In Bed with our Clients: Should Psychotherapists Play Matchmaker or is this Plain Old Erotic Countertransference?

This piece was originally published, in slightly different form, at Psyched in San Francisco

Last January, there was an opinion piece in the New York Times, written by Richard Friedman on whether therapists should play Cupid for our clients, basically performing as a matchmaker and setting them up on dates. The article focused primarily on the fantasies that some clinicians have had about wanting to do this and the potential issues that could come up regarding transference. It did not speak directly to erotic countertransference, but I think this is a key component of such a question.

Following the article, HuffPost Live did a segment on which I was one of four guest clinicians interviewed about our points of view on the issue. As expected, the show included diverse opinions and even had one clinician, Terah Harrison, who has expanded her practice to include matchmaking services. Another clinician, Dr. Lazarus, argued passionately that we are “uniquely well positioned,” to make such matchmaking recommendations to our clients.

Jeff Sumber believed it was unethical but he admitted to having such strong fantasies about fixing up his clients that he’d deliberately scheduled people back-to-back, in hopes they might meet. (I imagine his clients are now wondering as they arrive for therapy if the person leaving is someone he has selected for them?)

Guess which role I played on this segment? Yes, I was the conservative fuddy-duddy talking about ethics, dual relationships, and risk management.

One of the problems with acting upon these fantasies and meddling with our clients’ love lives is that our clients can come to believe that we know better than they do what is good for them. And we can fall prey to such beliefs ourselves. We can think we know our clients very well, and we do come to know them deeply. But we are not psychics or mind readers. We are simply psychotherapists. We were trained to improve people’s mental health and recognize relationship patterns so that we can help our clients identify these patterns, understand their origins, figure out if the patterns work, and shift them when needed. We were not trained to assess chemistry and dating potential between two people who haven’t met, so this is beyond the boundaries of our competence.

In some ways, we already play matchmaker to our patients in appropriate ways. For example, we may refer an individual patient to a couples therapist or to a psychiatrist, which is one type of matchmaking which actually serves the treatment. But for as many times as I’ve heard that my referral was a good fit, I’ve had clients return and say, “I couldn’t stand that doctor, I hated the other one’s website, and the third never returned my calls. Can you give me some other names?”

This kind of frank feedback might be more difficult to give if the person whose name and number I’m sharing is a potential romantic partner or someone from my personal life who they know I care about. They might feel pressure to please me or think I know better than they do who they should be dating.

One of the truths we all must learn as we become experienced clinicians is that our impressions of our clients (and our colleagues as well as others in our lives) are not objective. We are forming subjective impressions of people all of the time. If we mistake these impressions for “the truth,” then we’ve fallen prey to the fantasy of our own omnipotence.

One person in Friedman’s article recalled a boss who tried to set her up with one of his patients. Later, the female subordinate realized it was the boss who had a crush on her. For me, this was the very core element to this question of whether we should be doing this. I would guess that psychotherapists who become invested in trying to introduce their patients to potential romantic partners are passively expressing erotic countertransference. This may be a way to “get into bed” with one’s clients figuratively—since it’s very clear that to actually bed a client would be completely unethical.

After all, if you are successful in romantically hooking two of your clients up, you will ultimately find yourself in two therapies listening to two different people telling slightly different stories about one another. Will the stories match up? Is one person expressing more commitment than the other? Are you pulled to protect one of them? Unless it’s pure magic between them, you have placed yourself in the middle of quite complex terrain.

If the potential dating partner is not another client of yours, but, rather, someone you know in your personal life, you may then be getting extraneous information about your client from that person, unless you draw a firm boundary and refuse to hear such stories. Either way, you still have a commitment to maintain confidentiality and objectivity in that relationship. Is that even possible?

Regardless of which scenario unfolds, this is my idea of a psychotherapy nightmare in which I would be forced to try to stay objective and keep silent about two people to whom I have different allegiances. To maintain balance here would require extremely good boundaries (likely beyond my capabilities) or it would likely warrant a referral out of treatment in the more forseeable event that I lost my ability to remain objective.

The thought of wanting to intentionally create such a complication for my practice is improbable. Yes, I want the best for my patients. This, of course, includes their romantic happiness. But part of what I hope to do is to help them feel empowered to go out and find a partner on their own. I want to help them improve and trust their own judgment and intuition in finding good partners for themselves — not to believe they should depend upon my judgement or elevate my perceptions above what they believe to be true about themselves. This is one more reason that I think that matchmaking should not be on the psychotherapy menu.

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