The word “subtle” is a very subjective adjective in the context of this entry. So let me preface this by defining what sorts of “postures” or behaviors I do not consider subtle: overtly flirting with a client; seducing a client; carrying on a dual relationship with a client (whether romantic or not); and touching a client for reasons that have to do with one’s own needs. Of course, even within some of these examples there can be gradation and nuance. For example, a spontaneously fond and sparkly smile can be flirtatious in a sense, but for a client who struggles to connect to their own impact, power and presence and/or to interact playfully and spontaneously, it can be a sign of therapeutic progress. But for the interest of conceptual convenience, moving forward I will simply trust the reader to understand the nuances to which I allude here.
The other preface is that I want to be as raw and honest as possible because the case studies from which I have most benefited are those in which the writer is forthcoming not just about their mistakes in session, but the struggles they bring into the session. In short, those who are willing to speak those things that, those who lack depth and self-awareness, would see in black-and-white terms as “taboo”.
The client in this study is a single Caucasian cis-female in her late 30’s. Coincidentally, she too is a psychotherapist. She has been a client for about 2.5 years. Her initial reason for seeking was a desire to understand why she struggled to find and create romantic intimacy. It is often the case that a client’s conscious reason for seeking therapy is connected to deeper and more fundamental issues and this case is no exception. The deeper struggle for this client is that her unconscious organizing principles (avoid intimacy because it is scary, uncomfortable and even repulsive) conflict with her conscious desire to have more intimacy. It might also be worth noting here that prior to coming to me this client had seen a therapist for five years who had terribly invasive boundaries and who expected the client to please her.
The challenges for me with this client (and here is where I will be open about my counter-transference) are that at times she tries my patience by focusing on the minutiae of relationships and dating; in short, her tendency is to want to pull things back into content and focus on surface solutions and quick fixes. I understand this as an attempt to immediately resolve anxiety (that generally creates more anxiety). Though I understand that this is a defense for her (to stave off anxiety and to prevent her from facing the deeper issues), my desire to “cut-right-to-the-core” of things is often stymied by this. Thankfully the impatience has never impacted my ability to care for the client for any extended period of time.
I have also, at times, wanted the client to adopt a worldview and goals more similar to my own despite knowing that my worldview is as flawed and biased as anybody else’s. To be more specific, clients who tend to have what I perceive as more “conventional” goals and world views (white picket-fences, 2.5 children, BMW’s, vacation homes etc) often trigger my bias against unexamined assumptions of what makes a “good life”. If I am to go one deeper here, perhaps they force me to face the part of me that is conventional; that does want a big house (but instead of a BMW, a room for comics and sports, etc).
And finally, I have, at times, found this client to be physically attractive. The attraction tends to come and go (it was there early in the treatment, then generally faded away, and only just recently re-arose). I will be even more vulnerable and say that I have in brief moments, due to primitive defenses that quite likely arose from losing my biological mother during infancy), split women into part-objects. So I might long for their hair or their arms or their hands or random “parts” that symbolize for me childhood longings and deficits. For example, I remember being fascinated as a child by the hair of one of my dad’s girlfriends. The hair was long and soft and, in retrospect, my libidinal energy was directed toward it because it represented femininity and motherhood and comfort. I longed to possess so that I might feel whole.
Having just confessed to a few of my counter-transference reactions to this client, none of these have “taken over” and prevented me from providing a good-enough sense of presence and objectivity most of the time. Or, put another way, I nearly always succeed in grounding myself within minutes or seconds of floating away into my frustration or attraction. I have, in short, not succumb to any of the non-subtle forms of complicity mentioned above.
