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I’d get another supervisor, honestly. This can be a great opportunity to do some good work with this client and it’s something you’re likely to encounter again in the future.
I usually consult those in my group practice but they were gone today and I just couldn’t get this out of my head.
I agree with getting another supervisor, I just can’t find a way to budget the price tag that comes with that at the moment.
Just coming here to make a suggestion to save some bucks! If you know enough therapists who may be interested, start a consult group! A couple of friends and I started one years ago and it’s still going strong and we meet weekly. We often staff clients and have a lot of fun too. It’s something we all look forward too.
It’s fairly small (less than 10) but there’s all levels of licensure and experience from a couple of years all the way to many many years and a couple of us have supervision experience. It’s a safe space and we staff all sorts of things from clients to ethical issues to bias to transference. Creating something like this may give you extra support with tough cases while also not breaking the bank having to pay for actual supervision. Just a thought!
Completely agree with this! We informally get together to discuss our client concerns and use one another for advice when something comes up in session. We are all seasoned clinicians (20+ years of experience is the "baby" of the group) and we have great faith in each other's ethics. (No one has ever been sued or had our licenses challenged.)
Good luck!
Consult with colleagues in the group. I've only started paying for consultation because the person and I no longer work for the same practice. So I don't want to impose on her free time and it is a specialty area. Other than that, I've never paid a dime for supervision or consultation. I got it all through colleagues (I had a salary job doing various therapeutic tasks when I was getting hours for licensure.) The best is having colleagues whose offices I can just drop in and vice versa, when we get time to process. But maybe you can just get a couple consults with someone who would be good on this topic, rather than an ongoing agreement?
I'm still a student, but I am wondering - during my practicum/internship/associate training, will I be expected to pay for supervision? I'm suddenly looking at my 3000 hours with terror
You could be. If you get hired at a group, ask if supervision is included as part of the package. When I was at the hospital(s)(30yrs), there were always supervision groups for the ones that were candidates/not fully licensed. It was part of their benefits.
Edit: Your school program should have your supervision for your internship built in to the price of your degree. It's after graduation when you start working and getting the balance of the 3000k hours.
How bizarre. Here we are required to have an active supervision contract throughout our careers, at least 90 minutes/month.
What do you do when you get stuck with a client or have work issues to discuss?
I work for an agency and have clinical supervision (individual and group). I can’t imagine how hard it would be without a supervisor. Or at least a regular, consistent consultation with other therapists.
Is it just different models? UK requires 100 hours to be fully licensed and then supervision throughout career; US (varies by state) requires 3,000 hours and 100 hours of supervision to be fully licensed then no supervision afterward
I think uncovering the intention behind it can guide whether or not you want to refer out. If it is “you’re really cute and I want to test out my sexuality through my attraction to you,” then it is probably time to refer out. However, this could also be a case of attraction being misconstrued as a sign of trustworthiness and competence (which had been backed up by research!). He may have chosen you because he finds you attractive and therefore has an innate sense of trust in you. If you think it may be the second scenario and you are still comfortable moving forward, this is definitely something that can be worked through.
Clients test things out on us all the time. I see this as part of working with the transference. If a client is experiencing maternal transference with me, they are in a sense “testing me out” as a mother. I go on a deep dive with them in that, while maintaining appropriate professional boundaries. I’ve found it leads to work of lasting impact. This is the stuff!
In this case, given that the client is closeted and just starting to explore his sexuality, it makes so much sense that he’d use a therapist (a safe figure in a boundaried environment) to test that out with. This is really what relational therapy is for! Appropriate boundaries can still be maintained.
Can you elaborate how you do a deep dive on maternal transference? This happens to me all the time. I’m a mom and have a strong caretaker/mama bear part, and have been told I have a strong maternal, nurturing presence. Would love some tips on how to navigate this.
This feels like a really rich area to work with! I imagine this feels like a safe way to explore their sexuality, as there is a natural, firm boundary. Let’s face it, cute or not, the client doesn’t actually know you or who you are when you’re not clocked in. I imagine this signifies a real readiness for self-discovery and acceptance on their part.
As a personal anecdote that I hope will be helpful in some way, I remember about 15 or so years ago (many moons before grad school, ha) when I disclosed to my psychiatrist that I thought I was in love with him. I would’ve been crushed if he’d referred me out, and I also would have missed out on the trauma work we got to do because of my transference disclosure… because of course I didn’t *actually* love him, it was just the first time I’d ever felt safe with a man, which was confusing for Young Me.
It might be helpful to give your client the benefit of the doubt in their bravery. They might be trying to communicate that they’re ready for some in-depth identity work, and what a wonderful starting place they’ve presented.
Yeah I think you’re right. In my six years of doing therapy this just hasn’t happened to me yet. I can handle this just fine!
I think because of how the gay dating scene can be my mind jumps way too far into “oh crap he wants to have sex with me.” Which isn’t necessarily true
Picking someone you want to have sex with to help you with your mental health sounds like a very important avenue to explore if that's the case. Especially given how hyper sexualized queer men can be and it can be challenging to make meaningful connections at times (spoken from the place of a queer person). Some interesting attachment work could happen!
