IS FEAR OF TRANSFERENCE / COUNTER-TRANSFERENCE PREVENTING PSYCHOTHERAPISTS AND COUNSELORS FROM DISCUSSING SEX AND SEXUALITY ISSUES WITH THEIR CLIENTS ????- by R.Manoj Marital Counselor and Psycho Sexual Therapist Chennai

Transference is a phenomenon in psychoanalysis characterized by unconscious redirection of feelings from one person to another, in the case of psychotherapy from patient to therapist. Counter-transference refers to transference of feelings from therapist to patient.

            Generally any client meeting a therapist or a counselor for whatever problem it may be, find it difficult to initiate a discussion about their sexual life, sexuality or  sexual problems, even if the prime cause for meeting the professional may be directly or indirectly related to their sex or sexuality. But the disturbing fact is that many a times the professional themselves find it difficult to initiate this topic for discussion. May be the fear that, treading into one of the core part, of the most intimate personal space of the client, may lead to the development of strong transference or counter-transference; has been a strong barrier. The apprehension that, development of strong emotional feelings either by the client towards the therapist, or vice versa, may derail the therapeutic process and rather lead to a personalized relationship seems to be preventing them from treading freely into the sexual life of the client. But what most of these therapists fail to understand is that, unless and otherwise they are capable of understating this core part of a persons life in detail, the process of therapeutic intervention by itself may have a lot of limitations, curtailing the success rates. Moreover the uninhibited approach by the professional in to the sexual life of a client can serve as an important means to develop rapport with the client which is essential for the success of the therapy

            In many situations a client approaches a psychologist or a counselor with the intentions to share their problems and emotions in a detail but confidential manner; including their most personal secrets, which they find it difficult to share with anybody else. Sex and sexuality related problems are usually the most guarded secrets in the life of majority of the population. The status of a being the most guarded secret about the most intimate part of their personal space, has been the reason that, these issues not being discussed by any individual in a direct context or in detail with anybody including their close friends or even with the most intimate person in their life. In most of the situations in which it is discussed the conversation happens in a subtle veiled manner. Naturally the responsibility of initiating such a discussion rests with the therapist.

            Looking at the situation in a realistic rational way does provide substantiation to the these fear and apprehensions present in the professional because, what ever the model of psychotherapy that may be practiced by the professionals be it counseling, psychotherapy or more effective models like cognitive behavior therapy, the professional approach becomes effective only when there is an empathetic understanding of the clients problems and emotional associated with problems. This requires a lot of effective listening. Therapeutic listening requires interpersonal sensitivity. Empathy refers to how well the therapist can go into the client’s world and see and experience life the way the client does. The therapist will to some degree, experience the client’s feelings. To the extend that his/ her empathy is reasonably accurate, the therapist will be able to understand how the client structures and responds to certain events and relations. Therapeutic empathy includes the cognitive and emotional components of lived experience. Although there are intrinsic connections between warmth, love and empathy, there are not simple or direct. Therapist´s empathy may be experienced by a client as warm, or even loving, but warmth or love does not directly generate empathy and empathic understanding. But this empathetic approach which is understood as warmth or love by the client can lead to strong feelings of attachment towards the therapist, when the same is approach in adopted by the therapist in the issues related to sexual life. The intensity is lot more higher here because, the thinking pattern of the client usually happens based on the feeling that, the therapist is able to understand him or her in those segments of their life where nobody has understood them

            When compared to discussing any other vital areas of a clients life, while discussing the sexual life, the therapist may be highly sensitized to the transference component and inflate it out of proportion, because of the sudden reactions or changes that happens in the client when the subject is initiated. Many a times they may have to project complete insensitive to prevent strong transference and maintain the status of a professional approach which, can sometime be more disturbing to the client. In such conditions if a client responds negatively to the therapist, the therapist may be unconsciously motivated towards committing the error of taking a dynamically opposite stand of projecting higher sensitivity to avoid the derailment of the therapeutic process. In such situations the therapist should be able to take a balanced approach. Both in case of positive and negative approach by the client, when it cannot be ignored, the therapist should be able to attribute it to the internal object world of the client rather than a failure on the part of the therapist. Ambivalence about using effective professional techniques, because of the fear or transference or counter-transference fearing alienating the patient; Inability to set limits on sexually provocative patients and when patients present with issues such as abandonment, dependency, devaluation, demandingness, sexual preoccupations, abuse, betrayal, or exploitation by others, is equally damaging to the therapist and the therapeutic process.

            In some other cases therapists who become vulnerable to reciprocate the affection expressed towards them by their clients, sometimes even end up falling in love with clients. In some cases, the focus on the patient’s problems may allow the therapist compartmentalize and avoid his/her own personal problems or allow the therapist to displace his/her conflicts with others onto the patient. Some people are attracted to being therapists because it allows them a sense of competence, superiority, and apparent efficacy in relationships of sensitive nature where they feel a lack of competence. This illusionary competence felt in the role of a therapist may allow them to unconsciously pursue other goals, such as the need to have power or control, or the need to compartmentalize, intellectualize, and isolate oneself from one’s own problems. Such need base approaches can lead to the development of counter transference, which can be more damaging to both the professional and the therapeutic process. If the therapist is able to understand that the client was not in love with him or her as a person, but rather that the love was directed towards a more primary love object represented by the therapist, then the therapist could approach the work in a dispassionate and professional manner. Overcoming counter- transference depends on the ability of the therapist to discriminate accurately between feelings towards a client that are activated by client projections, and feelings better understood as having their origins elsewhere

            Transference may sometimes be a effective tool for building rapport with the client while both transference and counter transference can sometimes be damaging to the self image and professionalism. But fear of transference or counter transference should never prevent any professional from exploring the most sensitive / problematic area of the clients life. Adequate understanding of “self” in a professional role, appropriate and effective training in handling the transference and counter-transference as a part of training in the therapeutic process and seeking out consultation with a peer or senior professional,  to help whenever there is even a minimal doubt about addressing and potentially resolving the source of strong transference or counter-transference feelings are necessarily the methods to be adopted for, rather than avoiding the most sensitive area of sex and sexuality, to ensure professional excellence.