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Intimacy in Therapy: Reality or Dangerous Illusion?

It is widely accepted among psychotherapists and their clients that the relationship between a therapist and a client, or the so-called “therapeutic relationship”, is both intimate and professional at the same time. I believe, that “intimate” and “professional” dynamics cannot co-exist in the same relationship, but I also believe that it depends on how one defines “intimacy”.

Intimacy, like many other concepts, is understood differently depending on one’s cultural upbringing, personal experiences and personal views. Like everything else, it’s up to interpretation and that’s why it is dangerous to use this concept in therapy without clarifying what it means for both participants of therapy process (a client and a therapist) and without making sure they are both “on the same page” with it, that is to say they both have the same understanding of intimacy, how it applies to therapy and if it applies at all. Failure to make such clarification often results in clients getting harmed due to unrealistic expectations they may create of their relationships with therapists.

Unfortunately, many therapists often fail to clarify the concept of intimacy for themselves before they are able to clarify it for clients. Interestingly enough, it is usually a therapist who introduces the idea of intimacy in therapy to a client, and, with so much talk about clients “pushing” therapists’ boundaries, I wonder if by introducing the idea of intimacy being a “normal” part of the therapist-patient relationship it is, in fact, the therapist who is “pushing” the client’s personal boundary.

The concept of intimacy or rather an illusion of intimacy (in my view) in therapy is a huge topic that can’t be fully discussed in the short post. In order to do justice to this subject, I am currently working on the article on intimacy in therapy that may easily turn into a small book. I will post a link to it as soon as it is complete.

 
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13 Responses

  1. Ellen

    I agree that “intimacy” can have different connotations, and think that the use of this word could create problems.

    In personal and professional relationships people may test or push boundaries. In life, I think that boundaries can be somewhat flexible at times, usually more so in personal than in professional relationships.

    You mention that there is talk of clients “pushing therapists boundaries”. When that happens, it seems to me that it might be part of the therapist’s job to help a patient work on that. It might pose a challenge to the therapist, but it may be part of the job, especially if it is not too extreme.

    But, when a therapist pushes a patient’s boundaries (I had this experience), the patient is not likely to be prepared or trained to deal with this, and may have a general sense of discomfort rather than a knowledge that the boundary is being pushed.

    Many of us yearn for intimacy (even if we are not conscious of this yearning), so the use of this term may be somewhat seductive.

    Thanks for your post, and hope to see your article/book.

    • Marina Tonkonogy

      Thanks for your comment. Yes, intimacy is a confusing idea that cannot have one fixed universal definition. Just like many other things we all define it subjectively. With such lack of clear definition, implying that intimacy is a natural part of a therapist-patient relationship could be seductive and dangerous, and, by the way, when the therapist makes such suggestion this in itself may constitute patient’s boundary crossing depending on the circumstances. I think, many people, both therapists and clients, who believe that a therapist-patient relationship is both professional and intimate, simply confuse the fact that the client reveals a lot of intimate material to the therapist with relational intimacy. Those are different things though one can easily lead to another if the therapist is not mindful about his/her professional role at all times.

      As to boundaries, I define boundary somewhat differently from how many people see it. Usually, especially when it comes to professional boundaries, people rely on some ideas about what behavior is and isn’t appropriate in certain relationships and in certain settings. Very often those ideas are not their own, they pick them up from the external world. To put it simply, many people rely on what others think the boundaries should be in this or that particular relationship or circumstances and on the whole set of artificial rules that are supposed to accommodate those boundaries. I define boundary as simply what you decide to say yes or no to. By that definition, boundary is also a somewhat subjective idea but not completely subjective. There are some boundaries or behavioral rules that should apply under all circumstances. One of such universal taboos is the incest prohibition. Breaking such rule is always considered a transgression no matter what the circumstances are and no matter what personal opinion one may have about it. Similarly, in therapy, becoming sexual with one’s patients is also always considered a transgression, it’s not a matter of opinion or personal preference of a therapist.

  2. Ellen

    As a normal part of therapy a patient may reveal intimate information to the therapist. But if the therapist reveals too many details about his own intimate feelings toward the patient or toward others, the patient may feel that he/she cannot work with this therapist. However, it may be very painful to quit because of a bond that may have been formed.

    This can happen possibly because the therapist, in your words “failed to clarify concept of intimacy” for himself. But whatever the cause, the patient can be harmed.