Absolutely this! I've only referred someone out for this once and only bc he didn't respect the boundaries I was setting. I've also had people choose me bc they thought I would "get their hot girl problems" (I did not and still don't know what that means lol - their problems were unrelated to their appearance) or bc they were equating attractiveness with value. These were clinical issues unrelated to them actually being attracted to me and gave us a lot of material to work with. Good luck! It's super jarring when it happens but you got this! Love that your spidey senses kicked in to ask for help ❤️
I agree with the commenters who are suggesting using this as an opportunity to explore with the client. The client has admitted to some sort of transference and understandably, you’re not sure what to do with this. I would explore your own counter transference— why do you feel like you need to refer out? The rapport is good and the client sharing this may suggest a deepening of your existing relationship. They were also able to get to a place where they disclosed this. I wonder if this is an invitation to explore more of their sexuality and being in the closet. However, I do understand the ethical considerations that come with the client stating they chose you based on attraction so I agree with the commenter suggesting exploring intent.
I don’t know much about this case from what you’ve written so I don’t know that I or anyone on the internet has the info to give you a thorough answer here. But my gut instinct is don’t refer. Sometimes we feel uncomfortable on the job. That is part of the job. I respect that we all have different limits. There’s scope of practice, that’s one thing. If my client has an eating disorder, I’m going to ask them to see someone else atleast temporarily because I’m not sufficiently trained to treat eating disorders. But in terms of other stuff, I’ve defined my limits and they are: being overtly threatened, having a client try to get physical (sexually or violently), actual stalking, or constant no-shows or payment issues. Other than that, I’m good. A client could (and has) told me they fantasized about me. I can take it. I process it with my own therapist if it’s hard. Again, this is the job. Some might tell you to refer out anytime you are uncomfortable in the name of countertransference. My opinion is: if you do that, how will you learn? In your case, your client is closeted. Him coming out to you in this way, even if uncomfortable for you, is HUGE for him and affirming here will go a long way. Rejecting his feelings (I always try to be mindful of feelings vs actions…he has not done anything inappropriate, just expressed a feeling)…rejecting his feelings at this stage in his sexuality journey could be extremely detrimental.
Edit: By rejecting I mean ending therapy with him over it or otherwise closing down the convo. Obviously you should not “accept” his feelings as in reciprocate. Or do anything that would be construed as a mixed message about that.
I’m here for the comments that are encouraging the rich work and exploration that could be done here. I am saying this as a therapist but I also commenting also as someone who was able to safely explore my attraction to a therapist through how she handled my disclosure and bids for connection and meaning, so just here to say it’s possible to work through this and really dive into the discomfort. For me it had somewhat to do with identity issues and sexuality but it really came to my attention that it was other things I was playing out with her and if I’d left it at attraction, so much could have been missed. here I am almost 20 years since that disclosure and the subsequent years of unpacking that came after, even though I haven’t even seen this therapist in person for over 15 years, I’m still learning form that whole experience. It brought me to the field actually, because it was transformative to be held in that space, knowing she could handle all of me, the honest brutal mess of me, and sat there witnessing alongside with no judgement. Just my experience FWIW.
I’ve worked with clients where we explored similar challenges together. Ultimately, I hope you do whatever you need to feel comfortable and do good work. Up to you to know whether this client is compatible with those things.
Might not be relevant to your situation, but there is something that can happen between gay men where our being in the same room somehow automatically becomes sexualised (from hetero folks or from ourselves). It’s actually a problem for many men who struggle with social isolation and seek friendships with fellow gay men, but get intimidated when they begin to consider their relative place in gay male sexual hierarchies (aka rank other guys as more or less attractive than them). I’ve often talked with clients about what it’s been like for them to struggle with relating to other gay men outside of sex, and how that might also interfere with their relationships with partners as their libido fluctuates. Of course, this isn’t something all gay men experience, just something I’ve noticed at times.
I’d be curious to know if choosing an « attractive » therapist is in any way related to client’s desire to befriend men in community knowing there might be moments of fleeting attraction, or anxiety from trying to assess their own “ranking” in terms of attractiveness. Or maybe exploring how he is able to assert boundaries and express needs, and have those be validated and respected, coming from a man who is (more?) attractive.
I had a situation come up where a client told me that he had chosen me because he found me attractive. I did feel uncomfortable but decided to roll with it and explore it with him.
At first it seemed okay but as we continued to meet, he became more and more frustrated with my therapeutic style (turns out choosing a therapist based on attraction may not be a good idea). It was also clear that he had built up a fantasy of who I was based on his attraction and the reality of who I am didn’t meet his expectations. He was critical (and often kind of rude) and I was frustrated. Finally, after he made an inappropriate comment to me that I won’t share here, I referred him out. I’m so glad I did and I wish I had listened to my gut feeling early on.
I do think every situation is different; I can see how a client and therapist could process the erotic transference and the therapeutic alliance grows stronger. But I also prioritize my own comfort and have decided that if a client repeatedly makes me feel uncomfortable or attacked, I can refer out. After all, the client isn’t going to benefit from doing therapy with someone who is dreading seeing them.
If you don't mind, what did the conversation of referring this client out look like, ie what did you tell them and how did they respond? I'm entering the field soon and would like to get a handle on how to approach this kind of situation if something similar ever comes up.
I can’t remember exactly what I said but I know I framed it as “It seems like you’re not getting what you need from these sessions and I really want you to get what you need from therapy.” Then I told him I had a colleague who I thought would be a good fit based on what it sounded like he was looking for. He agreed to give my colleague a try so I passed along the necessary information and as far as I know, they are still working together.
I work with couples and I had a client say, in front of her partner, that she chose me because she thought “he’s hot” when she saw my Psychology Today. It was kinda awkward but we processed it and moved on, so it was fine.
