Sexual Feelings in Psychotherapy John Caffaro, Ph.D. Distinguished Professor California School of Professional Psychology Los Angeles, California

Sexual Feelings Arising in Therapy… A psychologist’s curiosity, courage, and sensitivity to exploring sexuality with clients is dependent on their own current experience and personal maturity Therapists’ personal sex life and maturity will impact their capability to assess and address sex-related issues with clients Will also affect here-and-now interactions with clients, leading some to over-disclose, avoid, or withdraw from crucial therapeutic interactions with clients

Sexual Feelings Arising in Therapy… Clinicians from diverse perspectives typically agree that positive transference or positive feelings are important to successful therapy Why wouldn't some clients want to make love with someone they share most intimate secrets with? Yet, it appears, many therapists remain intimidated or off-balance in the face of the compelling experience of sexuality-relevant issues evoked in the therapeutic relationship.

Sexual Feelings Arising in Therapy These positive feelings, in particular sexual feelings toward clients, are disconcerting to many therapists (Pope et al., 1986) In one study (Dalenberg, Aransky, & Dunkerley, 1996) an average of 18% of the clinicians who listened to each of the four clients disclosing sexual attraction responded punitively (as rated by both client and therapists) When the disclosure included a direct request for touch or sexual contact an average of 39% of the clinicians punished, referred, or terminated the hypothetical client

One Therapist’s Response “It would be inappropriate to even think about having a personal relationship. I wonder if this is how you interact with other people and what the reaction is that you receive from them. I think that if you choose to stay in therapy this is an area that needs to be explored. However, if you choose to terminate, I would be happy to give you referrals”

Characteristics of a Positive Therapist Response Clinicians who were part of a dyad successfully resolving a sexual transference were more likely (by report of their clients) normalize the feelings acknowledge positive reactions to the sexual material disclose that they too felt some sexual attraction not to make a distinction between "real" love or attraction and feelings that arose in therapy (Dalenberg et al., 2001)

My Own Experience A Brief Vignette - 1987 Donna (not real name) – attractive young woman who came for help with a prescription medication addiction Living in a religious sect (strict rules re clothing, hair, etc.) Formerly worked as visual artist in LA—currently unemployed Over 8-12 months time functioning significantly improved, ended addiction, met a man, and began to paint again

Clinical Vignette One bright summer day, she arrived for her appointment in a bikini. Our session focused primarily on an intensely difficult meeting she had the night before with a current boyfriend where he stated his wish to end the relationship About half-way thru, she began to sob heavily and slouch in her chair; suddenly she looked up at me and confessed to wanting end treatment and have sex with me

Clinical Vignette After resisting the strong impulse to run out of my office and drive directly to my mentor’s home, I replied: You really worked hard today and this has been a very productive meeting. And sometimes some of the limitations of my role can be frustrating. But some of what makes it frustrating also makes it work; it makes us therapist and client instead of family or friends

Conclusion If we understand the impact and function of sexuality on our general well being and functioning and how it is provoked in therapeutic relationships, we can use its power to create lasting changes in a deliberate, effective manner. Conscious, responsible self care including ongoing attention to the current state of our sexuality and its expression in our personal lives provides the foundation for personal maturity necessary to successfully address complex sexual feelings that may arise in therapy

Sexual Feelings Arising in Therapy There exists in most of us a tendency to avoid or deny countertransference feelings. This is based on several factors. Primarily, it is due to the nature of the issues themselves. What we repress in relation to our patients are the same incestuous, perverse, envious and vengeful desires that we prefer to not see in ourselves in any case. But also this denial is tolerated because it accords with certain highly unrealistic, but socially accepted images of what a psychotherapist is or should be-calm, without anger or desire, mature, only a little neurotic

Sexual Feelings Arising in Therapy Should a clinician with an abuse history disclose this Is nonerotic touch harmful to clients? Is transference love ”real”? Should the therapist who feels sexual attraction to a client refer the client? What ”should” a therapist feel toward a patient?