Attachment to Your Therapist

Originally Published 7/10/2010.

*** Now Available: Attachment to Your Therapist: A Conversation. This series of posts in expanded E-Book form, on Amazon.***

A reader submitted this wonderfull comment:

Anyway, I've been in therapy, on and off, for about 12 years. Dealing with "neurosis" I guess - trust issues, attachment issues, etc. Anyway, I'd love to see something about attachment, and more specifically, attachment to your therapist. I have a very strong attachment to my therapist and have come to see him as a father. I struggle with this on a constant basis, because he's not my father, he is my therapist and is one hell of an ethical one at that and would never ever stretch the boundaries (which of course are some of the things that I wish for...). Anyway, anything on those issues, would be incredibly useful. And yes, I do talk to him about it as well, but having a more detached view of it would be really helpful for me.

The consulting room is an emotional candy store. It is a place where you are the only person in the world and it's all about you. The therapist has no other mission but to understand you just as you are and help you heal and grow. It is as close as you can come in adult life to the one-way relationship of childhood where you receive but don't have to give back. In the case of psychotherapy, you do give back, but in a different currency, that allows for all the feeling of being taken care of. One therapist said, "you buy my time, but the rest is free!"

So it is no wonder that patients get attached to their therapist. Is that bad? No. It would only be bad if it caused harm. Anything this powerful can cause harm, but not if it is handled right as it seems to be in our reader's comment.  I think it is the main source of energy to drive the therapy forward. Here's how it works.

When patients come to therapy, there are really two patients. There is the adult patient who listens dutifully while the therapist drones on on about how understanding will help you make changes and it is hard work and it is really up to the patient to want to change. Meanwhile there is a little kid who knows how things really work. The child in us all knows what he or she needs and is not interested in dull substitutes. She (or he) came in with a list of unfinished business from long ago, all the issues that she was not able to solve at the time. When they couldn't be solved, what did she do? She saved them up for a time when conditions would be different and now it looks like conditions may just be right.

Why couldn't she solve the problems back then? Children know that when there are problems, the ones who have the real power to solve them are the parents (or other caregivers). The child's job is to influence the parent so the parent will take care of the problem. Let's say a parent is depressed and totally self-preoccupied. The child needs love and attention and can't get it. The child will invent a whole list of strategies:  Give the parent love, be unworthy so the parent will feel less bad, perform brilliantly so the parent will wake up and take notice. What they all have in common is the goal of changing the parent.

You guessed it, the child going into the psychotherapy consulting room is planning to use some of those very same strategies to get the therapist to change because that is how things get better.

Of course the therapist has another idea. The therapist thinks that the solution is for the patient (both child and adult) to accept the fact that there wasn't enough love from the parent and to go through all the painful feelings of rage, hurt and sadness that the child knows are best avoided.

Let me digress for a moment. The power of this situation is hard to underestimate, and with so much power there are opportunities for bad outcomes. Fortunately our reader's therapist has good boundaries and his patient is talking about what she is feeling. The key question about boundaries is whether the therapist has made or implied promises that he or she won't be able to keep. This one rule covers essentially all the bad things that therapists can do. When that does happen, whether blatant or subtle, it is an indication that the therapist's needs are taking precedence over the patient's, and that is not therapeutic.

So the two go through their dance. The therapist's humanness and real presence give the child hope and bring out young wishes and needs. On the other hand when they do come out, it is painful because they are not fulfilled. Hopefully the therapist understands this pain and, by being an empathic witness, helps it to heal. On the other hand, as the process goes on, the wishes are more and more obviously young ones. It is characteristic of childhood wishes that they don't have limits. As they intensify, they become less realistic, less adult and more insistent. This may be embarrassing, even cause for feelings of shame, but it is exactly what has to happen. As the wishes become more intense, the frustration with the therapist for responding only with understanding becomes more sharply painful. The anger, hurt and sadness are very real.

By putting off fulfillment to the future, the child was able to maintain hope and avoid the painful feelings. That is not so bad, since there was no way the feelings could be attended to back then. What the therapy has done is to force those long-avoided feelings out of hiding. Finally the situation from long ago has been recreated in the present and the feelings are palpably real. It is when feelings are actually present in the room that they can heal (see more on catharsis in the regular part of my website).

This part of the therapy process doesn't feel like therapy at all. There is nothing as-if about it. It feels like anger and pain and sadness about life. For better or worse, that is when the most important therapeutic work gets done. Eventually the feelings heal and a more grown-up, philosophical view takes over (not the pseudo-adult one we started with, but a real acceptance). As this happens, it becomes more clear that some of the wishes actually can be fulfilled, but not by the therapist. In time, others in the patient's outside world become more interesting than the therapist and now we are in the termination phase.

Be sure to check the other posts in this category. The next one is here.

Jeffery Smith MD