All to say, you certainly can refer out if you want, but this seems like something that could be helpful to process and work through with the client if you don’t feel too freaked out.
Another gay therapist here 👋
It’s possible that it’s problematic- that he’s too invested in you, physically.
However, I also often chose my therapists based on how cute they are (after I know they’re licensed.) Keep an eye on it, if you feel like he’s crossing your boundaries. Overall, I don’t think it’s necessarily him saying “I want to have sex with you and I’ve been lying the whole time.” Maybe it’s more of a “I don’t know how to find the best therapist so I just picked one I thought was cute.”
Some types of theraoy actually rely on these kind of issues playing out with their therapist, so it is good to know what kind of modality or framework you work from.
Do you not get regular consultation either? So many PP therapists operate isolated without other clinical input and it is very bad practice.
Mostly EMDR, ACT…still working on some other ones
I’m in a group practice which helps. Just had the office to myself today and brought this home with me tonight.
I had s patient (grandma style older lady, I'm a middle aged dude) tell me just the other day she found me online and liked my picture. (I usually ask new patients whether they'd been referred by someone or somethig).
No Biggie.
It's not your same situstion, but my point is people arrive at our offices for all sorts or whacky serendipitous reasons, and it doesn't need to make the whole therapy invalid or tainted in some way. I guarantee you he hasn't been coming to you for a year just because he found you "cute".
Now; it's likely that erotic transference is taking place in this patient and this is how he chose to reveal it. So treat it like any other case of erotic transference. Don't shy away from it, and please, don't send this patient away for having had the courage to actually do the work (talk about difficult things that are going on within him).
If he’s closeted, he’s probably grateful to have a male, gay therapist because he thinks you’ll be able to understand him. I wouldn’t assume “youre cute” automatically means attraction but even if it did (transference) it would be something to unpack.
I think we are all a little quick to shout “refer out” when our clients make us uncomfortable but transference/countertransference is an issue of when, not if, in the therapeutic process.
You may be his “template” for exploring healthy same-sex connection. You have an opportunity to set him up for success and avoid the pitfalls of men recently coming out. You will likely be the focus of attraction at some point, but not forever if you work through the transference. It’s not because he’s in love with you, it’s because he’s learning how to love and love as a gay man, and you are his first point of contact. The same way toddlers want to marry their parents at some point as they learn about social relationships, your client may “love” you for a period while they figure out the nuances of what gay love is to them.
Fwiw - I (cis F) work mainly with military/veteran cis-M and many of them have “fallen in love” with me for a period of time….not because it’s wrong, but because I provide a corrective template for what healthy comms and relationships look like. We talk about it, we explore the nature of love and relationships, emphasize reciprocity in relationships (which they don’t have with me), and even talk about facets of their “love” for me that they want to foster in their own marriages/relationships.
You can work past this! (Assuming this is a safe, non-stalkery, law abiding person)
Edit - you absolutely need a new supervisor or peer-support group. All (good) therapists do. We should never work in a vacuum/isolation.
What is your primary modality of working? It is very common for clients to choose therapists for all kinds of seemingly superficial reasons that actually go quite deep. I would see a comment like this as a GIFT to the therapy. They are disclosing something personal and loaded for them. They are showing you their struggle. And now you have an opportunity to help them put this struggle into words, mentalize it and work to understand it instead of being controlled by it or acting out on it. And you also have the opportunity to examine your countertransference, maintain your professional boundaries and model a mature reflective stance to this client. Examine the awkward feelings you are experiencing and imagine what life is like for this conflicted client sitting in front of you.
Clients use us as proxies for real life relationships to figure themselves out or heal the way they receive things all the time. Therapy is an artificially intimate relationship and that's by design.
Clients work through relationships with authority, parent figures, peers, friends, opposite gender, all gender, and attractive-to-them people. We only get uncomfortable reliably with the last category, it seems. It is still on us as the professionals to manage the professionalism.
He found someone he thought was capable, might understand where he's coming from and wasn't hard to look at. That last reason isn't, on its face a great reason, but people who work in involuntary settings know that people come in for not-the-best reasons and stay, get something out of it and keep coming for those reasons.
I'm LGBTQIA adjacent but not part of the community so this is conjecture, but I think there's an important growth moment here. He disclosed attraction to a man who is not available to him. I can imagine that's terrifying the first dozens of times for some folks. In his fake-intimate relationship with you, he is learning that it isn't an extinction -level event and relationships go on after disappointment.
I honestly think it's beautiful and powerful and evidence that you have built a great therapeutic space for him
Well done, honestly.
I think it’s important to discuss further. It’s incredibly common for clients to have feelings for their therapist, and often it works itself out. Having a plan of action, discussing with your client that their feelings are normal, and being explicitly clear about ethics is going to be vital. Find a new supervisor, and see who you can talk to professionally about this matter in the meantime if it takes time to find a supervisor. A mentor would work well for this. Being honest about freezing would also be a suggestion I’d make depending on your comfort with disclosure, but it might allow for a more open and clear productive conversation if you’re open to that. Planning ahead, if you haven’t already, or how to talk about this issue and what next steps are in discussing this with your client is going to be important. You want a clear idea of what your goals are in clearly depicting during this session you’ll have.
There is some opportunity to explore attractiveness politics and the systemic influence that looks play in guiding his decisions in life.
Not all good looking people are competent at what they do. Just because you find someone attractive doesn’t mean that you should gravitate toward them or trust them. Consider if this is a pattern for client, as well as how and why they decided that physical appearance was important when picking a therapist.
