s cool.

I would want to become friends with my therapist so that I could talk to her for extended periods of time and get her advice without paying $150 an hour (or $70 an hour over the phone). I also would like to know about her problems and help her out like she’s helped me. (at great cost, but still). She has told me a far amount about her life, but I would totally be willing to learn more and help her with her problems. However there are a lot of differences between us and we are at different stages of our lives so I don’t think a friendship would work.

The other thing is that since I am planning to become a therapist, it would be great to have her as a mentor. I know there is always a chance that if I stay in the area we would have a professional relationship, but I’d likely avoid that because of the awkwardness. I wonder if this ever comes up though. What happens if a client later becomes a clinical psychology student in the area or a therapist eventually and they end up working with or being trained by their former therapist! (by accident or not).

Also, I agree that the therapist doesn’t always have the power in the relationship. I feel that now its mostly the client and they are like consultants. (especially in CBT and related therapies). Also, in a lot of areas there are so many therapists to chose from, the therapist has to make some effort to attract and retain us.

It is not called a “dual” relationship anymore….changed to “multiple” relationship….which is not necessarily unethical or harmful.

As a therapist I find that Irvin Yalom’s quote that “friendship is often necessary, but not sufficient” rings true. Most new therapists, and certainly patients don’t have any frame of reference beyond friendship to categorize a sense of closeness and openness than that of a close friendship. In longer-term therapy this relationship is unique for most.

Hopefully this is brought up in any longer term therapy relationship. I talk about these things, since after years of being a therapist, I find that process oriented self-disclosure is powerful and I hope that those I work with openly talk about the therapy experience with me–not merely the words/content of therapy.

The temporary nature of these relationships remind us all of the temporary nature of life in general and of relationships perhaps we have lost. I’ve had more difficulties with the children I’ve worked with then adults. Many of the children have been abandoned by parents or abused, and have limited to no good templates for good/close relationships. Saying goodbye to some of these children has always been the most difficult for me. I have learned to talk about closure issues far in advance, and help them to identify what they like about counseling/our relationship and how they act differently with me and urge them to find/develop this with others in their life, since I will not be there in the future.

Boundaries don’t have to be presented harshly, but I believe the temporary nature of the therapy relationship needs to be addressed, most attuned therapists should realize when this needs to be done–waiting to the last meeting is not a good time. I have felt a sense of sadness saying goodbye to many people over the years, even some of my more challenging patients, but I always remember that the goal is for people to help themselves, and I don’t want to contribute to a sense of victim identity or learned helplessness, by some sense of empathy gone awry. Just because the relationship is temporary and doesn’t continue on doesn’t mean we weren’t ‘friends’ in a sense, I just think its dangerous to fulfill my own psychological needs via my counselor role. I will think fondly of many of those throughout the years whom have removed their masks with me, and struggled to make sense of themselves and their lives and find ways to continue on in this journey called life.

And a sexual relationship with your therapist should NEVER happen. That is a clear violation of ethics and boundaries.

A few years ago, I was seeing a male therapist. He was very kind and compassionate. He was a good listener. He was very attractive.

I started having feelings toward him that made me pull back and look at the situation more objectively.

He was married with children. He never took advantage of me in any way. I doubt that he was even aware of how I felt about him. I never revealed my attraction to him.

Once I recognized that my attraction to him was natural, I was able to deal with how inappropriate it would be if I acted on my feelings.

I wasn’t in love with him…it’s just that he represented the kind of male figure I wanted to have in MY life.

We all would love to have a friend that we can share our innermost feelings with, who will always listen and never judge, who will be there.

We want somebody to share life with and do fun things with.

But our therapist cannot provide all of those things.

A little over two years after I stopped seeing my psychologist in a professional relationship I was back in town, called her and asked if it would be appropriate to have dinner with me. She agreed and we had a very pleasant time, not in any way bordering on therapy. Since then, when I return to the area, I always contact her and we go out to dinner or eat at her house. I always enjoy it and I believe she does too or else she wouldn’t continue the practice. We do not go into therapeutic issues, we talk about what we are doing and what we have done since the last time we visited. We also exchange Christmas cards/letters.

I believe this relationship is appropriate, ethical and mutually positive.

On the other hand, my current psychologist has many characteristics of my past one but I would never ask for a friend relationship while in therapy. I have given her one gift, a bowl bowl I threw in a pottery class which she appropriately accepted. I think buying her a gift would not be appropriate nor would it be good to give a gift on a regular basis. She maintains professional boundaries. Even my case manager (social worker) watches boundaries carefully. I once offered to loan her the book Unquiet Mind and she declined and said she couldn’t accept a loan of anything from me. (She did accept a bowl which I appreciated.)

I am friends with my old therapist now. We are actually really good friends and catch up for coffee a lot. There does come that time when she tries to be the therapist still but not very often and I don’t think it is harmful at all.

I’m cutting it off with mine especially after reading everything online about transference. My therapist keeps herself like a girl that one would pick up at a bar, with piercing and dyed hair (serious). And although I don’t feel in love or anything I felt some attraction.

The problem I have is that since you can not do anything with your therapist this is the same f***ing bullshit as in real life and I would much rather have a girl that I can do anything I went with rather than pine over some dummy that would potentially rather just shuffle me away because it is part of ethics, the job, etc. It feels the same as just ordinary every day life (and as it probably should after I read all this stuff). It sucks so I think I just need a therapist that is older or something.

Would I have sex with my therapist? yeah but would it ever happen? no. and plus getting turned down is just as bad as what is described as actually having these encounters with the therapist.

so all in all I give up. I don’t know if I’m a special case or what but this is a sad part of life and to hell with it. If the therapist feels great about having that kind of power then good for her, but I could rather care less at this point.

I would like to show thanks to you just for bailing me out of this particular difficulty. Right after exploring throughout the internet and obtaining views that were not productive, I thought my life was gone. Existing without the presence of strategies to the issues you’ve resolved as a result of the article is a serious case, and ones which may have adversely affected my career if I hadn’t encountered your site. Your personal capability and kindness in controlling all the things was precious. I don’t know what I would have done if I had not encountered such a thing like this. I am able to at this time relish my future. Thank you very much for this expert and sensible guide. I will not think twice to suggest your blog post to anyone who should get recommendations on this issue.