by Martha Stark, MD / Faculty, Harvard Medical School


A supervisee of mine presented the following, which demonstrates how powerful it can be when the therapist is willing to go out on a limb in pursuit of a patient. 


The patient was an attractive young man who had been coming to treatment because of difficulty he had tolerating sustained intimacy with women.  Of note was the fact of an unusually close relationship to his controlling mother.  With respect to his female therapist, he appeared to feel good about her, although he always kept himself somewhat at a remove from her. 


Over time, the therapist became aware of feeling a certain charge in the air between them, the nature of which she couldn't quite put her finger on.


After about a year into their work, the therapist one day decided to be bold.  With her heart in her throat, she asked him if he had ever found himself having sexual feelings about her.  The patient, with some hesitation, responded that he did not feel sexually attracted to her because she was not his type.


The therapist, able to preserve her good feelings about herself even in the face of her patient's "rejection" of her, managed somehow to get said, "Do you ever imagine that I might have sexual feelings about you?"


As it turns out, the patient had long feared that his therapist, like his mother before her, had a sexual hunger for him and wanted to control him.  Prior to this point, he had never dared to share this fear with his therapist. 


But once this fear had been exposed to the light of day by his therapist's courageous intervention, the patient was freed up to talk about how frightened he had always been that the women in his life would want to devour him with their desire for him – and how terrified it made him to think that they might want to control him in this way. 


Once the patient's fear had been named, it became easier for the patient to deliver his authentic self into the relationship with his therapist and the level of their engagement deepened considerably.  Furthermore, as the patient got more and more in touch with just how outraged he was by his mother's violation of him, he became better able to sustain intimate contact with the women in his life on the outside. 


This example demonstrates the transformative power of a therapist's willingness to put herself out there on behalf of a patient who, frightened and angry, initially rebuffs her.  The therapist's ability to pursue him even so enables the two of them to get to the bottom of what had been interfering with his ability to commit to the therapy relationship – namely, his fear that his therapist might try to take him over.  It was this fear that had made it difficult for him to engage authentically in the therapy relationship (and with women, more generally) – it was this fear that had fueled his hopelessness and despair about ever being found.