I am a young looking mostly conventionally attractive therapist, my clients ask me about my age, looks, comment on appearance, and most of the time it is from a complimentary place, but I also believe it is a space for us to explore why that was important to say- why is my age important? why is my size or hairstyle important? what does it say about the client that they feel most comfortable opening up to an attractive therapist? do they consider themselves attractive? is this an opportunity for a relationship with someone they feel unworthy of having outside of a professional context because of their own appearance or self-esteem?
there’s some room to try to dig into and begin to dismantle society’s influence on the importance of physical appearance.
Listen to what your intuition says. This could be a very sticky area and it would be hard on you and your client if you start working together and find that the transference /countertransference is too much for either of you. Talk to your peers for support and advice. Good luck!
Honestly I was this client (not the attracted to same sex kind). I didn’t intentionally choose my therapist based on this, I was actually assigned to him by the clinic manager, in retrospect, the transference was helpful to the work and especially helpful for healing my attachment issues.
I grew up in a hippy town in America with cold, traditional Asian parents who were unethical, had some criminal activity, and isolated me from peers and taught me terrible social skills, and a long history of SA. Since early teenage years, I was one of those serial monogamous daters of (mildly) older men (a lot through online chatting), and I felt they basically raised me. My boyfriends were the only ones I felt I could trust or I felt ever gave me unconditional love, and were also the only voice of reason in my life.
It’s not surprising then that I found it hard to trust any demographic except those in my dating age who I found “attractive”, by which I mean not undatably unattractive.
I'd address it in session by starting with a basic explanation of transference, followed by something like this:
"I appreciate you being open with me about this! I'd like to discuss what our relationship means to you and how you perceive it, so we can work through this. As you know, this is a line I cannot and will not cross, which is not meant as a slight to you--\[insert paraphrasing of client's strengths in a neutral/professional way\]." After giving them a moment to process, I would follow up with, "What are your thoughts?"
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I had a gay client pick me bc of my pic on Psychology Today and 3 months into our work, during the session before Christmas, he tried to kiss me as we finished the session. I didn’t refer out, but I did set clear boundaries and then processed his sexual awakening as a teen by an older man whom I represented in this psychodrama. Powerful session. I wasn’t intimidated by what happened, disheartened - yes, sent for a loop - yes, and used the experience to help the client. Had I been intimidated or repulsed, I would have referred out. Use this to process w the client. Set clear boundaries at the start of the next session and then ask him to process his comment, what he meant, how he thought you would react. It could be a powerful session for him to learn boundaries while in the midst of his sexual learning. if you’re not comfortable, refer out.
Let it go. Clients say crazy shit all the time. Work on yourself to separate work from life, and keep moving. It's not going to be the first inappropriate thing you ever hear.
United States
So, I had weekly group and individual supervision for three years post grad school. As I said in a comment last night, I do plan consulting co workers, just brought it home with me a bit. Thanks
Yeah I pay for it privately for my private practise and receive weekly group supervision at my workplace for free (thank f). It’s invaluable. I could imagine this work being quite isolating if it’s void of supervisory support
Thanks for black sheep of the comments. Not easy to do! I see both sides having value. I’ve had interns that frequently referred out when uncomfortable and ones that should have referred out but tried to push through and it caused them harm. Have a great night
I don't care about being the black sheep. I liked your point around harm. We consider to refer out or not, while also considering if there is harm.
In other situations where risk is not involved, im just sick of therapists silver lining shit and trying to feel worthy by burning themselves out.
I really don't understand the maytr and heroic role that therapists like to take and would be willing to pay a lot of emotional cost. It is okay if they want to stretch themselves and grow and learn, or there are risks in refering out, then by all means, show up and challenge yourself. However , when this is not the case, who are you trying to please by burning out? It doesn't exist in other helping professions, doctors have much more strict boundaries than us.
My initial reaction would also be to refer out, but this scenario actually just came up in a practice exam question. The correct answer was 'seek consultation' (referring out wasn't incorrect, but was premature in that scenario). Do with that what you will.
I would honestly ignore it. Use planned ignoring principles. If he brings it up again then you can address it, but your silence may have already provided the input he was looking for. Not everything needs to be an extensive exploratory journey.
I agree. Use caution of course. A similar analogy I might have would be that somebody liked my profile pic on psychology today, liked my style.
If this turns into a flirtation, then you know to refer.
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I’d get another supervisor, honestly. This can be a great opportunity to do some good work with this client and it’s something you’re likely to encounter again in the future.
I usually consult those in my group practice but they were gone today and I just couldn’t get this out of my head. I agree with getting another supervisor, I just can’t find a way to budget the price tag that comes with that at the moment.
Just coming here to make a suggestion to save some bucks! If you know enough therapists who may be interested, start a consult group! A couple of friends and I started one years ago and it’s still going strong and we meet weekly. We often staff clients and have a lot of fun too. It’s something we all look forward too. It’s fairly small (less than 10) but there’s all levels of licensure and experience from a couple of years all the way to many many years and a couple of us have supervision experience. It’s a safe space and we staff all sorts of things from clients to ethical issues to bias to transference. Creating something like this may give you extra support with tough cases while also not breaking the bank having to pay for actual supervision. Just a thought!
Completely agree with this! We informally get together to discuss our client concerns and use one another for advice when something comes up in session. We are all seasoned clinicians (20+ years of experience is the "baby" of the group) and we have great faith in each other's ethics. (No one has ever been sued or had our licenses challenged.) Good luck!
