Working with Sexual Attraction in Psychotherapy Practice and Supervision

A Humanistic-Relational Approach

Biljana van Rijn, Jasenka Lukac-Greenwood

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000097221
• Edition: 1
• Topic: Psicologia
• Subtopic: Psicoterapia

Working with Sexual Attraction in Psychotherapy Practice and Supervision addresses some of the challenges associated with sexual attraction in psychotherapy practice and supervision, as well as within services, and helps therapists, supervisors, and managers to navigate them with openness and self-reflection.

The book focuses on practical and applied issues, using a relational humanistic-integrative theoretical approach as a backdrop for understanding. Split into three parts, it deals with issues related to clinical practice, supervision and ethical issues. Chapters support in-depth exploration in all three arenas of practice and are completed by editors providing a reflective summary.

Enriched with case examples and research written by senior relational practitioners, the book will be beneficial to therapists, supervisors, and service managers in the field of psychotherapy.

Part 1

Clinical practice

Sexual attraction in the therapy room

1.1 Let’s talk about sex

Female therapists’ experiences of working with male clients who are sexually attracted to them

Jasenka Lukac-Greenwood

Context of the research study and this chapter

The chapter of this book is based on the research I conducted as a part of my professional training as a counselling psychologist and a psychotherapist which was inspired by my desire to delve deeper into an area of clinical work which I felt was particularly complex.

In my personal experience, my response to a male client’s sexual attraction was the least understood or discussed area of my work. My tendency was to feel either maternal or ashamed and I was curious to explore the extent to which some of those feelings might be embedded within the wider socio-cultural context as well as belonging to my individual, psychological background.

The most difficult aspect of the therapeutic relationship with this client was associated with a period of work when he implicitly or explicitly communicated his sexual feelings towards me whilst paying me directly in cash. For me, the situation had strong connotations of prostitution which made me feel dirty, non-professional, and unskilled. Although this was not a persistent aspect of our work, it was the one I made no use of. I mentioned it in supervision, but I made light of it, laughing and not giving it proper weight.

Later on, when I separated the context of payment, and as such the image of prostitution, I managed to address the issue of sexual attraction with the client, but I did it with the sense of ‘being done to’, as if the client was a ‘perpetrator’, and I was the ‘victim’. Under the protection of being a passive recipient of sexual attraction, I started to enjoy the situation. I found this even more difficult to admit to myself, discuss in supervision, or make use of in the work. The difficulty was associated with what it means to be enjoying being an object of sexual desire – ‘the slut’, by my own and society’s standards of behaviour for married, professional women. Therefore, fear of embodying the prostitute in different ways, either by being paid for services which (although not directly) were linked with the client’s sexual arousal, or by enjoying the feeling of being a sexual object, was detrimental in exploring the nature of our relationship. At other times, on the other hand, I also remember having tender, motherly feelings towards the client. In retrospect, it is difficult to know whether my motherly response was a defence against more difficult feelings of being a ‘slut’ or whether my different responses were a reflection of different aspects and phases of our work. However, what is very clear is my difficulty in using and working with the more sexualised feelings.

Although, my experience was shame and embarrassment (as well as enjoyment at a later stage), I did not want to make a presumption that all female therapists would experience the same feelings. Instead, I wished to explore the experiences of other therapists and the extent to which they were able to use it in their work with clients. This was the starting point for my investigation which I share here, hoping that other practitioners might also find it of interest and use.

Brief outline of the study

In this research, I explored female therapists’ experience and ways of working with male clients who are sexually attracted to them. I used Hollway and Jefferson’s (2008) hybrid method ‘Free association narrative interview’ which provided me with a way of integrating my psychotherapeutic and research skills. Most importantly, it enabled me to work with the notions of ‘unconscious’ and ‘embodied’ knowledge and to include my and participants’ personal and interpersonal reflections as part of data with which I worked.

The process of research involved open-ended interviews with five psychotherapists, three of whom I interviewed twice and two of whom I interviewed three times. The follow-up interviews helped with building rapport and trust, aided reflection, and enabled more collaborative meaning making between participants and me.

One of my participants refused information on age and ethnicity. Other participants were all older than 50 years of age and had extensive experience of working as psychoanalytic or TA psychotherapists. The names given to them in this chapter are not real.

Key findings

As a result of analysis of the interviews, I produced detailed reports on the work within and between participants’ accounts. However, in this chapter I will focus on three key themes which stood out for me and which I believe would be of most interest to practitioners. First, in relation to the question of the nature of experience, participants reported that experience differs depending on the client. More specifically, my study suggests that experience differs depending on whether therapists felt reciprocally sexually attracted towards the client or not.

Secondly, the research question about the extent to which therapists used the experience in the work with clients appears to be related to the extent to which therapists feel the conflict between personal and professional selves. And thirdly, in relation to the most personal question of whether other therapists had similar experience of feeling like a prostitute, my study suggests that I was the only one feeling like that! I will explore each of these themes and their implications in detail below.

What was the experience of female therapists?

As mentioned above, in response to my first research question, all participants reported that it is not something that is possible to describe in a generalised way because experience varies with each client. They described it as a changing dynamic dependent on the context and the interaction of experiences of sexuality that the therapist and the client bring into the relationship.

Although in retrospect this sounds obvious, in fact, this is not something which particularly stood out for me either from reading the literature or from my experience of working therapeutically.

In terms of the literature, from the theoretical point of view, this is a far cry from some of the classic writing on the subject which considered erotic phenomena as an inevitable process of the therapeutic process, a transference from the earlier childhood relations onto the therapist (Freud, 1915). This view of the sexual attraction is more in line with more recent relational thinking in psychotherapy which emphasises the importance of the therapists’ and patients’ intersubjectivity (Gabbard, 2001; Gerrard, 1996, 2010; Mitchell, 1988), rendering it complex phenomena, difficult to predict or master.

