Category Archives: Therapy

Handling the Erotic Transference: Male Patient, Female Therapist

Seem to be getting lots of queries about erotic transference, otherwise known as falling for your shrink.  Since I specialize in treating men, thought I’d take a crack at the subject from the particular angle of male patient/female therapist.

Male patients – all patients – bring to therapy the gender role expectations, attitudes and behaviors they experience in their other male-female relationships. But because the doctor/patient  relationship  in psychotherapy is a unique – and often new – experience, male patients often do not know quite how to proceed.  And this can make for discomfort difficult to tolerate.  For both the patient and his therapist.

In part this is so because there are so few models for an intimate professional relationship.   In fact, it’s often rare for a man to have a relationship that is intellectually and emotionally intimate but with no physical/sexual intimacy.  They tend to go together for many, if not most, men.   And for countless men, intimacy is physical intimacy.  Women are likely to share private thoughts and feelings with a variety of platonic co-workers, neighbors, friends and family.  For many men, particularly men of a certain age,  vulnerability, attunement, expression of deep feelings most often occur in the context of a sexually intimate encounter – and seldom elsewhere.  The notion of  intimacy without a sexual component simply does not compute.  “Intimacy” is code for “sexual intimacy.”

In these instances, it’s crucial that the woman therapist establish and maintain strict behavioral boundaries – at the same time as she encourages verbal exploration of uncomfortable thoughts, feelings, and yes, even sexual fantasies.  Talking, not doing.  This requires constant vigilance.  Therapists can get uncomfortable and awkward.  Patients can attempt to catch the therapist off-guard and deprofessionalize the relationship, particularly when they fear becoming too vulnerable or losing control.  The male patient whose glance lingers a bit too long shifts the discomfort from himself to his therapist.  Not that his therapist isn’t uncomfortable herself…

Discussing all this can prove amazingly beneficial.  By delving into all this rather than avoiding, by talking but not doing, the therapist provides reassurance of the safety of the therapeutic alliance, necessary for the trust effective psychotherapy requires.  (And make no mistake:  it is the therapist’s job to make sure “nothing happens.”   Always.)  The shared, in vivo context provides common ground for exploring sexual and emotional intimacy issues, often the very issues that prompted therapy.

And talking about sex, sexual feelings, without doing?  Well, that’s apt to be a rather novel experience.  How often do men and women talk honestly, openly, about sex – without engaging in sex?  Lots to learn, lots to learn…

Copyright © 2013 Marlin S. Potash. All rights reserved.

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The Nice and Not-So-Nice Therapist: Who is Really Nicer?

NICE ?

How nice should a therapist be?

Nice. Someone pleasant, agreeable.  “He’s such a nice guy,” we say, imagining someone good natured, kind-hearted.  Or  exacting, evidencing great skill:  “Nicely done!”  Or scrupulous, exacting, hard to please:  “Give me a nice piece of corned beef” – which really means “give me your best cut, extra lean!  Nice can mean trivial, easily dismissed: “that’s nice, but”  or treading carefully, behaving delicately: “be nice to your cousin!”  And then there’s making nice, acting as if one were feeling all those good things, somewhat hypocritally.  Oh, and the ironic nice, a nice that means not nice at all:that’s a nice way to say thank you!”

How can one word mean such different – even antithetical – things?  Its origin provides hints.  Originally Middle English, it meant stupid or foolish, deriving from the Latin nescius ignorant, by way of French.  It meant coy, reserved, and by the 16th century fastidious, later still  fine, subtle (considered by some the ‘correct’ sense, and on to the current pleasant, agreeable.

What happens when conflict and confrontation-avoidance masquerade as being nice?  When does acting nice not only not equal being or feeling nice, but actually serve as a cover for feelings that are anything but nice?  When is being nice a cop-out for not dealing with the difficult and messy – but important – stuff?

Which brings us to the question of the day:  Exactly how nice should your therapist be? How nice is therapeutic?

Therapy’s not about appearance, but substance.  And when it comes to the therapy experience,  there’s often a difference between nice and helpful.

If the therapist’s prime motivation is to be liked, well, then, she’s got to act nice to be seen as, thought of, as nice.  When being nice is crucial, gratifying the patient is crucial,  first and foremost, pretty much always.  Even if it means avoiding the tough stuff; especially if it means avoiding the tough stuff that doesn’t feel so, well, nice

But if the therapist’s prime motivation is to promote learning – to provide tools for a better life, to help her patient become all s/he can be, to heal – real trumps nice every day of the week.  It may not always feel nice.   But if your therapist  goes beyond skin-deep nice, if together you do more than scratch the surface – explore and understand and accept what’s real – you’ve got a shot at goodReal good.  Which has a whole lot more healing power than some ironic nice.

Copyright © 2012 Marlin S. Potash. All rights reserved.

Reasons to Leave your Therapist, Part III: Therapy Love? How about Therapy I’m starting to Hate?

