Sigmund Freud once wrote that when it comes to psychotherapy, "It will never be possible to avoid little laboratory explosions."
The founder of psychoanalysis wasn't referring to the risk of accident with a bunsen burner, but the possibility of sexual chemistry between a therapist and their patients. Although it's not known whether Freud himself ever actually crossed this professional boundary, other eminent psychoanalysts like Carl Jung and Otto Rank are thought to have had sexual relationships with their female clients.
Most of us, regulatory bodies included, now recognise this as a serious faux pas—one that can leave therapists at risk of losing their license or even a prison sentence. But that isn't to say strong attraction never arises in the therapy room. It's widely known and accepted that people crush on their therapists, and the feeling can on occasion be mutual.
As for the number of therapists who have had sexual contact with a patient or patients during their career, studies vary wildly. Some literature points to figures as low as the 0.2 percent mark, while others indicate higher numbers. In 1997, clinical psychologist Susan Baur conducted an anonymous survey of 5,000 mental health professionals and found that 95 percent of therapists reported having sexual fantasies about their patients. Of course, that doesn't mean any of the respondents had ever acted on their attraction.
If you were to go to your therapist today and declare your undying love, they would most likely tell you that what you are feeling is "transference." The term refers to the process through which a patient transfers pre-existing emotional experiences and needs onto their therapist. It's thought this phenomenon occurs because past feelings, memories, and sensations—particularly those from early childhood—rise to the surface when you're in a therapist's office.
This, according to experts, can result in a strong connection to the therapist and sometimes dredge up intense feelings like anger, jealousy, and love. The crux is that the feelings are sparked by the therapist's professional persona, not their real life personality.
When this happens in reverse—that is, when the therapist has an emotional reaction to what the patient shares during therapy—it is known as "countertransference." This can manifest itself as maternal, paternal or, as demonstrated in Baur's study, sexual feelings.
Dr David Mann is a UK-based psychotherapist with over 30 years of clinical experience, and the author of several books on erotic transference and countertransference. "From my experience, falling in love with a therapist or falling in love with a patient is almost inevitable," he tells VICE. "Therapists have their own sexuality like everybody else, and they bring it with them into the analytic setting."
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"These patients end up with the same emotional problems you see in incest victims," Dr Nanette Gartrell, a psychiatrist at the University of California told the New York Times in response to a panel conducted by the American Psychological Association which addressed the issue. "They have trouble trusting anyone, they're frightened of being taken advantage of in intimate relationships, and they are severely depressed."
The Australian Psychological Society's code of ethics states that psychologists cannot have sex with a patient for at least two years after the professional relationship has ended. Even then, it has to be discussed with a senior psychologist, and the patient is advised to have independent counselling.
The Australian Medical Board's official position is that: "A breach of sexual boundaries is unethical and unprofessional because it exploits the doctor-patient relationship, undermines the trust that patients (and the community) have in their doctors and may cause profound psychological harm to patients and compromise their medical care."
Even when actual physical contact doesn't occur, it can still be deeply unsettling for someone to hold unresolved feelings for their therapist. "My therapist dumped me," says one commenter on mental health network Psyche Central. "I am heartbroken, she couldn't see me anymore because she doesn't think she has the skills to help me. I feel like I have nothing to live for anymore. My whole world revolved around her."
Another Psyche Central post reads: "My therapist said he couldn't treat me because I need a higher level of care than he can provide. I wrote him and asked him if it was permanent or was there a possibility of me getting to see him in the future, but he never answered…
"I think I've lost him forever and I'm so heartbroken that I ruined things with him."
Sexual attraction and strong attachment during therapy is clearly an occupational hazard, but does that mean a therapist should just walk away from temptation, or abandon therapy if a client becomes too attached to them? "I've definitely known therapists to terminate therapy because of it," says Dr Mann, who in his book Psychotherapy: An Erotic Relationship also talks about what he sees as the unwillingness of many in the profession to engage with the possibility of erotic feelings towards a client.
"In my opinion, the hasty denial or repression of erotic desires is more likely to have a detrimental effect," Dr Mann says. "It's helpful for the patient to express their desires to their therapist in an upfront way, so that they can work through them together. It's also important that the therapist understands that it's okay to be aroused, or attracted to, or in love with their client."
By inviting these feelings of transference and countertransference into the session, Dr Mann personally believes that both therapist and patient are able to have more productive and revelationary therapy. "Obviously the burden is on the therapist to look at and question these feelings, but never act on them," he adds. "That would be highly unethical and an abuse of the therapist's position."
Dr Samantha Carbon is a psychotherapist in London. "I'm not immune to erotic transference, and I'm very much aware of the mother-and-child development, and how that might be manifesting in the relationship with my client," she says. "That's not to say that beyond that there isn't an erotic transference, but I think that [for female therapists] it's often also linked to that maternal relationship; there's that real maternal bond happening in the room."
Ultimately, the aim of psychotherapy is to use talking to release repressed emotions and experiences, and to make the unconscious conscious. It is only through having a cathartic experience that a person can be helped or "cured." Transference, Dr Mann says, can be key to this. "I had one patient who was sexually abused from a young age. Her sense of self was so warped that she couldn't see herself as being worthy of anything other than serving the needs of men."
When she tried and failed to instigate sex with him, she felt rejected. "But it was very necessary that someone, somewhere, held the boundary," Dr Mann continues. "What had happened to her was unacceptable; she might have felt that was all that she was worth, but she needed to be respected and she needed my restraint."
Once the transference has been addressed in the therapy room, "the patient can come to terms with what they are projecting onto me, and the reality that I am not the person they have turned me into."
"I have to be aware that whatever the client sees in me is very much a representation of their inner world," Dr Carbon says. "It's such a unique and intimate situation and there's going to be some powerful transference, not only from the client but from the therapist. As a therapist, you need to be able to feel comfortable working in a space where attraction exists."
As for patients, Dr Mann says feeling as if your therapist is the perfect, caring partner you always wanted is normal. But at the end of the day your therapist only human. "All we're doing in therapy is essentially trying to work with this feeling of intimacy and understand it, so that the patient doesn't have to keep on reliving the past," he continues.
"Then they can eventually take me as I am. I'm a much nicer person when I have my therapist hat on. But really, I'm just an ordinary sort of guy."
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