Intimate boundaries: Therapists’ perception and experience of erotic transference within the therapeutic relationship

Client Attraction to Therapists - A Mixed Methods Study of Therapist Experiences

OBJECTIVES

There is a paucity of qualitative and quantitative work exploring characteristics of client attraction towards therapists (CATT) and strategies for handling those situations. The present study aimed to explore CATT using mixed methods, including providing updated rates of client attraction in the therapeutic relationship and examining characteristics of CATT.

METHODS

A sample of 204 therapists (74% female; Mage = 36.74) completed an online survey with multiple-choice and open-ended questions on therapist demographics and experiences with clients endorsing attraction (including client disclosure, therapist emotional reaction, strategies for addressing, conceptualization, and supervision). 77% of respondents reported a cognitive-behavioral (CBT) theoretical orientation.

RESULTS

54% (n = 111) of respondents had a client express CATT, and anxiety was the most commonly reported emotional reaction. Qualitative results suggested that CATT was complex and multifaceted, that therapist and client identities played a key role in CATT, and that therapists often feel uncomfortable and/or unequipped to manage the situation. Therapist respondents reported using a variety of strategies to address the disclosure (e.g., normalization, setting boundaries). Supervision was reported to be useful, but at times insufficient.

CONCLUSION

The present research showed that CATT was a common clinical experience; yet therapists often feel anxious or unequipped to manage the situation. This study highlights the importance of clinical training on managing client attraction, especially from a CBT perspective. Directions for future research include further exploration of the intersection of client and therapist cultural and identity factors in the development and characteristics of CATT.

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.