September is back to school, back from summer vacation, and for many the beginning of a new year and a new beginning.  In our lives, some things are always beginning, and some ending, but it often takes contemplation to know which should be which…

How in the world do you know when to end therapy?  There are a number of scenarios, depending on you, your therapist, and your course of treatment. Leaving the good experience can be tough; ending a not-so-good, or a downright bad, therapy can be even more difficult.

Ending before you begin:  What’s a fair amount of time to decide if this is the (right) therapist for you?  What if you get a funny feeling early on?  What if you’ve been given a referral by someone you trust, and you have a terrific initial conversation, only to find something comes up early on that really bothers you?  Should you start with a therapist when you’re not so sure she’s the right one for you?

Yup.

Here’s a shortcut to what I think is the right balance:  you should feel comfortable enough to speak openly and honestly, but not so comfortable you feel as if you’re having coffee with a friend.  Go with your feelings.  If it feels right, dive in, if not, keep looking.

Ending in the middle:  You’ve hit a speed bump.  Maybe your therapist did something you didn’t like, or has turned out to have shortcomings you hadn’t seen before (I have certainly been guilty of both, and no doubt will again).  Maybe your therapy’s veered in a direction that doesn’t quite feel on the mark.  Maybe there’s something you just can’t bring up, maybe even bring yourself to face – about the problem that brought you in to therapy in the first place, about your feelings toward your therapist, about your thoughts or conclusions. 

Bring it up.  No matter what it is, whether you are “right” or “wrong” think you “should” feel this way or not, might “hurt feelings” or “make her angry.”  Bring it up.  Because that accomplishes two things:  you get it out and realize you’re still alive (hopefully with a tour guide who’s calm and compassionate), AND you get to see how your therapist reacts.  Does she minimize what you say, make you feel small or silly or just plain wrong or bad?  Or does she listen, take you seriously, consider her part in your discomfort and work with you to get over (not around) the bump?  Because that will tell you all you need to know.  Can’t avoid the bumps, I’m afraid; can avoid feeling afraid to talk about the bumps with the therapist who’s meant to help you do so.

Ending when it feels as if you’ve been going forever.  If therapy’s been uncomfortable and unproductive for a long time, if you find yourself leaving each session wondering why you bother,  if you keep trying to communicate something but your therapist really doesn’t seem to get it/you,  if you feel increasingly frustrated (maybe even angry), it’s time to reassess.

If, after months, maybe even years in therapy, you are feeling that you’ve hit a wall, chances are you have.  If, after months, maybe even years in therapy,  you are feeling unheard, you’ve got to wonder:  what will it take for this therapist to get me?  Actually, maybe you’ve got to stop wondering, and just start saying your goodbyes.  Because if you’ve invested months and years in treatment and your therapist still doesn’t get it, or you’ve stopped learning anything significant about yourself long ago, or if you’ve gotten stuck in the land of diminishing therapeutic returns: it is time to go.  Maybe time to end therapy, maybe just time to end therapy with this therapist.  Doesn’t mean it hasn’t been real, useful, important; just means it hasn’t been for a while.  A dry spell is one thing – every therapy relationship (geez, every relationship) goes through those – but a dry spell that lasts for weeks and months is more than a dry spell.  It’s a dessicated therapy experience.  And that is none too therapeutic.

Copyright © 2012 Marlin S. Potash. All rights reserved.

You and Your Therapist: Part IIa. Therapy Love, Revisited

Sometimes I feel like there’s a wall between me and my therapist.  And sometimes I wish there were some sort of wall between me and my therapist!  It doesn’t make any sense to me.  And I worry:  does it mean she can’t help me?

It’s making me so uncomfortable!  How do I stop falling in love with my therapist?  It’s making me so uncomfortable! How do I keep my therapist from falling in love with me? 

Sometimes I think I don’t even like my therapist.  Do I have to for therapy to work?  I don’t think my therapist even likes me.  Does she have to for therapy to work? 

I hate it when my therapist is mad at me.   Why does it bother me so much? What do I do?  I hate it when I am mad at my therapist.  Why does it bother me so much?  What do I do?

Questions like these just keep rollin’ in to us here at Feeling Up in Down Times.  In the initial installment of Therapy Love, we addressed those good  (sometimes confusingly so) feelings:  loving your therapist – or wondering if your therapist loves you.  But what about all the uncomfortable negative feelings:  worrying if your therapist secretly hates you – or if you secretly hate your therapist?  Worrying if your therapist is angry with you for not acting on what you’ve supposedly been learning in your therapy.  Worrying if you’re too angry with your therapist for therapy to be helpful.

When you come to trust someone as much as you can the therapist you share so much of yourself with, when you come to trust your therapist “gets” you, you’d think you’d feel comfortable, safe, free to be yourself.  And that is usuallythe case.  But in a cruel twist of fate, it can also mean that whatever negative feelings do come up seem particularly meaningful and important.  And that, in turn, makes it both more uncomfortable to share them with your therapist – and more important to do so.

Maybe those negative feelings are so uncomfortable because the relationship comes to matter so much.  Because therapy love just feels so real, almost like the real thing.  Therapy Love is a real thing, it’s just not the realthing.  Therapy love is a state of heightened emotions in a situation where your every emotion is under a microscope:  one you and your therapist share and look through together.  Or – often and –  a microscope you’re uncomfortable having anyone else look through, especially your therapist.  All in an intimate relationship that looks and feels just enough like a real life relationship to make you wonder:  what’s going on here, and what do I do about it?

