For Therapists: Addressing Sexual Feelings That Arise in Therapy

Sexuality is often a sensitive issue. In recent months, many people have come forward, speaking out about inappropriate, harmful, and abusive sexual behaviors and actions taken by people of positions in greater power. These abuses of power and their effects have too long been in the shadows of silence. The topic of sexuality deserves greater awareness from all of us. By taking the time for honest and open self-reflection, we can all help prevent the misuse of power.

What is inappropriate and harmful sexual activity? For the purposes of clarification, let’s say this includes any physical or verbal behavior that is suggestive, seductive, harassing, demeaning, or exploitative. When a person in therapy is attracted to their therapist, this can often be discussed in therapy without harm—as long as the therapist is not excessively affected by attraction or countertransference. The therapist must be able to focus on the sexual issues of the person in therapy only to the extent such discussion is based on their therapeutic process. It is also essential to establish and uphold boundaries, including an explicit agreement that there is no possibility of sexual relationship at the time or in the future.

Issues related to sexuality present enough challenges in ordinary relationships. When it comes to the therapeutic relationship, sexuality can be even more of a challenging and complex consideration.  Here are some things to consider when examining sexual feelings toward or from people in therapy.

Coping with Sexual Feelings Toward a Person in Therapy

It can first help to explore why you may be attracted to a particular person. Is there something about them that meets one of your needs? Perhaps it is a natural need, but it is one that must be met elsewhere.

1. Talk to a colleague who can help you sort out what you are experiencing and take appropriate steps to keep the therapeutic relationship ethical.

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2. Seek personal counseling. Working with your own counselor can help you resolve your feelings and uncover any issues in your life you may be struggling to deal with effectively.
3. If you are unable to resolve your feelings, terminate the professional relationship and refer the person to another therapist.

Coping with Sexual Feelings from a Person in Therapy

A good first step here is to acknowledge the person’s feelings as normal. Appreciate their courage and vulnerability around bringing them up or having them named. Explain that although the intimacy that often develops within the therapeutic relationship is powerful, it is best described as a kind of contextual love that is specific to the power differential relationship. Sexualizing this kind of love is detrimental to your work in therapy.

1. Make it very clear, with both words and body language, that a sexual relationship is outside the bounds of the therapeutic relationship. (Ethical codes vary in their statements of how long after termination it is considered ethical to begin a sexual relationship, if ever.)
2. Make every effort not to shame or reject the person you are working with. Track for and attend to any signs of shame or rejection.
3. If appropriate, look for therapeutic ways in which issue of sexuality can be addressed and explored.
4. When sexual feelings are unspoken or unconfirmed, use your best professional judgment to determine what would best serve the person you are working with: naming the feelings yourself or waiting for them to make the choice to do so.
5. Be prepared in advance. Consider how you might handle this kind of situation or how you might handle it with greater skill. Seek the support of supervision.

How Can We Deepen Our Understanding?

The issue of sexuality goes much deeper than simply understanding feelings and setting boundaries. These several questions, brought up by students, can help you explore this topic further in order to deepen your understanding.

• “When a client tells me they are attracted to me, I feel flattered and awkward. How can I express myself so the attention doesn’t end up on me and my response, or so my client doesn’t get the wrong impression?”
• “How do I work with clients who automatically associate intimacy with sexuality?”
• “Do I need to shut down my sexuality altogether to be an ethical therapist or body worker?”
• “How can I help a client understand the difference between therapeutic or transpersonal love and personal love?”
• “What are right and wrong uses of sexual current?”
• “Can sexual current itself be separated out from therapeutic love and intimacy? Or is it just to be “managed,” understood and accepted?”
• “Should the experience of sexual current in a session always be named?”
• “How can I tell if a client is misunderstanding my intentions?”
• “What range of control do I personally and realistically have over my sexual feelings?”
• “How can I effectively and appropriately use this control?”
• “Is there a way this client’s attraction could be used therapeutically?”

Here are a few stories for further consideration:

• “A male counselor was attracted to a female client. He knew she was in crisis and offered to meet her in a restaurant to provide professional support. Having just gone through a nasty divorce where her ex-husband had numerous affairs, she was in a vulnerable position. She talked about feeling unlovable and unattractive. The counselor placed his arm around her shoulder to comfort her and offered to follow her home to check on her safety. He offered nurture and support, and from there they slipped into a sexual situation.” This counselor, who took advantage of his client’s vulnerability, has likely been led more by unmet personal needs and poor boundaries and judgment than malicious intent to harm. Sexuality is a strong motivator, and it can warp a person’s ability to make good judgments. As a friend says, “Please stay away. My hands grow larger and my head smaller when love is before me.”
• A caregiver writes: “My point of view is that what we need most of in this world is love. Love motivates my work, and I believe it is the most fundamental of all healing energies. When I sign a note to a client, “love,” I am not worried about people personalizing it with me since everyone knows or senses that I am not being romantic or suggestive. I think we are all adults here. And I still call my clients, “darling” sometimes. No one gets the wrong idea.” These words may be compelling, but people everywhere, especially people in a lesser power role, do get the wrong idea, do misinterpret, do make words mean something they want them to mean, and do confuse personal and transpersonal love, particularly when vulnerable and longing for love and acceptance.
• As part of a process of relationship repair between a student and a teacher, the student explained her experience. “I was confused by how you related to me in terms of your body language and energy when we met at a restaurant to talk about some theoretical questions I had. Your words and lack of help in focusing me and our conversation on the question created more and more confusion and insecurity within me. I felt ashamed of these feelings. Then when you sat down next to me at the table, instead of across from me, I felt invaded and manipulated. I felt uncomfortable and expressed my discomfort and vulnerability with the “newness” of being with a man, in particular a single man in this type of context. It felt more like a date than a teacher-student meeting. I felt ignored and disregarded when you failed to respond to my concern and discomfort. I began to feel that your needs were more important. I feel angry now as I see that I was subtly forced to push my needs aside in order to maintain the relationship with you and get my question answered. I needed you to maintain the boundary of teacher and student because I couldn’t do it myself. I trusted you, and this trust was violated. My shame prevented me from resourcing myself and correcting the situation, but I hold you responsible for seeing this and doing something about it in order to care for me and protect my spirit as a vulnerable student and single woman.” The courage and clarity of both the student and the teacher in facing this situation enabled clarity and resolution. The teacher understood, apologized, and did some therapeutic work to better understand his boundary issues and lack of sensitivity and responsiveness to his impact.

These stories illustrate how important it is to both think proactively about how you will respond to sexual issues when they arise and to learn how to attend to and repair relationships when needed. When personal sexual desires get involved, thinking can become very warped.

It is especially important to seek out and use resources such as colleagues and supervision when faced with ethical dilemmas, things about which you feel ashamed, or mistakes you have already made or believe you may make. If you are unsure how to begin this process on your own, the support of a compassionate counselor can help.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.