Feeling sick

She got so scared of the licensing board knocking on her door that she refused to handover my client file when i asked. She ran to the police and said I threatened her and she was terrified. I have no history of crime or threats but the point is ..she twisted the law to make her the victim of a “threatening client.” Is this common? She altered my file and if discovered by the Board is it a serious crime in California. Also, if the Board discovers how she intentionally harassed me and lied to the Judge. She got an ex parte restraining order…she had a lawyer and I did not….it was not a fair hearing. She lied about why she terminated which leads me to believe she must have tampered with my file.

Thanks.

A close friend of mine who also saw this woman for individual T. committed suicide in her office. And she claims she suffered PTSD and couldn’t handle me anymore if I got angry. She thought I was going to retaliate over my friends death. There were some very painful transference & countertransference issues at stake here.

As I look back on it I wish I had never seen her. It caused immense emotional pain and rejection for me in the end. My friend was also in the midst of a terrible transference with her. He was madly in love with her. I think she should have referred him out or told me that it might be too complex to treat us both.

I’m not clear on this or not but she had me talk about my sexual fantasies with her when I told her I was attracted to her. She’s very beautiful. I noticed those fantasies were hard for me to disclose but she wanted to hear them. I couldn’t tell if there was some counter-transference going on here but it sure seemed like there was some sort of erotic arousal during this time.

In the Ethics code it states that any type of sexual innuendo even if it is verbal is a violation. I felt like this was a very grey area to interpret in my situation.

In retrospect, I had bored the man to death. If he had said so, I might have jumped in front of a bus on my way home. How could he have been both ethical and honest?

There are certainly a goodly number of times when the lack of fit is apparent to the therapist out of the chute.

There are also a good number of times when the lack of fit doesn’t show up until session three, five, or fifteen. Maybe the therapist thinks that the patient is presenting with A, and then comes to see over time that it’s B. Maybe the patient doesn’t reveal until session #4 she’s a neo-Nazi, or he’s brutally homophobic, or whatnot. Maybe it doesn’t come out until session 6 — or 16 or 26! — that Mr. X (or Ms. X!) sitting across from us is the same X person who broke our sister Marcy’s heart in graduate school…or that we’ve developed a crush on Monsieur or Madame/Mlle. X that no amount of supervision is going to allay.

Again, thanks for the great original post! I look forward to reading your next one.

My sense is that if the therapist doesn’t sense the TA, they are less inclined to terminate the relationship, even though doing so would be in the best interest of the client.

This is based on my personal experiences: I have been to over 10 therapists (in Los Angeles) in my life and NONE of them have have terminated the relationship, even when I didn’t really trust them (this is before I became interested in the topic).

Bottom line is that sometimes, therapists are forced to make compromises because they need to make money. Depending on the ethical compass of the therapist, I imagine that this line can be hard to walk, given conflicting factors: making money and what’s in the client’s best interest.

I think posing the question of erotic countertransference as an “Ask the Ethicist,” question is a wonderful idea and I’d love to hear Dr. Barnett’s take on it.

As with many ethical issues, I would expect his answer would not black or white but would be more gray and would depend upon a number of issues, including the therapist’s comfort, level of safety, the developmental level of the client, and whether or not the information provided could be useful clinically (or personally) vs. harmful to *this particular* client. I also expect that discussing countertransference in the context of a longer therapy vs. after just one session would make a significant difference.

I would hope all therapists are weighing these factors when deciding what to disclose, rather than applying a blanket policy to all scenarios.

Lastly, @TPG, you mention: how harmful it can feel to a client to be told it isn’t a good fit after s/he’s “invested psychologically in a therapy of three, five, fifteen, or fifty or more sessions…”

Let me be clear: I do not consider 3-50 sessions to be the time for any therapist to determine it’s not a good fit and offer no explanation. I am in full agreement with you there. The time to assess the fit is early on, together, with you and client both acknowledging that this is what you are doing. My piece refers to the first one or two sessions, and not something longer.

