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Dear Dr. Saltzman:

A few months back, I experienced a notion regarding my therapist when he had initiated a hug at the end of a session rather spontaneously. I felt that there was perhaps something more therein (perhaps I was just overreacting).

As time has passed, I've found myself having intense erotic feelings toward him, as well as a psychiatrist I occasionally see. I'm very much aware of the phenomena of erotic transference and countertransference and have experienced such before with teachers and professors. Though I've hinted at a few things before, these feelings have yet to be addressed in the psychotherapeutic setting.

After just having had an extremely productive session in which I initiated a hug (for the first time in many months), I said I would be ready to open up and start talking more next time. I'm wondering how to address such feelings with the concerned parties? I don't want this to jeopardize our psychotherapeutic relationship in any way. Maybe I'm still living in a bit of a fantasy world and am stuck believing that these feelings I have toward my therapist and psychiatrist could come to fruition and therefore am more reluctant to mention such.

I know I need to address this subject matter, but I don't know where to begin. Any suggestions would be much appreciated.

Thank you very much for your time and consideration!



Dear Roxanne--

Thank you for your question. In my view, it is usually wrong for a therapist to hug a patient (client) during the course of treatment. If there is to be a hug at all, I like to save the hug for the end of treatment. In this way, the hug becomes a hug to celebrate the new functional equality of the two people--now no longer doctor and patient, but two people who have finished a project together and who, most likely, will not meet again, or at least not meet under the intimate circumstances of the consulting room. Most importantly, since the hug is a goodbye hug, it is not a gesture which might complicate future work.

Since I was not there to see and feel what happened, I cannot say anything specific about that particular hug, but the fact that it has troubled you so much at least suggests that it was not a good idea.


The drive toward sexual expression is powerful in all primates, including human beings. Erotic feelings naturally arise between people, no matter which social roles they may be occupying at the time, and therapists and patients certainly are not immune. In fact, as you pointed out, certain relationships (such as teacher/student, or therapist/patient) sometimes seem particularly marked by erotic feelings, and we call this "transference" because it is believed that at least part of the erotic fascination results from the transfer of feelings once directed towards early caregivers--mom or dad, for example--onto the teacher or therapist.

But the feelings of a patient for his or her therapist are more than just transference. The process of exposing ones problems, fears, and hopes to another person who hears them with empathy may begin to feel a lot like a personal love relationship. True, since the patient does most of the exposing, while the therapist is the one to offer the empathic understanding, the relationship is a lot more one-sided than the typical romantic involvement. Nevertheless, feelings arise which are not just sexual, but also may feel, particularly to the patient but possibly also to the doctor, a lot like falling in love.

Now one of the most important principles in effective psychotherapy is that the transference feelings must not be acted out, but seen, interpreted if necessary, and understood for what they are. It is the job of the doctor, not of the patient, to see that this principle is honored. This work does not always require that the transference feelings be discussed explicitly, but the work does demand that the therapist not gratify the patient's erotic and romantic feelings, but rather allow them to arise ungratified, and then to fall away again.

Indeed, many, if not most, therapies involve, at least to some measure, the idealization of the therapist, and then the fading away of that idealization. In other words, the patient may begin to feel that the therapist is a kind of superman or superwoman, but as the therapy progresses, the idealization changes into the understanding that we are all just human beings, including the therapist.

The therapist, for his or her part, has the obligation to accept the patient's idealizations (which may be erotic), but to give them back to the patient eventually. In other words, the therapist accepts the idealizations, but does not begin to feel that they really apply to oneself. After all, they are the patient's idealizations, and really apply more to the patient's inner family than they do to the therapist. If the therapist knows and remembers this, when the patient is ready to stop idealizing the therapist, the therapist will gladly stop being idealized. If the therapist forgets this and begins to act towards the patient as if the idealizations really were like what happens in a love affair, the therapist may not want to stop being idealized, and the therapy will be compromised. This is why that hug might not have been such a good idea. Humans, like gorillas, enjoy hugging and being hugged, but psychotherapy is not supposed to be about the therapist's enjoyment, nor even the patient's. Healing is the point, not enjoyment.

Since feelings are beyond our control--they just come and go like the wind in the trees--the problem in any therapy cannot be with feelings in and of themselves--even with formidable erotic ones--but rather in how the therapist attends to them. I say in how the therapist attends to them because the client has no obligation whatsoever to use self-control in this matter. It is 100 percent up to the therapist to use care and discretion in this and in all the other delicate situations that arise in the intimacy and privacy of the consulting room. In this regard, the patient is like a child, and the therapist must be the adult. Many adults have erotic feelings towards children, but most would not think of acting on them. When an adult acts out sexually with a child, we do not blame the child, and the same is true of therapists regarding their patients. The patient is not to blame--ever--but the therapist is 100 percent wrong if he or she acts out sexually with a patient.

In general, if a therapist becomes aware of strong erotic feelings toward a client--feelings which threaten to jeopardize the therapeutic relationship by sexualizing it--he or she is obligated ethically to find a way to deal with those feelings in a way which will neither compromise the therapy, nor injure the patient. The first recourse might be to ask the help of a colleague to whom one will confess the feelings and ask for help in understanding them. If that kind of help is not sufficient, and if the feelings are getting in the way of therapy, the therapist must refer the client to another professional for treatment.

Now, you say that you felt an erotic overtone at the time of the hug, so I assume three possibilities:

1. Your therapist had erotic feelings for you, and, when he hugged you, you felt them.

2. You had erotic feelings for your therapist which you projected on to him when he hugged you. By "projection," I mean the phenomenon, known widely in psychology, in which a person imagines that his or her own feelings really belong to another person.

3. Your erotic feelings were mutual.

I am simplifying here, for there are other, more complex possibilities, but you get the idea.

Now judging from what you have written, it seems clear that you have erotic feelings towards both of your caregivers. And, if your caregivers are any good at all, those feelings must not, and never will "come to fruition," as you said. There is nothing wrong with your fantasizing sex with either or both of those people. You certainly have a right to your desires and to your fantasies about them. But you should try to understand that your fantasies must remain fantasies if you are to benefit from--and not be hurt by--the treatment you are undergoing. Acting out sexually compromises the entire psychotherapeutic enterprise, and this is why it is unethical in the extreme.

The way to address your sexual attraction towards your therapist and towards your psychiatrist is simple, or should be simple if your doctors are any good at all. You simply state that you have the feelings without trying to be delicate about it, and you let these trained professionals deal with it, just as they have to deal with all the other details of your inner life. You also have the right, if you wish, to ask your doctors if they have any such feelings towards you. If they have any trouble at all dealing with your confession or with any questions you may ask about their feelings towards you, in my opinion you should find new doctors right away.

I hope this will help.

Be well.

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