You take a deep breath.  You bring it up, into the light of day.  You explore the realm of contradictory feelings, the juxtaposition of loving and hating.  Because the one thing you can count on if you do risk sharing those tough feelings with your therapist  is that you’ll learn an awful lot.  About yourself.  About yourself in relationships. It’s rare to have a dedicated person and place to talk about the good, the bad and the ugly – with the very person you’re feeling those things about, when you’re feeling those things.  Unlike the other people you may love, your therapist doesn’t have any vested interest in the outcome.  Your therapist is working for your insight, in your best interest.  It starts in the relationship between you, but it extends beyond that, way beyond that.

Even with any fears or anger or disappointment.  Even better than any fantasies.  And  that just might be the best thing about Therapy Love.

Copyright © 2012 Marlin S. Potash. All rights reserved.

I’ve Hit a Wall. Help!

When I began this blog, I intended to focus on the psychological effects of the economic downturn, and to provide tools for the stress the roiling markets produced.  Who would have guessed just how often I’d get requests for advice on how to manage the therapeutic alliance!  How to get your therapist to like you.  How to get your therapist to love you.  How to leave your therapist.  How to make sure you don’t have to leave your therapist.  How to handle it when your therapist leaves you.

But one of the biggest surprises of all is just how often the search that brings someone to my blog is “How to mess with my therapist’s head.”  I admit I am stymied.  Why in the world would anyone want to do that?  Why spend your money and your time supposedly seeking treatment from a professional when what you really want to do is pull one over on him or her?  Assuming you’re in a bona fide psychotherapy, which you pay for with your hard-earned time, money and commitment to self-disclosure, isn’t it a waste to focus on subterfuge, misleading your therapist, playing games, even vengeance?

Help me out here:  what, exactly, is this all about?  And why are so many people interested in how to do the best job undermining the very therapist they pay to help them?  Any thoughts would be most appreciated.  There’s clearly something here for me to learn!

Copyright © 2012 Marlin S. Potash. All rights reserved.

You and Your Therapist: Part V. Take a Therapy Vacation

Hot time, summer in the city.  Thoughts go to the Cape, the Hamptons, the Jersey Shore…

Well, maybe not specifically, but the imagination does drift to escaping the city’s humidity at the beach, by the pool,  in the country. Oh, the lazy days of summer!  So, should you take a therapy vacation?

Who, you?  Your therapist?  Yup.

You:  You stop working in therapy, really;  you phone it in.  Oh, you show up – most of the time – but your head’s not into it.  You forget to do your homework (you were going to meditate, exercise, daily, remember?).   You’re finding it too hard to resist the long weekend away, the chance to catch the new movie in air-conditioned bliss on a summer Friday…

Your therapist:  Juggling everyone else’s summer vacation schedule and wondering:  take August off, since patients are out of town, or be one of the few therapists in town, available for patients?  Struggles with patient-envy:  patients enjoying being on vacation, therapists worrying if they’ll have a practice come autumn…

Sometimes, a vacation from therapy’s the way to go.  If you’re not going to fully invest your energies in the process (either patient or therapist), don’t waste your/her time and money.  If you’re running on empty, therapy becomes a matter of diminishing returns – something that’s often noticed only after that break.

So go for it.  Time for a break so you can return, refreshed, ready to work, learn, grow, change.  Time for a therapy vacation.

Just remember: you don’t want to lose ground or forget what you’ve learned so far.   A break from therapy – summer vacation – isn’t an excuse to forget everything you’ve learned in therapy.  And it certainly isn’t an excuse to forget to pay attention to what’s good for you – and what’s not.

Copyright © 2011 Marlin S. Potash. All rights reserved.

Can’t Be Said Much Better Than This…

Life’s never easy.  We can decide what we want.  (Well,  some of us can;  for others, even knowing what we want is not so easy). 

There’s much we can choose, if we are fortunate.   And we are all, all of us, quite fortunate (even when, on those bad days, we don’t feel that way).  And though there’s no sure-fire path to getting it all, good psychotherapy can help find – and clear – the path to happiness.  Search, question, focus, discipline, know what matters, meditate, learn about and face oneself honestly in the company of a therapist who listens and “gets it”: safe landing, real contentment and true happiness are indeed possible.

Even if there’s no guarantee of getting/having even what we (think we) need.  Even if it’s finding and traveling the path to, not being and staying at some desired destination.

Sometimes therapy’s about listening – both the therapist, and the patient – to the felt need.   Permitting the feelings, the desires, the sense of urgency:  wanting what we want, when we want it.

And then accepting that it is however it is.  And if we share our most private wishes with someone who hears, gets it – and accepts us as we are – well, sometimes, maybe, that’s really as good as it gets.  And it’s quite good enough.

Is it any wonder people fall in love with their therapists?

Copyright © 2011 Marlin S. Potash.  All rights reserved.