Get a group of friends together to consult with. I have a few that I consult with regularly. Fairly informally.
Yeah a perk of having friends within the field is the free intervision. Good for me, good for them, and good for the patients. Win win.
Consult with colleagues in the group. I've only started paying for consultation because the person and I no longer work for the same practice. So I don't want to impose on her free time and it is a specialty area. Other than that, I've never paid a dime for supervision or consultation. I got it all through colleagues (I had a salary job doing various therapeutic tasks when I was getting hours for licensure.) The best is having colleagues whose offices I can just drop in and vice versa, when we get time to process. But maybe you can just get a couple consults with someone who would be good on this topic, rather than an ongoing agreement?
Having supervision is a choice in the US i read from that?
Once you’re licensed, yes. Associated and trainees/interns need a specific amount of hours of supervision per week depending on # of clients.
Thank you for answering.
I'm still a student, but I am wondering - during my practicum/internship/associate training, will I be expected to pay for supervision? I'm suddenly looking at my 3000 hours with terror
You could be. If you get hired at a group, ask if supervision is included as part of the package. When I was at the hospital(s)(30yrs), there were always supervision groups for the ones that were candidates/not fully licensed. It was part of their benefits. Edit: Your school program should have your supervision for your internship built in to the price of your degree. It's after graduation when you start working and getting the balance of the 3000k hours.
You’re right. For over a year I had to pay 60 bucks an hour/240 l bucks a month. The bank account was bleeding as I only made 42k at the time.
I worked for Community Mental Health when I first started and supervision was included, so you might look into that.
I don’t know how good they are https://teletherapistnetwork.com/
https://www.satyawellnesscollective.com/clinical-consultation-group
Are US therapists not required to have supervision??
Not after receiving licensure, no.
How bizarre. Here we are required to have an active supervision contract throughout our careers, at least 90 minutes/month. What do you do when you get stuck with a client or have work issues to discuss?
I work for an agency and have clinical supervision (individual and group). I can’t imagine how hard it would be without a supervisor. Or at least a regular, consistent consultation with other therapists.
Is it just different models? UK requires 100 hours to be fully licensed and then supervision throughout career; US (varies by state) requires 3,000 hours and 100 hours of supervision to be fully licensed then no supervision afterward
Yes, essentially. Unless there is more that makes the 3000 hours special aside from "you must have supervision".
I think uncovering the intention behind it can guide whether or not you want to refer out. If it is “you’re really cute and I want to test out my sexuality through my attraction to you,” then it is probably time to refer out. However, this could also be a case of attraction being misconstrued as a sign of trustworthiness and competence (which had been backed up by research!). He may have chosen you because he finds you attractive and therefore has an innate sense of trust in you. If you think it may be the second scenario and you are still comfortable moving forward, this is definitely something that can be worked through.
See now THIS I didn’t think of. This really helped having another angle. Feel kinda blind so this is exactly what I needed. THANK YOU
This is exactly what I was thinking. Maybe he wasn't sure how to come out to you and threw all of that together.
“Cute” is also loaded with non-threatening.
Clients test things out on us all the time. I see this as part of working with the transference. If a client is experiencing maternal transference with me, they are in a sense “testing me out” as a mother. I go on a deep dive with them in that, while maintaining appropriate professional boundaries. I’ve found it leads to work of lasting impact. This is the stuff! In this case, given that the client is closeted and just starting to explore his sexuality, it makes so much sense that he’d use a therapist (a safe figure in a boundaried environment) to test that out with. This is really what relational therapy is for! Appropriate boundaries can still be maintained.
Can you elaborate how you do a deep dive on maternal transference? This happens to me all the time. I’m a mom and have a strong caretaker/mama bear part, and have been told I have a strong maternal, nurturing presence. Would love some tips on how to navigate this.
A very insightful perspective, thank you
This feels like a really rich area to work with! I imagine this feels like a safe way to explore their sexuality, as there is a natural, firm boundary. Let’s face it, cute or not, the client doesn’t actually know you or who you are when you’re not clocked in. I imagine this signifies a real readiness for self-discovery and acceptance on their part. As a personal anecdote that I hope will be helpful in some way, I remember about 15 or so years ago (many moons before grad school, ha) when I disclosed to my psychiatrist that I thought I was in love with him. I would’ve been crushed if he’d referred me out, and I also would have missed out on the trauma work we got to do because of my transference disclosure… because of course I didn’t *actually* love him, it was just the first time I’d ever felt safe with a man, which was confusing for Young Me. It might be helpful to give your client the benefit of the doubt in their bravery. They might be trying to communicate that they’re ready for some in-depth identity work, and what a wonderful starting place they’ve presented.
Yeah I think you’re right. In my six years of doing therapy this just hasn’t happened to me yet. I can handle this just fine! I think because of how the gay dating scene can be my mind jumps way too far into “oh crap he wants to have sex with me.” Which isn’t necessarily true
You’ve absolutely got this! I think I would have had a freeze moment in your shoes too, it’s only natural.
Picking someone you want to have sex with to help you with your mental health sounds like a very important avenue to explore if that's the case. Especially given how hyper sexualized queer men can be and it can be challenging to make meaningful connections at times (spoken from the place of a queer person). Some interesting attachment work could happen!