    • Marina Tonkonogy

      This is one of the points I want to make in my article or book (whatever comes out). The point is that intimacy is a mutual experience of sharing personal things, or, at least, this is one of the dimensions of intimacy (the other one being mutual feelings). But such mutual sharing is not supposed to take place in therapy and is prohibited by professional ethics because it contradicts the premise of therapy. The therapist is there to help the patient process his or her experiences, not to share their own experiences. When interactions turn into mutual sharing, it’s no longer therapy, it’s more like a friendship or more. And, yes, of course, the patient is harmed regardless of the cause of such boundary crossing. If the patient quits therapy because he or she feels that the therapist’s self-disclosure has become inappropriate, it’s actually the best case scenario when the harm is or could be avoided. It’s much worse when the patient gets stuck with the therapist who doesn’t understand their professional role because of the attachment that has been formed. In that case, harm is inevitable.

  3. Could you say a bit more about attachment in therapy ? When my therapist suggested I consider ending therapy I suddenly felt betrayed . Because of some remarks he had made I came to believe he would always be there for me and that ending therapy would be a joint decision . We have talked about this and I guess to some degree have reached a resolution . I just never thought I had developed such strong feelings for him and I don’t believe that if he hadn’t encouraged intimacy between us I could have ever made the progress I have . So , I want to walk away and not feel like I have lost a beloved friend forever or that I overvalued and distorted this relationship to such a degree that I misinterpreted his part in creating this bond . What might I have done to prevent this outcome ?

    • Marina Tonkonogy

      Hi David,

      Such concepts as attachment and intimacy in therapy are sensitive subjects for people because we, as humans, naturally tend to get attached and to form bonds with those who show kindness and empathy and listen without judgement, which therapists usually do. Besides, many of us have been emotionally deficient since childhood and, consciously or unconsciously, we seek emotional “feeding” whenever and wherever possible. We often feel that only through relationships with the “right” people we may find happiness, which is an illusion, of course, but this illusion is a part of human nature.

      So, when attachment develops in therapy, it’s a perfectly natural phenomena. The devil is in the details.

      Has the attachment grown to a degree that it has turned into dependency when your entire well-being now depends upon seeing your therapist regularly?

      Has the attachment been stimulated by your therapist’s encouragement of “intimacy” or has it grown naturally just by the virtue of seeing him and talking to him regularly?

      Attachment formed as a result of getting used to regularly seeing somebody is different from attachment stimulated by the suggestion that the relationship is “intimate” that may play into your fantasy that the relationship is something more that what is consistent with the premise of therapy and may create unrealistic expectations of what is and isn’t possible in this relationship. When someone suggests that your relationship with them is intimate, that intensifies the attachment tenfold especially when this person is a therapist who has significant psychological power over you.

      When your therapist suggested that your relationship with him was “intimate”, what did he mean by that? Have you asked him what he meant?

      Have you ever asked yourself what intimacy means to you and how “intimacy” with a therapist is different from intimacy with a friend, a lover? Or IS there any difference at all? And if there is no difference then why are you paying him? You don’t pay your friends for listening to you, do you? What exactly is your therapist doing that is different from what a close friend or a mentor would do that justifies your paying him?

      I am not trying to invalidate your experience and the fact that you have benefited from whatever the relationship with your therapist have had to offer to you. I am just trying to make a point that the lack of clarity about the nature of your relationship with him creates a confusion about what to expect from him and such confusion may potentially traumatize you.

      To answer your question about whether you overvalued and distorted this relationship to such a degree that you misinterpreted his part in creating this bond, I am not sure what exactly you misinterpreted so if you clarify that I may be able to answer.

      As far as the distortion of the relationship, it is your therapist, not you, who distorted it by suggesting that it is an intimate relationship. Once again, it all depends on your and his definition of “intimacy”.

      By my definition, intimacy entails mutual feelings of warmth, or love, or attraction, or all of the above depending on the nature of the relationship AND it also entails equal sharing of personal material between two people. In an intimate relationship no one holds back, people share their thoughts, experiences, feelings, memories, events with each other freely and in equal amounts. Therapist could NEVER share their personal material equally with patients. He or she is forbidden from doing so both legally and ethically because such sharing would contradict the purpose of therapy. Therefore, intimacy can never exist in therapy. And, therefore, any therapist who suggests to a client that their relationship is intimate is either ignorant and doesn’t understand his or her professional role or plainly unethical or both. This is what I believe, but I don’t force my beliefs on others.

      If your definition of intimacy is different and if, by your definition, intimacy in therapy is possible, that’s fine. In this case, just ask yourself if your definitions and your beliefs are serving you well or if they perpetuate some unrealistic fantasies that might feel good for the time being but may potentially hurt you in the long run.

