Help! I have obessive thoughts about my therapist! Or– What is transference?



Recently, I received an email from a reader asking for some help. He knew his cognitive behavioral treatment (CBT) which had gone well for several years, hit a snag. He felt his hidden obsessive thoughts about his therapist were getting in the way of the treatment's progress. He asked me if there were any CBT techniques to help him get past this road block. He said,  "…this obsession really
is quite disturbing to me. I feel that it is not fair [to] the therapist
who is not seeing me make any progress. Any advice would be more than
appreciated."

Here, edited a bit, is my response…


What you describe is not uncommon in many forms of psychotherapy, so please do not think poorly of yourself for it. We call it transference.

Transference in psychotherapy is defined as an unconscious process
where the attitudes, feelings, and desires of our early
significant relationships get transferred onto the therapist.

As your relationship with your therapist deepens,
the situation triggers familiar feelings related to previous
connections with others, like to your parents, for example. You begin to experience the therapist, in the
present, in much the same way you had experienced a significant person from your past. Sigmund Freud, the great grand-daddy of all therapists, was the first to observe this process.

You do not say what form the obsessive thoughts you have about your
therapist take, but regardless of whether they are positive or
negative, sexual or parental, taking a look at these thoughts can be an important part of
your therapeutic process. In other words, instead of giving you some
specific CBT exercises to 'get rid of them' I would strongly (and
gently) suggest you talk with your therapist about them
directly.


I know… this is very hard; I hope I am not asking too much. From what
you write you have a reasonably good working relationship with your
therapist. You have worked together for years, only now you are
both feeling 'stuck'. It could very well be these transference feelings
are blocking your progress, as you suggest. As therapists we are
trained to help our clients process transference thoughts and feelings in a
way that is helpful to you, for your emotional growth.

Since you ask for a CBT technique I will share one that I often use for clients who are faced with doing something they dread. It's called
'Biking up the Hill'.

Imagine you are at the bottom of a big hill and you want
to get to the other side, only there is something very scary at the top
of the hill (in this case opening up to your therapist about your
obsessive thoughts). You work hard biking up the hill but the closer
you get to the top where the scary thing is, the more anxious you
become. This is a very human feeling; many times we get so anxious we
give up, and go back down the hill the same way we came up.


In CBT we recognize that retreating WORKS! Unfortunately, we are less
anxious when we turn back, which just reinforces our avoidance. The
problem is we still want to get to the other side, so we become
frustrated (stuck). Visualize a good outcome when you open up to your therapist. It takes some practice but by repeatedly telling
ourselves the anxiety will go down (AND STAY DOWN) if we would only get to the top, through the scary thing, then we can coast over to the other side. Only then are we truly free of the anxiety!

It is annoyingly true that the anticipatory fear we experience (imagining telling your therapist about your thoughts) is much
greater
than how we actually feel after doing the dreaded thing (opening up to your therapist) and afterward (leaving the office with relief). This has happened to
me SO many times, in all kinds of situations, and each time I'm amazed at
how true this is.

I wish you the very best,


Dr. Aletta

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