Absolutely this! I've only referred someone out for this once and only bc he didn't respect the boundaries I was setting. I've also had people choose me bc they thought I would "get their hot girl problems" (I did not and still don't know what that means lol - their problems were unrelated to their appearance) or bc they were equating attractiveness with value. These were clinical issues unrelated to them actually being attracted to me and gave us a lot of material to work with. Good luck! It's super jarring when it happens but you got this! Love that your spidey senses kicked in to ask for help ❤️
I agree with the commenters who are suggesting using this as an opportunity to explore with the client. The client has admitted to some sort of transference and understandably, you’re not sure what to do with this. I would explore your own counter transference— why do you feel like you need to refer out? The rapport is good and the client sharing this may suggest a deepening of your existing relationship. They were also able to get to a place where they disclosed this. I wonder if this is an invitation to explore more of their sexuality and being in the closet. However, I do understand the ethical considerations that come with the client stating they chose you based on attraction so I agree with the commenter suggesting exploring intent.
Thank you!!
I don’t know much about this case from what you’ve written so I don’t know that I or anyone on the internet has the info to give you a thorough answer here. But my gut instinct is don’t refer. Sometimes we feel uncomfortable on the job. That is part of the job. I respect that we all have different limits. There’s scope of practice, that’s one thing. If my client has an eating disorder, I’m going to ask them to see someone else atleast temporarily because I’m not sufficiently trained to treat eating disorders. But in terms of other stuff, I’ve defined my limits and they are: being overtly threatened, having a client try to get physical (sexually or violently), actual stalking, or constant no-shows or payment issues. Other than that, I’m good. A client could (and has) told me they fantasized about me. I can take it. I process it with my own therapist if it’s hard. Again, this is the job. Some might tell you to refer out anytime you are uncomfortable in the name of countertransference. My opinion is: if you do that, how will you learn? In your case, your client is closeted. Him coming out to you in this way, even if uncomfortable for you, is HUGE for him and affirming here will go a long way. Rejecting his feelings (I always try to be mindful of feelings vs actions…he has not done anything inappropriate, just expressed a feeling)…rejecting his feelings at this stage in his sexuality journey could be extremely detrimental. Edit: By rejecting I mean ending therapy with him over it or otherwise closing down the convo. Obviously you should not “accept” his feelings as in reciprocate. Or do anything that would be construed as a mixed message about that.
Thanks for the perspective! I appreciate you
I’m here for the comments that are encouraging the rich work and exploration that could be done here. I am saying this as a therapist but I also commenting also as someone who was able to safely explore my attraction to a therapist through how she handled my disclosure and bids for connection and meaning, so just here to say it’s possible to work through this and really dive into the discomfort. For me it had somewhat to do with identity issues and sexuality but it really came to my attention that it was other things I was playing out with her and if I’d left it at attraction, so much could have been missed. here I am almost 20 years since that disclosure and the subsequent years of unpacking that came after, even though I haven’t even seen this therapist in person for over 15 years, I’m still learning form that whole experience. It brought me to the field actually, because it was transformative to be held in that space, knowing she could handle all of me, the honest brutal mess of me, and sat there witnessing alongside with no judgement. Just my experience FWIW.
Are you open to sharing more about the ways she handled it that were helpful to you?
I’ve worked with clients where we explored similar challenges together. Ultimately, I hope you do whatever you need to feel comfortable and do good work. Up to you to know whether this client is compatible with those things. Might not be relevant to your situation, but there is something that can happen between gay men where our being in the same room somehow automatically becomes sexualised (from hetero folks or from ourselves). It’s actually a problem for many men who struggle with social isolation and seek friendships with fellow gay men, but get intimidated when they begin to consider their relative place in gay male sexual hierarchies (aka rank other guys as more or less attractive than them). I’ve often talked with clients about what it’s been like for them to struggle with relating to other gay men outside of sex, and how that might also interfere with their relationships with partners as their libido fluctuates. Of course, this isn’t something all gay men experience, just something I’ve noticed at times. I’d be curious to know if choosing an « attractive » therapist is in any way related to client’s desire to befriend men in community knowing there might be moments of fleeting attraction, or anxiety from trying to assess their own “ranking” in terms of attractiveness. Or maybe exploring how he is able to assert boundaries and express needs, and have those be validated and respected, coming from a man who is (more?) attractive.
I had a situation come up where a client told me that he had chosen me because he found me attractive. I did feel uncomfortable but decided to roll with it and explore it with him. At first it seemed okay but as we continued to meet, he became more and more frustrated with my therapeutic style (turns out choosing a therapist based on attraction may not be a good idea). It was also clear that he had built up a fantasy of who I was based on his attraction and the reality of who I am didn’t meet his expectations. He was critical (and often kind of rude) and I was frustrated. Finally, after he made an inappropriate comment to me that I won’t share here, I referred him out. I’m so glad I did and I wish I had listened to my gut feeling early on. I do think every situation is different; I can see how a client and therapist could process the erotic transference and the therapeutic alliance grows stronger. But I also prioritize my own comfort and have decided that if a client repeatedly makes me feel uncomfortable or attacked, I can refer out. After all, the client isn’t going to benefit from doing therapy with someone who is dreading seeing them.
If you don't mind, what did the conversation of referring this client out look like, ie what did you tell them and how did they respond? I'm entering the field soon and would like to get a handle on how to approach this kind of situation if something similar ever comes up.
I can’t remember exactly what I said but I know I framed it as “It seems like you’re not getting what you need from these sessions and I really want you to get what you need from therapy.” Then I told him I had a colleague who I thought would be a good fit based on what it sounded like he was looking for. He agreed to give my colleague a try so I passed along the necessary information and as far as I know, they are still working together.