However, even the most recent literature betrays a certain degree of tension between the theoretical thinking on the subject and its application in the consulting room. For example, whilst there is a widespread agreement about the importance of the co-construction of the therapeutic relationship (Maroda, 2010; Stolorow et al., 2002), the issue of a ‘real’ relationship and its related notion of ‘the present’ in the consulting room is not something which is uniformly discussed or appears to be agreed upon. With the exception of the most recent literature in the existentialist tradition in relation to therapists’ self-disclosure (Berry, 2014; Marshall and Milton, 2014), the most prevalent way of considering the work with sexual dynamics involves linking them with our own or our client’s early history without much being said about how to deal with the feelings evoked in the present moment.

This made me wonder whether it might be assumed that once understood as originating in the past, the feelings in the present would cease to have a grip on an individual. However, based on my experience of talking to therapists, I was left wondering whether this really is the case and whether to help therapists contain some of the difficult feelings associated with sexual attraction, more than an understanding of the transferential aspects of it might be required. Consequently, I have come to see my study’s finding that therapists experience varies with each client as a further prompt indicating the need for further theoretical conceptualisation of the ‘present’ in psychotherapy and ways in which this can be worked with.

Additionally, from a more practical point of view, one of the key implications of this finding relates to the provision of training and clinical supervision. Although participants noted the relative lack of teaching on the subject, echoing similar views expressed in the literature (Bodenheimer, 2010; Rodgers, 2011) ultimately, this research suggests that rather than being taught, the real learning on the subject comes from having spaces where the dynamic can be explored reflectively and reflexively. Participants reported that this was most commonly done in their personal therapy and clinical supervision, something which is also highlighted in the previously published literature as well as numerous chapters in this book (Smith-Pickard, 2014a; Worrell, 2014). On the whole, participants described a positive role of supervision in terms of it helping them recognise the dynamic, finding ways of verbalising it, recognising ways in which they might be implicated in it (i.e., by being seductive) and ultimately in helping them be less defensive so that the dynamic becomes more available for examination and work with the client.

Who hits on whom? Experience differs depending on reciprocity of the sexual feelings between therapists and clients

Again, although this may seem very obvious, in retrospect, it wasn’t something which for me clearly stood out from the literature I read so far. However, as Agar and Fenton (Chapter 1.3) or Hitchings (Chapter 1.2) write, ‘who hits on whom’ makes all the difference.

When therapists do not experience the reciprocal sexual attraction, my study suggests, it is power dynamics that get activated between them. On the contrary, in the situation when there is a reciprocal sexual attraction felt by therapists, they reported the sense of mutuality, love, and fears of boundary transgressions.

Lack of reciprocity in sexual feelings and resultant power dynamics

The context of therapeutic work in which therapists did not feel reciprocal sexual attraction towards their clients appears to be interesting on several accounts. First, it seems that it puts the therapist in a very powerful position which is not always easy to experience. Participant 2, Alex, spoke about this most directly by highlighting how unnerving it would have been to have contemplated that she had so much of an impact on the client. Further, subsumed within it, lack of sexual responsiveness seems to have activated an aspect of therapists’ experience best described as the conflict between how they felt and what they thought they should feel in their role as therapists.

Most directly, participants talked about it as being ‘rejecting’, struggling to find a way of reconciling feeling personally disgusted with the client with her role as the therapist. As Pippa put it, the struggle involved a question of how to find an authentic and empathetic way of responding to the client when you do not feel the same way.

How do you say to somebody you disgust me…

or

… sense of “Yes, I have sex but not with you”, … [a sense of] rejecting.

And finally, a theme which I have come to see as a response to this power imbalance, in situations when participants did not feel sexually responsive towards their clients sexual attraction, they reported being preoccupied with their incompetency, fears of being at fault, or making a mistake. I found this one of the most striking findings, possibly because it didn’t feel ‘rationally’ explicable.

Pippa talked about this dynamic in a most direct way by recalling a time when she was a relatively inexperienced therapist when, without quite knowing what she might have done, she had a generalised fear that her client’s sexual attraction towards her was somehow her fault.

Most surprisingly, perhaps, even participant 4, Sarah, who came across as the most confident in her ability to work with sexual dynamics, described a moment when she doubted herself and wondered whether she had made a mistake by not anticipating a client’s desire for a hug and then not being able to prevent it.

I have also noticed that this worry over making a mistake was accompanied by participants’ anxiety about exposing or naming the dynamic of male client’s attraction towards themselves, fearing that it could potentially be experienced as shaming for the client. Although, at the time of the interviews I simply accepted this explanation, therefore revealing something that is unconsciously understood between us, in retrospect, I started to wonder why the exposition of male sexual desire would necessarily be experienced as shaming.

The fact that the participants feared being put down by the clients in some way suggests that power plays a significant part in this dynamic. For example, participants feared either being made to feel ‘silly’ by the client who would deny his sexual attraction, or presumptuous by being made to feel that they gave themselves more credit than they deserved.

Linking these findings with the literature which talks about the capacity to provide or withhold sexual availability as being very powerful, and thus very dangerous (Mitchell, 1988), I have come to see this sense of responsibility, fear of being made to feel at fault or being put down as well as denying or turning a blind eye to the sexual dynamic as therapi...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of contributors
• Editors’ Introduction
• Part 1 Clinical practice: sexual attraction in the therapy room
• Part 2 Sexual attraction and sexual identity in supervision
• Part 3 Ethics: preventing and dealing with transgressions
• Index