Let us begin two sessions ago. My client named that she was having trouble feeling connected to herself and to me. This is not an uncommon experience for this client. Her observation aligned with my own in that I too was feeling the distance and the sense that the client was caught up in the dilemma I presented earlier: a desire for presence and closeness vs the ease (but loneliness) of distance. In moments like these I had tended to turn toward basic sensory awareness exercises or toward an exploration of what is happening in the here-and-now (within her and between us) with mixed success. Since I was feeling especially sprightly and confident in my work that day I spontaneously thought of an intervention: I asked the client permission to sit closer to her on a fold-out chair (I tend to sit a few arms lengths away and this put me at about 1.5 arms lengths away). After getting consent I grabbed a large scarf/blanket and had her hold one end of it while I held the other. I asked her to pull it a bit on her end during which I held it firm. Then I pulled it while she held firm. Eventually we moved it back and forth between us in a kind of rhythmic way. My intention was for her to feel my “there-ness” and for her to feel her own “there-ness”; a sort of symbolic representation of how we can impact one another while still having the safety of separateness. She suddenly appeared more present and grew slightly tearful. She said that the exercise allowed her to connect to how isolated she had recently felt in her life. I moved back into my regular chair and we had what I considered to be a productive session. I will even confess to feeling quite pleased with myself after the session.
Yesterday the client showed up to session looking more focused and grounded. She also appeared melancholy. I took this as a sign that we might be able to dive right into the work. I was not wrong. My client shyly said, “I think I should tell you this even though it’s hard” before sharing a dream in which we were romantically together; in which she felt “happy, loved and attractive”. She added, “The crazy thing is that even in the dream I knew you where my therapist but I felt safe.” The client and I were able to explore the dream and she realized that I represented to her what she sought: intimacy, warmth, attunement and physical attraction, and thus, she was projecting onto me the idea of the longed for partner. She was intellectually aware of the fact that I am imperfect and that the reality, even in our sessions, is that she both longs to be closer to me while also feeling repulsed by that closeness. Indeed, she realized that part of what made the dream so appealing was that the repulsion was gone. My inner-response to her dream was mostly grounded. The groundedness with which I responded has a lot to do with my experience and confidence in responding to erotic transference. However, it would be a lie if I did not admit to also being aided by my own self-esteem issues in which it is hard to take in or believe that another could be attracted to me. The part of me that felt flattered was outweighed by my knowledge that the attraction was more about what I represented in the nearly-perfect-container of therapy. The client, in turn, had enough self-awareness to know–at least intellectually–that it was not about me either. Thus we collaborated and had what I believe to be a productive session. Indeed, the exploration of the counter-transference even allowed the client to come to her own vital insights: “Maybe I focus on all the tiny things of what goes wrong in my dating situations because it keeps me from really staying with my fear of intimacy”. The client also realized, “Maybe I enjoy sex with unavailable people because I don’t have to worry about the intimacy.” I feel excited for the work that we might sink our teeth into in the coming sessions (experience teaches me that we may take a few steps back or sideways and that this wont’ be perfect and linear but that, even so, these were important seeds to have planted). This therapeutic success was, in large part, facilitated by the client’s courage, self-awareness and by the trust and safety we have built.
But this has me wondering about my part in things beyond my representing a few ideals of intimacy for the client. Is it just projection if I have fed into it? For example, do my postures and/or mannerisms and/or choice of words convey my attraction? Have I subtly seduced the client in these ways? Am I vicariously meeting my intimacy needs through this and/or other clients? Did I unconsciously use the “blanket exercise” mentioned above because I find the client easy to get close to physically? Would I have done the same with a client of a different sex, gender or with looks that did not fall within my attraction template? I’m embarrassed to answer with a “perhaps not”. And as I ask these questions I find myself, once again, humbled beyond belief. I realize that if, for example, the client does not moved on from the fantasy as easily as I might want to believe, that I may need to scrutinize even more closely my part in enabling or co-creating it. And more than that, find a way to use it productively in a session. In light of these questions the therapeutic “victory” suddenly feels more precarious. This is not to say that I am not proud of both myself and the client for how we worked with the issues at hand, only that it could just as easily lead to more challenges for the work and self-reflection, and honest self-evaluation for myself.
Fragmented Thoughts 