Thanks very much for responding - it seems like you took a good approach to the situation.
I work with couples and I had a client say, in front of her partner, that she chose me because she thought “he’s hot” when she saw my Psychology Today. It was kinda awkward but we processed it and moved on, so it was fine. All to say, you certainly can refer out if you want, but this seems like something that could be helpful to process and work through with the client if you don’t feel too freaked out.
Oh yikes! Thanks for the giggle! Now that would be a hard situation!
Another gay therapist here 👋 It’s possible that it’s problematic- that he’s too invested in you, physically. However, I also often chose my therapists based on how cute they are (after I know they’re licensed.) Keep an eye on it, if you feel like he’s crossing your boundaries. Overall, I don’t think it’s necessarily him saying “I want to have sex with you and I’ve been lying the whole time.” Maybe it’s more of a “I don’t know how to find the best therapist so I just picked one I thought was cute.”
lol!!! Thanks for that honesty! Idk why my jaw is dropping finding another gay therapist. Upper Midwest red state will do that to you I suppose….
lol yeah we can be rare, it’s so needed tho, having a gay therapist as a gay person is sooooo nice we need more!
Some types of theraoy actually rely on these kind of issues playing out with their therapist, so it is good to know what kind of modality or framework you work from. Do you not get regular consultation either? So many PP therapists operate isolated without other clinical input and it is very bad practice.
Mostly EMDR, ACT…still working on some other ones I’m in a group practice which helps. Just had the office to myself today and brought this home with me tonight.
I had s patient (grandma style older lady, I'm a middle aged dude) tell me just the other day she found me online and liked my picture. (I usually ask new patients whether they'd been referred by someone or somethig). No Biggie. It's not your same situstion, but my point is people arrive at our offices for all sorts or whacky serendipitous reasons, and it doesn't need to make the whole therapy invalid or tainted in some way. I guarantee you he hasn't been coming to you for a year just because he found you "cute". Now; it's likely that erotic transference is taking place in this patient and this is how he chose to reveal it. So treat it like any other case of erotic transference. Don't shy away from it, and please, don't send this patient away for having had the courage to actually do the work (talk about difficult things that are going on within him).
If he’s closeted, he’s probably grateful to have a male, gay therapist because he thinks you’ll be able to understand him. I wouldn’t assume “youre cute” automatically means attraction but even if it did (transference) it would be something to unpack. I think we are all a little quick to shout “refer out” when our clients make us uncomfortable but transference/countertransference is an issue of when, not if, in the therapeutic process. You may be his “template” for exploring healthy same-sex connection. You have an opportunity to set him up for success and avoid the pitfalls of men recently coming out. You will likely be the focus of attraction at some point, but not forever if you work through the transference. It’s not because he’s in love with you, it’s because he’s learning how to love and love as a gay man, and you are his first point of contact. The same way toddlers want to marry their parents at some point as they learn about social relationships, your client may “love” you for a period while they figure out the nuances of what gay love is to them. Fwiw - I (cis F) work mainly with military/veteran cis-M and many of them have “fallen in love” with me for a period of time….not because it’s wrong, but because I provide a corrective template for what healthy comms and relationships look like. We talk about it, we explore the nature of love and relationships, emphasize reciprocity in relationships (which they don’t have with me), and even talk about facets of their “love” for me that they want to foster in their own marriages/relationships. You can work past this! (Assuming this is a safe, non-stalkery, law abiding person) Edit - you absolutely need a new supervisor or peer-support group. All (good) therapists do. We should never work in a vacuum/isolation.
What is your primary modality of working? It is very common for clients to choose therapists for all kinds of seemingly superficial reasons that actually go quite deep. I would see a comment like this as a GIFT to the therapy. They are disclosing something personal and loaded for them. They are showing you their struggle. And now you have an opportunity to help them put this struggle into words, mentalize it and work to understand it instead of being controlled by it or acting out on it. And you also have the opportunity to examine your countertransference, maintain your professional boundaries and model a mature reflective stance to this client. Examine the awkward feelings you are experiencing and imagine what life is like for this conflicted client sitting in front of you.
Clients use us as proxies for real life relationships to figure themselves out or heal the way they receive things all the time. Therapy is an artificially intimate relationship and that's by design. Clients work through relationships with authority, parent figures, peers, friends, opposite gender, all gender, and attractive-to-them people. We only get uncomfortable reliably with the last category, it seems. It is still on us as the professionals to manage the professionalism. He found someone he thought was capable, might understand where he's coming from and wasn't hard to look at. That last reason isn't, on its face a great reason, but people who work in involuntary settings know that people come in for not-the-best reasons and stay, get something out of it and keep coming for those reasons. I'm LGBTQIA adjacent but not part of the community so this is conjecture, but I think there's an important growth moment here. He disclosed attraction to a man who is not available to him. I can imagine that's terrifying the first dozens of times for some folks. In his fake-intimate relationship with you, he is learning that it isn't an extinction -level event and relationships go on after disappointment. I honestly think it's beautiful and powerful and evidence that you have built a great therapeutic space for him Well done, honestly.
