To Tell or Not to Tell: Dealing with Sexual Fantasies in Therapy

The therapeutic relationship is one that is quite unique. In fact, it is one that is probably unlike any other. For some people, the process of therapy can be quite intimate. The therapeutic relationship is one in which a lot of personal details are shared. Patients trust their therapists to listen, understand what they’re going through and challenge them to do things differently while also offering hope and support. This kind of intense self-disclosure and trust are two of the components that comprise emotional intimacy, so it is completely understandable when patients end up feeling close to their therapist. Sometimes that feeling can lead to sexual fantasies about the therapist which I believe is a symbolic representation of that closeness.

When this happens, many patients wonder if they should confide this fantasy to their therapist. My answer to this question is, “It depends.” While good therapists should be able to handle the disclosure of a sexual fantasy that involves them, sometimes they cannot get past the awkwardness. As such, patients need to ask themselves what outcomes they hope to achieve by telling. If the dream is interfering with how they interact with their therapist in therapy, then they need to talk about the fantasy so that they can work through it together.

If, however, patients want to tell their therapist in the hope that they will share their attraction and begin a romantic relationship with them, then I recommend that they keep silent about the fantasy. Therapy only works when the therapist remains objective. That is one reason why mental health codes of ethics all forbid dual relationships (e.g., sexual relationships, friendships, business partnerships). Therapists cannot do their job effectively if they have a personal relationship with their patients.

Thus, if patients truly value their therapist’s assistance in accomplishing the goals they’ve set for themselves, then I suggest that they reflect on the reasons behind their desire to share the fantasy, evaluate the impact such a disclosure will have on the therapeutic relationship and proceed from there. 

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