And so we sit together, my client and I. He is weeping, deep sobs making his large body quake. Tears over a woman who could not return his love. I sit with him, holding his despair. My eyes also feel wet and sad, but I notice other feelings within myself. First there is anger – who is this idiot woman who doesn’t realize what a sweet, kind, partner he could be to her? And the other feeling – the urge to come over to the couch, put my hand on his or rest it on his back. The desire to touch. Maternal feelings. Protective feelings. Nothing I would act on, but something I would observe in myself with him and other clients from time to time. A kind of feeling that reminds me that despite the intimate connections we create in our work, there are also barriers we do not cross.
When I was in graduate school studying to become a psychologist, we were encouraged to explore our counter-transference. We were told it was common to sometimes have strong feelings for our clients. We might feel anger, rage, sexual longing, disgust. I was warned about sexual attraction. I was warned about daydreams and fantasies about clients. But nobody prepared me for the love. Nobody adequately prepared me for the sense of closeness and care that I experience when sitting with a patient.
It didn’t bloom during the early stages of my career. Since I was usually limited to brief therapy in a college counseling center (6 – 8 sessions), there wasn’t much opportunity to develop such deep connections. I was too busy patching people up and referring them to other mental health professionals who would be the ones to hold their hands and walk a longer, deeper path with them.
College counseling may have been my first dream. But after eight years, it lost its luster. I wanted to see people past the crises they were having and to go deeper with them. So I found an office and started accepting private practice referrals.
It took a couple of years for me to begin to notice that clients who I met with for a couple of months were people I felt I barely knew. At my former job, these were the people I was seeing “long-term.” Now, meeting with someone for eight sessions felt like the tiniest tip of the iceberg.
Not every client becomes a longer-term patient, and not every client is looking to do that kind of work. But to deny the intimacy that we experience as mental health professionals is to miss something essential. There is nothing more lovely than looking at my appointment book for the week and seeing a list of the names of people I’ve come to care for deeply. I had no idea how deeply I would be moved by my work.
I don’t tell clients I love them. As a psychologist who is very much aware of licensing board complaints, risk management and transference concerns prevent me from saying much more than “I care about you and your well-being.”
But sometimes I get teary in a session watching a couple interact together in a way that seemed impossible when they first came to me. My heart explodes with joy. Sometimes, I witness a success with someone who has been in pain for a long time and my heart wants to dance around the room. Or I feel outrage when someone hurts a client who is dear to me. But I never feel like I can reveal my heart and show clients where they map inside it: how much some of them come to mean, how much I believe in them or hurt for them or adore them. It would make things weird.
These feelings are not romantic or sexual. They are deep affection for who a person is, compassion, belief in them, a sense that when they hurt, I hurt for them. The knowledge that their successes make me proud like a parent (I don’t necessarily mean the successes that come from our work).
I have tried to discuss this with other clinicians, and I have been met with a variety of responses. A few people are willing to admit they feel similar things. But our risk management sensors, and clinical judgment has kept us from making the care we feel so explicit. Cards to our vests, we are cautious in the words we use. But at the same time, the feelings seem important, and I wish we were not so confined to not express the very thing that could be extremely healing to some people.
So we love them in silence.
There are those who deny that love can exist within a relationship with financial implications. This stuns me. The idea that someone paying (or receiving) money from another would preclude the development of “true feelings” seems limited to me. I’ve seen and heard of many examples involving the exchange of money or “work” in which loving feelings have developed: nursing, sex work, massage therapy, childcare, teachers, physical therapy, spiritual counseling, traditional and arranged marriages…these are just the situations that immediately come to mind. It makes no sense to me to suggest that the exchange of money puts a cap on one’s emotional experience or connection. But perhaps the belief that it does serves as self-protection for some? Perhaps the worry about abusive relationships, which certainly can and do develop, makes it easier to say that this is all fantasy and projection. But I don’t buy it.
Some have admitted they told long-term patients who were dying or dealing with end of life issues that they loved them. It intrigues me that only in the face of death will some clinicians feel free to say the unspeakable. Is this a good or a bad thing? Is it because there is a looming time cap on the relationship and reduced fear of a board complaint?
Others tell me they don’t feel this love at all. Or they insist that loving feelings must be romantic or sexual. For these people, I feel sad. I know what my romantic and sexual feelings are like. They are accompanied by attraction, fantasy, longing, desire for more, thinking about someone in a craving sort of way. This isn’t what I’m talking about. To put a finer point on it, there is nothing unrequited about this love. It just looms quietly in the shadows, ironically unspoken in rooms otherwise punctuated with the most taboo words and stories.
I wonder if those who insist this is sex or romance have ever really experienced love in a more pure form? It worries me to think that people who don’t have access to such feelings are doing this work.
The times I’ve felt most aware of the love has usually been when a client is hurt, feeling shame, wanting to disown an aspect of self, struggling with self-love, and I wish I could loan mine out. Instead I try to beam the love to them through my face, my eyes, while I use words to remind them they are human and working hard on very difficult things and that I care deeply about them in this work and respect how they are showing up and being vulnerable.
But it’s interesting because I think in this one way, I am my least authentic self with clients. When I feel love, I circumvent it or find another way to convey it because it is too dangerous to speak. I regret that at times.
Here is another thing. I learned long ago that the aspects of psychotherapy that make the most significant impact on treatment aren’t the style of therapy or theoretical orientation, length of treatment, or number of years of experience the therapist has. The things that are connected to better outcomes are empathy and our ability to create an emotional connection with a client. Since I learned that, I have considered it a matter of both ethics and clinical efficacy to not take on a client unless I believe at the start that I can come to care for them deeply and make an emotional connection. It is one of my principles.
I have never told a client I love them. These words are too easily misinterpreted. Even the term “therapist love,” which is cute and tries to put a frame around it feels cheap and minimizing. I understand that a one-sided weekly therapy relationship over the years or even multiple-sessions-a-week therapy for decades, isn’t the same as a friendship, romance, or a family relationship. I understand it isn’t the same love that would develop if this were a reciprocal relationship. But I’m not going to let people tell me what is and isn’t real in my heart. And I’ll be damned if I’ll let people tell me that what I experience as love isn’t really love. Even if it goes unnamed and must exist in the air and the spaces between the words we actually speak. I’ll just have to hope that my clients can feel it and hear it in the spaces in between, behind the ticking of the clock and the hum of the white noise machine.