Skip to main content
Log in

How Therapists Experience and Manage Patients’ Romantic and Sexual Feelings for Them

  • Empirical Report
  • Published:
Academic Psychiatry Aims and scope Submit manuscript

Abstract

Objective

Many therapists will one day be confronted with a patient who develops romantic or sexual feelings toward them. Studies on this topic often remain theoretical in nature and less often focus on how therapists manage such situations. Therefore, this study aimed to investigate how therapists experience this occurrence and manage their feelings.

Methods

Eight focus groups were conducted with 36 participants in Flanders (Belgium). Both therapists-in-training and therapists-in-practice participated, having different educational backgrounds. The data were explored using the principles of thematic analysis.

Results

Therapists indicated that they try to dissuade any further development of their patients’ romantic or sexual feelings by using strategies such as emphasizing their personal relational status, adjusting their appearance, and avoiding any physical contact with their patients. Some therapists question their own professional behavior, feeling guilty, confused, or insecure, wondering if they may have, in some way, provoked these feelings. Therapists who are at an earlier stage in their careers experience more difficulties managing their patients’ romantic or sexual feelings toward them and worry they will not be considered a good professional therapist if such a situation occurs.

Conclusions

Educational programs in psychotherapy should be more cognizant of the incidence of patients’ developing romantic or sexual feelings toward therapists and provide more comprehensive and practical instruction on how to cope with such feelings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Sonne JL, Jochai D. The, “vicissitudes of love” between therapist and patient: a review of the research on romantic and sexual feelings, thoughts, and behaviors in psychotherapy. J Clin Psychol. 2014;70(2):182–95. https://doi.org/10.1002/jclp.22069.

    Article  PubMed  Google Scholar 

  2. Pope KS, Tabachnick BG. Therapists anger, hate, fear, and sexual feelings - national survey of therapist responses, client characteristics, critical events, formal complaints, and training. Professional Psychology-Research and Practice. 1993;24(2):142–52. https://doi.org/10.1037/0735-7028.24.2.142.

    Article  Google Scholar 

  3. Morgan J, Porter S. Sexual harassment of psychiatric trainees: experiences and attitudes. Postgrad Med J. 1999;75(885):410–3. https://doi.org/10.1136/pgmj.75.885.410.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Gelso CJ, Pérez Rojas AE, Marmarosh C. Love and sexuality in the therapeutic relationship. J Clin Psychol. 2014;70(2):123–34. https://doi.org/10.1002/jclp.22064.

    Article  PubMed  Google Scholar 

  5. Gelso CJ, Bhatia A. Crossing theoretical lines: the role and effect of transference in nonanalytic psychotherapies. Psychotherapy (Chic). 2012;49(3):384–90. https://doi.org/10.1037/a0028802.

    Article  PubMed  Google Scholar 

  6. Gelso CJ, Hayes JA. The psychotherapeutic relationship: theory, research, and practice. Hoboken, NJ: John Wiley & Sons; 1998.

    Google Scholar 

  7. Stefana A. Erotic transference. Br J Psychother. 2017;33(4):505–13. https://doi.org/10.1111/bjp.12231.

    Article  Google Scholar 

  8. Rabasco A, Mariaskin A, McKay D. Well, that was awkward: when clients develop romantic feelings for therapists. Cogn Behav Pract. 2021. https://doi.org/10.1016/j.cbpra.2021.09.004.

    Article  Google Scholar 

  9. Housman L, Stake J. The current state of sexual ethics training in clinical psychology: issues of quantity, quality and effectiveness. Prof Psychol Res Pract. 1999;30(3):302–11. https://doi.org/10.1037/0735-7028.30.3.302.

    Article  CAS  Google Scholar 

  10. Celenza. The guilty pleasure of erotic countertransference: searching for radial true. Studies in Gender and Sexuality. 2010;11:175–83. https://doi.org/10.1080/15240657.2010.513222.

  11. Luca M. Editorial Introduction. An encounter with erotic desire in therapy. In: Luca M, editor. Sexual attraction in therapy. Clinical perspectives on moving beyond the taboo. A guide for training and practice. West Sussex: Wiley Blackwell; 2014. p. xvii-xxiii.

  12. Van Rijn B, Lukac-Greenwood J. Working with sexual attraction in psychotherapy practice and supervision. A humanistic approach: Routledge; 2020.

    Book  Google Scholar 

  13. Harris SM. Teaching family therapists about sexual attraction in therapy. J Marital Fam Ther. 2001;27(1):123–8. https://doi.org/10.1111/j.1752-0606.2001.tb01145.x.