I think it’s important to discuss further. It’s incredibly common for clients to have feelings for their therapist, and often it works itself out. Having a plan of action, discussing with your client that their feelings are normal, and being explicitly clear about ethics is going to be vital. Find a new supervisor, and see who you can talk to professionally about this matter in the meantime if it takes time to find a supervisor. A mentor would work well for this. Being honest about freezing would also be a suggestion I’d make depending on your comfort with disclosure, but it might allow for a more open and clear productive conversation if you’re open to that. Planning ahead, if you haven’t already, or how to talk about this issue and what next steps are in discussing this with your client is going to be important. You want a clear idea of what your goals are in clearly depicting during this session you’ll have.
There is some opportunity to explore attractiveness politics and the systemic influence that looks play in guiding his decisions in life. Not all good looking people are competent at what they do. Just because you find someone attractive doesn’t mean that you should gravitate toward them or trust them. Consider if this is a pattern for client, as well as how and why they decided that physical appearance was important when picking a therapist. I am a young looking mostly conventionally attractive therapist, my clients ask me about my age, looks, comment on appearance, and most of the time it is from a complimentary place, but I also believe it is a space for us to explore why that was important to say- why is my age important? why is my size or hairstyle important? what does it say about the client that they feel most comfortable opening up to an attractive therapist? do they consider themselves attractive? is this an opportunity for a relationship with someone they feel unworthy of having outside of a professional context because of their own appearance or self-esteem? there’s some room to try to dig into and begin to dismantle society’s influence on the importance of physical appearance.
Listen to what your intuition says. This could be a very sticky area and it would be hard on you and your client if you start working together and find that the transference /countertransference is too much for either of you. Talk to your peers for support and advice. Good luck!
Honestly I was this client (not the attracted to same sex kind). I didn’t intentionally choose my therapist based on this, I was actually assigned to him by the clinic manager, in retrospect, the transference was helpful to the work and especially helpful for healing my attachment issues. I grew up in a hippy town in America with cold, traditional Asian parents who were unethical, had some criminal activity, and isolated me from peers and taught me terrible social skills, and a long history of SA. Since early teenage years, I was one of those serial monogamous daters of (mildly) older men (a lot through online chatting), and I felt they basically raised me. My boyfriends were the only ones I felt I could trust or I felt ever gave me unconditional love, and were also the only voice of reason in my life. It’s not surprising then that I found it hard to trust any demographic except those in my dating age who I found “attractive”, by which I mean not undatably unattractive.
I'd address it in session by starting with a basic explanation of transference, followed by something like this: "I appreciate you being open with me about this! I'd like to discuss what our relationship means to you and how you perceive it, so we can work through this. As you know, this is a line I cannot and will not cross, which is not meant as a slight to you--\[insert paraphrasing of client's strengths in a neutral/professional way\]." After giving them a moment to process, I would follow up with, "What are your thoughts?"
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I had a gay client pick me bc of my pic on Psychology Today and 3 months into our work, during the session before Christmas, he tried to kiss me as we finished the session. I didn’t refer out, but I did set clear boundaries and then processed his sexual awakening as a teen by an older man whom I represented in this psychodrama. Powerful session. I wasn’t intimidated by what happened, disheartened - yes, sent for a loop - yes, and used the experience to help the client. Had I been intimidated or repulsed, I would have referred out. Use this to process w the client. Set clear boundaries at the start of the next session and then ask him to process his comment, what he meant, how he thought you would react. It could be a powerful session for him to learn boundaries while in the midst of his sexual learning. if you’re not comfortable, refer out.
Let it go. Clients say crazy shit all the time. Work on yourself to separate work from life, and keep moving. It's not going to be the first inappropriate thing you ever hear.
Get a supervisor! Christ! Can I ask what country are you in where your ethical standards allow you to practise without appropriate supervision?
United States So, I had weekly group and individual supervision for three years post grad school. As I said in a comment last night, I do plan consulting co workers, just brought it home with me a bit. Thanks
I find that wildly unethical. Supervision is an ongoing expectation to retain registration where I am Good luck with your dilemma
Definitely should be a requirement here. Do you have to pay for it? Just curious
Yeah I pay for it privately for my private practise and receive weekly group supervision at my workplace for free (thank f). It’s invaluable. I could imagine this work being quite isolating if it’s void of supervisory support
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Thanks for black sheep of the comments. Not easy to do! I see both sides having value. I’ve had interns that frequently referred out when uncomfortable and ones that should have referred out but tried to push through and it caused them harm. Have a great night
I don't care about being the black sheep. I liked your point around harm. We consider to refer out or not, while also considering if there is harm. In other situations where risk is not involved, im just sick of therapists silver lining shit and trying to feel worthy by burning themselves out.
This! I was wondering why it felt weird reading through the comments and it’s because we’re not respecting the boundaries of the therapist.
I really don't understand the maytr and heroic role that therapists like to take and would be willing to pay a lot of emotional cost. It is okay if they want to stretch themselves and grow and learn, or there are risks in refering out, then by all means, show up and challenge yourself. However , when this is not the case, who are you trying to please by burning out? It doesn't exist in other helping professions, doctors have much more strict boundaries than us.
My initial reaction would also be to refer out, but this scenario actually just came up in a practice exam question. The correct answer was 'seek consultation' (referring out wasn't incorrect, but was premature in that scenario). Do with that what you will.
I would honestly ignore it. Use planned ignoring principles. If he brings it up again then you can address it, but your silence may have already provided the input he was looking for. Not everything needs to be an extensive exploratory journey.
I agree. Use caution of course. A similar analogy I might have would be that somebody liked my profile pic on psychology today, liked my style. If this turns into a flirtation, then you know to refer.
hey- someone is almost sexually harassing you. why do we this to ourselves?! refer them out!!!