      One thing I can tell you is that if you continue to believe that intimacy can be a part of therapy, you will never be able to walk away from your therapist without feeling that you’ve lost a beloved friend. If your therapist suggested that you and he had an intimate relationship (which was very seductive of him to do IMO) then, naturally, you see him as friend. How else are you supposed to see him if that’s what he suggested? In our mind the idea of intimacy immediately translates into a close friendship or a love relationship because those are the only relationships where mutual sharing flows freely and equally back and forth.

      I should also say that it’s very convenient for a therapist to suggest “intimacy” with a client without clarifying what it means and how it squares with their professional role.

      As to your question how you could’ve prevented the current situation, you couldn’t. It was your therapist’s responsibility to prevent this outcome, not yours. You, like many people, walked into a consulting room not knowing how therapy works and it was your therapist’s responsibility to provide you with utmost clarity. If there was enough consumer information for people seeking therapy, then I’d say it was your responsibility to educate yourself about this process as much as possible before hiring a therapist, but there is virtually nothing out there for consumers. In such informational vacuum no one can expect to know all they need to know beforehand. I hope, my website could help remedy this situation to some extend.

      At this point, however, you do have a responsibility to watch out for your best interests. If you started doubting what’s happening in your therapy, it is your responsibility to take care of yourself. Inform yourself as much as you can, reflect on your therapy process and clarify your goals, ask your therapist to clarify things for you, talk to him about your doubts and concerns and see if he takes them seriously or if he becomes defensive and dismissive. His reactions will tell you a lot.

      • I’m grateful for all the information and insights and because I don’t feel like I have resolved this issue I want to employ your suggestions .

        It is true that intimacy can have many levels of meaning – what I hoped to express was the emotional character of intimacy as it applied to our relationship . I havn’t developed this level of intimacy in any relationships outside of therapy . I think this accounts for why I feel so badly about ending therapy . We have talked about what I might do to form these relationships outside of the therapeutic hour but I don’t think I have …..

        Some background might be helpful here . I have been married for 35 years and the unhappy nature of my marriage was one of the principal reasons I began therapy . Also , my son had been DX. with Schizio-Affective disorder . This was after 10 years of dealing with my oldest daughters Dx of Schizophrenia and untold hours trying to find help for her ….. I felt like I just could not manage any more and with his support I found the courage to leave and comes to terms with how I could help and how I couldn’t . So I have been on my own now for two years .

        I have begun to think I may have been less than realistic about who he is and what he can offer …..Of course I have ……

        • Marina Tonkonogy

          Hi David,

          Welcome back.

          I understand what you are saying when you speak of reaching such a degree of emotional closeness with your therapist you haven’t had with anyone. I can relate to this. I had a similar experience in my last therapy, though not exactly the same because I had some relationships outside of therapy that were quite fulfilling.

          I have to admit I still struggle with understanding the concept of intimacy in the American culture. As I’ve mentioned, I come from a different cultural background where this idea was much more narrowly defined. A mutual feeling of deep emotional understanding, mutual sharing of very personal experiences and connecting through such sharing were defined as closeness, not intimacy. Therefore, I am still more comfortable referring to this type of connection as closeness instead of intimacy.

          I could speak volumes about how culture influences our relationships and our beliefs about how relationships “should be”, but you have an immediate concern so I’ll try to respond to it the best I can.

          First off, you don’t have any reasons to blame yourself for making an error in assessing your relationship with your therapist. As a patient, you have never been in a position to make an accurate assessment, especially if it was your first therapy experience. The problems you had initially brought to therapy were big, the emotional suffering you were experiencing based on what you’ve described was profound and the burden of carrying all that by yourself with no support was very heavy. All that put you in a too vulnerable of a mental state to be able to make sound judgments and accurate assessments of what was going on in your therapy. It was your therapist’s responsibility to exercise sound judgments for both of you, and, if there was any confusion about the nature of your relationship with him, the entire responsibility falls squarely on him. It’s very important to remember this because people in your situation often blame themselves when they shouldn’t.

          Client and therapists aren’t equal parties and client-therapist relationship is not an egalitarian equal relationship. Therapist, by the virtue of his work, is in a much more powerful position. Client is in a much more vulnerable position. Under those conditions, a brotherly closeness cannot naturally occur because brotherhood implies equality, and if feels to you like it did take place in your relationship with your therapist, it means you were confused about the nature of the relationship from the start, and your therapist is the only one responsible for that confusion.

          Now, in terms of your therapy ending, the worst thing your therapist can do now IMHO, after he confused you and after he’s been encouraging and fostering your emotional dependency on him for quite some time, is to terminate therapy abruptly. Under current circumstances, that would constitute abandonment, which is unethical. The best thing he could do now to correct his mistakes is to take responsibility for confusing you and to apologize. Then, you and he need to decide collaboratively if he still has something of benefit to offer to you. If yes, you may continue seeing him for some time, but the relationship has to become professional as it’s supposed to be.