    Article  CAS  PubMed  Google Scholar 

  14. Luca M. Trainee therapists’ moralistic reactions and defensive handling of client sexual attraction in therapy. J Psychol Ther. 2016;1(1):27–33.

    Google Scholar 

  15. Lukac-Greenwood J, van Rijn B. Female therapists’ experiences of working with male clients who are sexually attracted to them. An exploratory study using a free association narrative interview method. Couns Psychother Res. 2020;21(4):957–69. https://doi.org/10.1002/capr.12392.

  16. deMayo R. Patient sexual behavior and sexual harassment: a national survey of female psychologists. Prof Psychol Res Pract. 1997;28(1):58–62. https://doi.org/10.1037/0735-7028.28.1.58.

    Article  Google Scholar 

  17. Barnett JE. An introduction to boundaries and multiple relationships for psychotherapists. Issues, challenges, and recommendations. In: Zur O, editor. Multiple relationships in psychotherapy and counseling. Unavoidable, common, and mandatory dual relations in therapy. New York: Routledge; 2017. p. 17–29.

  18. Arcuri A, McIlwain D. Skilled handling of sexual attraction in therapy: a grounded theory of what makes the difference. In: Luca M, editor. Sexual attraction in therapy. Clinical perspectives on moving beyond the taboo. A guide for training and practice. West Sussex: Wiley Blackwell; 2014. p. 153–72.

  19. Creswell J, Plano Clark V. Designing and conducting mixed methods research. third edition ed. Los Angeles: Sage Publications, Inc; 2017.

  20. Kaushik V, Walsh C. Pragmatism as a research paradigm and its implications for social work research. Social Sciences. 2019;8(9):255–71. https://doi.org/10.3390/socsci8090255.

    Article  Google Scholar 

  21. Krueger R, Casey MA. Focus groups: a practical guideline for applied research. 5th edition ed. Los Angeles: Sage; 2015.

  22. Hennink M, Hutter I, Bailey A. Qualitative research methods. London: Sage Publications Ltd; 2011.

    Google Scholar 

  23. Herbst A. Ethical considerations when a client crosses sexual boundaries: my experience as a student therapist. Psychotherapy Bulletin. 2015;50(1):33–6.

    Google Scholar 

  24. Kidd PS, Parshall MB. Getting the focus and the group: enhancing analytical rigor in focus group research. Qual Health Res. 2000;10(3):293–308. https://doi.org/10.1177/104973200129118453.

    Article  CAS  PubMed  Google Scholar 

  25. QSR International Pty Ltd. NVivo qualitative data analysis software, version 12. 2018.

  26. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2008;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa.

    Article  Google Scholar 

  27. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893–907. https://doi.org/10.1007/s11135-017-0574-8.

    Article  PubMed  Google Scholar 

  28. Fusch P, Ness L. Are we there yet? Data saturation in qualitative research. Qual Rep. 2015;20(9):1408–16. https://doi.org/10.46743/2160-3715/2015.2281.

    Article  Google Scholar 

  29. Morrow S. Quality and trustworthiness in qualitative research in counseling psychology. J Couns Psychol. 2005;52(2):250–60. https://doi.org/10.1037/0022-0167.52.2.250.

    Article  Google Scholar 

  30. Olson JD, McAllister C, Grinnell LD, Gehrke Walters K, Appunn F. Applying constant comparative method with multiple investigators and inter-coder reliability. Qual Rep. 2016;21(1):26–42. https://doi.org/10.46743/2160-3715/2016.2447.

    Article  Google Scholar 

  31. Prasko J, Diveky T, Grambal A, Kamaradova D, Mozny P, Sigmundova Z, et al. Transference and countertransference in cognitive behavioral therapy. Biomed Pap Med Fac Univ Palace Olomouc Czech Rep. 2010;154(3):189–97. https://doi.org/10.5507/bp.2010.029.

    Article  Google Scholar 

  32. Lotterman J. Erotic feelings toward the therapist: a relational perspective. J Clin Psychol. 2014;70(2):135–46. https://doi.org/10.1002/jclp.22065.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lara Vesentini.

Ethics declarations

Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted in the Medical Ethics Committee of the Vrije Universiteit Brussel (B.U.N. 143201524243).

Disclosures

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vesentini, L., Van Puyenbroeck, H., Van Overmeire, R. et al. How Therapists Experience and Manage Patients’ Romantic and Sexual Feelings for Them. Acad Psychiatry 47, 352–359 (2023). https://doi.org/10.1007/s40596-022-01714-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40596-022-01714-0

Keywords

Navigation