Asian woman talking with psychologist about problems after married sitting on sofa in counseling office.

Psychotherapy is a source of healing for millions of people, including many who have experienced abuse, trauma, or dysfunctional relationships in the past. In order for therapy to be effective, a client must be willing to be open and vulnerable with the therapist, so that they can share their deepest feelings. Typically, being able to bring these feelings into the light and explore them with the help of a trusted therapist leads to insight and the development of healthier patterns.

Being able to trust a therapist enough to share these thoughts is rarely instant; rather, trust develops over time. In addition to the conscious sharing of thoughts and feelings, transference is another way that therapists may come to understand what is going on with their clients, often unconsciously.

What is Transference in Therapy?

Transference is a term used in psychology to describe a phenomenon in which a person redirects feelings they have about one person onto another one. In essence, the client projects emotions, desires, or fantasies about someone in their past onto someone in the present—such as their therapist.

Transference can be positive or negative, and it doesn’t take place exclusively in therapy. For instance, a person might “click” with a new coworker because they remind her of a favorite sibling, or mistrust a new romantic partner because they are reminiscent of a cheating ex-spouse. But transference does often happen in the therapeutic space, and it can be a very useful tool if used properly, helping the client to identify and understand patterns in their relationships.

For instance, the client may treat the therapist as an idealized mother or father figure. The therapist may then call certain actions or statements to the client’s attention and help them explore how their relationship with a parent has impacted their other relationships, often without their awareness.

Another type of transference that can take place in therapy is sexualized transference, in which the client develops an attraction to the therapist, often a powerful one. Sexualized transference is common, rather than an unusual exception, and therapists are trained to recognize it and deal with it in a way that is designed to help, rather than harm the client. Clients typically experience this type of transference as genuine love and desire for the therapist, rather than a projection, and it must be handled with compassion and sensitivity.

Many therapists also experience something called “countertransference,” in which they experience feelings of love for, or sexual attraction to, their patients. A significant majority of therapists report having experienced countertransference. Most handle it appropriately, perhaps in consultation with a supervisor or their own therapist. Some do not, and take advantage of the therapeutic relationship for their own gratification.

When a therapist engages in inappropriate and/or sexual contact with a client, it is abuse of transference—and it constitutes therapeutic and medical malpractice.

Abuse of Transference and Therapeutic Malpractice

Let us make one thing perfectly clear: it is never acceptable for a therapist to have a sexual or personal relationship with a client, even if the client believes they are in love with the client. The therapeutic relationship is an unequal one. The client is experiencing some kind of pain or distress in their life that caused them to seek therapy. That makes them vulnerable, as does the fact that the therapist knows a great deal about their feelings, secrets, desires, fantasies and shame. The therapist holds a great deal of power in the relationship, and it is incumbent on him or her to use it wisely, for the therapeutic benefit of the client.

Because therapy is about the client, not the therapist, the therapist’s true self is largely unknown to their client. This makes the therapist a convenient blank screen onto which it is understandable that the client might project their feelings. The therapist has been educated and prepared to deal with this transference. The client almost certainly has not, and may be blindsided by the strength of their feelings for the therapist, believing such powerful feelings must be true love. The therapist must not take advantage of this by engaging in a sexual or personal relationship with the client.

Abuse of Transference is Not Always Sexual in Nature

Abuse of transference often manifests itself as an inappropriate sexual relationship between a therapist or psychiatrist and client, but a relationship need not be sexual in nature to be therapist abuse. Any relationship between the therapist and client outside the bounds of the therapy room has the potential to be abusive, because it is unequal. The parties do not know each other equally, as friends would; one party holds all the knowledge and power.

Furthermore, therapists have a professional and ethical duty to act in their vulnerable clients’ best interest. Any conduct that affects the therapist’s ability to objectively evaluate and treat the client’s mental health may violate those professional ethics. That includes regularly texting or calling clients (other than to schedule or conduct therapy), attempting to connect with them on social media, or having them run errands or do favors for the therapist.

As a client, it is important to educate yourself about the signs of therapist abuse, but it is never your fault and you are not responsible for preventing it. If you believe your therapist has engaged in abuse of transference, consult with a medical malpractice attorney who has experience dealing with therapist abuse to discuss your options. Contact The Fraser Law Firm P.C. to schedule a consultation.