          I suspect though that after what has transpired going into a professional mode would be impossible, in which case, it’s your therapist’s responsibility to find you further assistance and to make sure that your transition to a new therapist is smooth and not traumatic.

          It may be helpful for you to take a break from therapy to give yourself some space and time to process all this and to get more clarity on how to proceed.

  4. Ellen

    The term “intimacy” may be problematic. But I think that once a patient has developed a bond with a therapist, it is very important that the therapy end on a positive note. If a patient feels that he was helped overall, then the sorrow of the parting may be worth it.

    In my case which was based on transference, I think that the overall experience was negative, including the parting which I initiated to the chagrin of the therapist.

    • Marina Tonkonogy

      Intimacy is definitely a confusing term. As I said in the post, everyone has their own understanding of intimacy, which largely has to do with the culture one was raised in.

      In my culture of origin this term had a much more narrow meaning than it does here, in the US. It was applied only to love relationships/encounters and was thought of as the highest degree of emotional closeness that naturally leads to foreplay and sex. In other words, “intimacy” in my culture was understood as an emotional prelude to sex.

      Therefore, even though I know that Americans understand intimacy more broadly, when someone tells me about intimacy with a therapist or intimate moments with friends, it makes me cringe. Instinctively, I still see intimacy as something belonging only to one specific type of human relationships and only to specific situations. I don’t want to say that my cultural vision of intimacy is the “right” one and all other visions or definitions are “wrong”, but I do feel much more comfortable with my cultural definition, because it is much less confusing to me.

      In regards to deep emotional connections in other types of relationships, we used the term “closeness” to describe them rather than “intimacy”. That’s why it’s natural for me to say “close friends” or “close friendship” instead of “intimate friends” and “intimate friendship”. When people use the word “intimate” when describing their interactions with anyone other than their life partner, spouse, date and such, it really rubs me the wrong way.

      So, for me personally, therapists would create more clarity and less confusion for their clients if they never use the term “intimacy” in reference to their relationships with clients. It is natural for a therapist and a client to develop a bond if they’ve seen each other for a fairly long time, but, no matter how strong the bond becomes, I don’t believe it makes their relationship “intimate” in any way. It brings them closer to each other in some respect, in the sense that they are certainly no longer strangers, but that still doesn’t warrant the use of the term “intimacy”. Not in my view. IMO, intimacy is much bigger than just an attachment to someone you have seen for a long time and for whom you’ve developed warm or even intense feelings.

      Intimacy to me entails MUTUAL openness about each other’s deepest vulnerabilities that we normally don’t let anyone else see. The key word here is “MUTUAL”. For intimacy to take place, both people have to be equally open with one another on a very personal level. Such MUTUALITY cannot take place in therapy because it would defeat the purpose of therapy. Therapy sessions are for a client, not for a therapist, to use for exploring their personal material. Therefore, personal sharing in therapy is always (hopefully) one-sided and never mutual. So, by design, intimacy between therapist and client cannot take place.

      What does take place instead is an interplay of therapist’s and client’s transferences where they both project their unconscious material onto each other. This unconscious interplay gets confused with intimacy only because some strong feelings get involved on both sides. Unfortunately, many therapists are unable to recognize the trap of the mutual unconscious dynamics, which often brings about traumatic outcomes. This is one of those classic cases where therapists can’t see how their unresolved issues stay on their way of doing decent work and how they make them professionally impaired. Since you’ve mentioned that the problems in your therapy were due to your transference, it is possible that what I described above took place in your therapy. In any case, you are not the only one whose therapist was unable to work effectively with your transference, and you are certainly not the only one who has experienced transference in therapy. Transference is nearly universal phenomena and in therapy it plays major role in vast majority of clinical cases. I don’t know if you had a chance to read my two posts about transference. If not, you might find them informative.

      • Yes , thank you . I agree with your definition of intimacy in and out of the therapeutic relationship . I am also grateful for your bringing into the discussion transference as I am sure this is also at work in a less than identifiable measure . I have come to love this guy – not in an intimate – I want to get sexual with him way ( at least not consciously ) but as a best friend – a brother who will always look out for me – someone I can trust implicitly – and someone I want to know I will always be there for in return . So here is my error – there can never be the a give and take here . I left to explore why – why have I failed in this way to create this for myself ? And if he thinks I’ve reached the conclusion of my therapy , what do I do ?

  5. Ellen

    Thank you very much for your insights which have helped me.

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