If the two of you agree to work together and then *later* during the therapy process the therapist feels it isn’t a good fit, this is quite a different situation than the one I wrote about and I fully agree that it should be managed differently with accompanying levels of disclosure and processing. Also, therapists do have a duty to bring up ending therapy or referring out if they feel they are not being helpful to a client. And this should not be a secret to the client.

Thanks again for your contributions to this discussion.

“Do you think that level of detail makes sense no matter how soon in the process this occurs?”

I have a one response: Absolutely.

The situation that Dr. Kolmes posits is one where the patient is satisfied enough with the therapeutic alliance to want to continue it, but the therapist is the one who pulls the plug against the patient’s will. As she writes in her original post…

“But what about when you think it’s a good fit and the therapist doesn’t? This can be uncomfortable — particularly if it doesn’t match your perception of the connection you made.”

Good grief. Could one think of a more upsetting scenario for a patient, to have invested psychologically in a therapy of three, five, fifteen, or fifty or more sessions, and then have their therapist tell them that they have to move on, even though from the point of view of the patient, the THERAPY IS WORKING? (Sorry for the all caps, but the point had to be made emphatically).

Shattering, potentially. I could see people leaving therapy never, ever to return.

So I would say, yeah. No matter what the length of the therapy — even a single session — the right therapeutic move for the patient would be for the therapist to open up and share. (Obviously, there’s more to share in a longer therapy. But even after a single session, there’s going to be plenty to say.)

I can see how a rupture like this could be terribly upsetting after even one session. I could see how it could be doubly upsetting even after one session if the therapist is coy, or obfuscates, fibs, or merely tells 50% of the truth.

This does not mean that the therapist ought be insensitive in choice or words or tone. But if there’s an error to be made, it ought to be made on the side of fully and truthfully communicating any and all the information that the patient would need in the future to process this harsh event, even if the disclosure is unflattering to the therapist.

As for a reveal of an erotic counter-transference being tantamount to sexual harassment under the APA guidelines? I’d love to have you pose that question to Dr. Jeffrey Barnett at APA, on his public psychotherapy ethics blog.

http://www.divisionofpsychotherapy.org/category/ask-the-ethicist/

My guess would be that’s highly, hugely unlikely, but I’m just guessing. In any case, the literature is not without discussion of this kind of reveal (see Jarl Jorstad’s 2002 piece in the Scandinavian Psychological Review, for starters).

In all cases, a therapist acting on erotic counter-transference is unethical and even criminal. This is, however, a far cry from discussing it in the room at a final termination session where the therapist is terminating the relationship, particularly in the context of specifically telling a patient that a therapist is terminating due to an unresolvable erotic or love countertransference. That’s about the opposite of sexual harassment as I see it.

Besides. Patients know a lot more than they often get credit for. One only remember Irving Yalom’s essay about the overweight female client her wrote about in LOVE’S EXECUTIONER — his countertransference was profound. At the end of the therapy, he revealed some of his feelings. As he said to her…

“Well, what I mean is that I hadn’t worked before with heavy patients, and I’ve gotten a new appreciation for the problems of.. “ I could see from her expression that she was sinking even deeper into disappointment. “What I mean is that my attitude about obesity has changed a lot. When we started I personally didn’t feel comfortable with obese people.” In unusually feisty terms, Betty interrupted me. “Ho! ho! ho! Didn’t feel comfortable. that’s putting it mildly. Do you know that for the first six months you hardly ever looked at me? And in a whole year and a half you’ve never, not once, touched me? Not even for a handshake!”

He’d never said a word. Yet the patient knew.

***

So again. In this fraught situation? Full disclosure to the patient. Please. Anything less is a disservice.

Many, many thanks, Dr. Kolmes, for making this original post. It has set in motion a very interesting and important discussion, and I wonder what some of the other therapist professionals here think.