Intimacy in Psychotherapy: An Exploratory Survey Among Therapists

Erotic Feelings Towards Patients in the Psychotherapy Session: Investigating Their Relationship With the Characteristics of the Therapist, the Patient, and the Treatment

Experiencing erotic feelings towards a patient is a fairly common occurrence, not pathological per se, during phases of psychotherapy. This study aims to analyze associations between, on the one hand, the presence in therapists of romantic attraction (RA), sexual attraction (SA), or flirting behavior (FB) toward patients and, on the other hand, a series of characteristics of therapist, patient, and treatment. Between April and June 2022, 547 psychotherapists completed an online survey investigating their affective and behavioral responses toward their most recently treated patient. Compared to female therapists, males showed significantly higher prevalence of SA alone (p < .001) or in combination with RA (p < .01), FB (p < .01), or both (p < .05). Multivariate adjusted regression models showed that RA was associated with patient age ≤40 years (OR:39.49 for age 18-29; OR:28.44 for age 30-39), male sex (OR:10.40), and diagnosis of mood disorder (OR:14.08). Furthermore, RA was associated with intense countertransference feelings of tenderness towards the patient (OR:79.77) and hostility towards significant figures in their life (OR: 77.93). SA was associated with the therapist's male sex/gender (OR: 16.14), psychoanalytic orientation (OR:13.34), post-license experience ≤20 years (OR:6.12 for 1-9 years; OR:6.08 for 10-19 years). Lastly, FB was associated with the therapist's male sex/gender (OR:16.94).

Intimate and sexual feelings in psychotherapy: educational topic or still taboo?

BACKGROUND

Intimate and sexual feelings are common within psychotherapy, with negative outcomes when not managed adequately.

AIMS

This study aims to investigate the understudied topic of these intimate and sexual feelings in basic education and psychotherapy training programs.

METHOD

In this convergent mixed method study, both a survey (N = 786) and 8 focus groups (N = 36) were conducted among psychotherapists in Flanders, Belgium (November 2016 - June 2018), using inferential and thematic analyses respectively.

RESULTS

The majority indicates that dealing with intimate and sexual feelings towards clients was hardly part of either their basic education or psychotherapy training. Talking about such feelings with peers or supervisors remained difficult because of concerns about being judged. Therapists indicating this topic was addressed in some way in their training indicated more often that they did not perceive it as a taboo topic. Therapists advocated a more open discussion and reflection on this topic. Education and training, as well as support from renowned key figures in their field, were regarded as important incentives to initiate change.

CONCLUSION

Psychotherapy training should focus on how to deal with intimate and sexual feelings, referring to introspection and exploration of these feelings in a more integrated way during training.

Lo(u)st in Therapy: Development and Psychometric Evaluation of the Therapists' Attitude toward Sexual and Erotic Feelings Scale (TASEF)

This study aimed to develop the Therapists' Attitude toward Sexual and Erotic Feelings (TASEF) scale for assessing therapists' attitudes and responses toward sexual and erotic feelings in therapy. A total of 507 therapists participated in two separate studies. Study 1 focused on finalizing the format of the TASEF and evaluating its construct validity. Through Exploratory Graph Analysis, four factors were identified within the TASEF questionnaire: Gratification, which captures the positive affect experienced by therapists in response to a patient's sexual attraction toward them; Fear, which represents therapists' apprehension or discomfort when encountering sexual feelings from the patient; Threat, which reflects the perception of risk or danger that erotic transference poses to the patient, therapist, and the therapeutic process; and Aversion, which encompasses the therapist's discomfort or aversion toward the patient's sexual feelings. Study 2 aimed to confirm the structure of the TASEF questionnaire and assess its overall validity. The results showed that the TASEF demonstrated adequate overall validity, with higher convergence validity observed for the Fear, Aversion, and Threat clusters compared to the Gratification cluster. The TASEF enables therapists to understand and manage their emotional reactions to sexual feelings in therapy, maintaining standards of care.