Healthcare Training Institute - Quality Education since 1979
CE for Psychologist, Social Worker, Counselor, & MFT!!

Section 6
Client Attachment to Therapist

Question 6 | Test | Table of Contents

Read content below or listen to audio.
Left click audio track to Listen; Right click to "Save..." mp3

Situational factors, or the environment, may play a part in facilitating the onset of an abusive relationship. In pointing this out, I remove no responsibility from the therapist. The responsibility of the abuse lies with the therapist because the removal of constraints is planned by this professional.

♦ 3 Situational Factors of an Abusive Relationship
Here are three examples of situational factors being manipulated by the therapist to remove constraints.
-- 1. First, Mary's therapist told her to make a late appointment, after the secretary had left.
-- 2. Second, he knew that her husband had moved out following the divorce. He invited himself to her home for a "cup of tea."
-- 3. Third, he invited her to his house to read a copy of the play he had written on a weekend, when his wife and two children were in another city visiting relatives.

Regarding the situational factors, it might be interesting to note at this time that the literature suggests the lower incidence of client abuse by social workers as opposed to psychiatrists and other mental health professionals might be attributable to their work situations. The work situation of a social worker working for an agency is often the setting of a busy public office.

♦ Intense Feelings Bound up in the Relationship
A second warning sign, as mentioned earlier, is client vulnerability. Attachment Theory plays a major role here. As you know, children develop attachments to their parents, siblings, and other family members. The quality of these attachments depends on a number of factors, including the consistency and availability of the main parent figure, or "primary caretaker."

As was the case with Mary, during her first three years, she was exposed to repeated parental absence, emotional unavailability, and abuse. She thus developed a tendency for "anxious attachments," with clinging behavior and fears of being separated from significant others. She learned about this abuse from an aunt. This abuse led to her tendency to cling to important others, be possessive, and fear abandonment. As you know, relationships based on such characteristics are sometimes called "symbiotic," meaning that there is a psychological fusion of two people. The symbiotic relationship, or in some cases codependent relationship, allows the person to avoid re-experiencing the vulnerabilities and anxieties of childhood, thus causing a power imbalance with others.

♦ Idealizing the Professional
A person is more likely to form a symbiotic relationship with a mental health professional. As a result, they end up idealizing the professional, clinging to them and fearing abandonment. Specifically in the case of Mary, she was unable to leave the relationship, even though it was damaging and exploitative. Kenneth Pope who wrote "Sexual Involvement with Therapists" indicates connections between childhood abuse and symbiotic or codependent relationships with an abusive therapist almost seems to orchestrate the client's enslavement.

♦ The Wish for an Omnipotent Rescuer - A Life and Death Matter
However, many of the clients we treat have had abusive childhoods. What was different in the case of the abused client? The literature seems to incite a traumatic transference often occurs at a certain level. I define a traumatic transference as an intense, life-or-death quality of the reaction by a survivor of childhood trauma to a person in authority. The survivor's emotional responses have been changed by experiences of terror and helplessness. Abused clients cast the mental health professional in the role of omnipotent rescuer. However, at the same time, they state their mistrust of them. Mary stated many doubts, suspicions, and feelings that she had to try to control the therapist by giving into his sexual advances

4 Warning Signs
No doubt, with Mary, the four warning signs indicated by Pope came in to play:
-- 1. First, Mary's idealization of the professional;
-- 2. Second, her wish for an omnipotent rescuer;
-- 3. Third, her intense feelings bound up in the relationship;
-- 4. Fourth, her impression that the survival of the treatment relationship was a life-and-death matter.

All four of these factors lead to the power entrapment of a childhood trauma victim with an abusive professional.

- Pope, Kenneth PhD and Bouhoutsos, Jacqueline. Sexual Intimacy Between Therapists and Patients. Praeger, New York, 1997.
Course Reviewed 2023

Peer-Reviewed Journal Article References:
An, M., Hillman, J. W., Kivlighan, D. M., Jr., & Hill, C. E. (2021). Changes in client attachment in relation to client distress: A response surface analysis. Journal of Counseling Psychology. Advance online publication.

Cuttler, E., Hill, C. E., King, S., & Kivlighan, D. M., Jr. (2019). Productive silence is golden: Predicting changes in client collaboration from process during silence and client attachment style in psychodynamic psychotherapy. Psychotherapy, 56(4), 568–576

Mallinckrodt, B., & Jeong, J. (2015). Meta-analysis of client attachment to therapist: Associations with working alliance and client pretherapy attachment. Psychotherapy, 52(1), 134–139. 

O'Connor, S., Kivlighan, D. M., Jr., Hill, C. E., & Gelso, C. J. (2019). Therapist–client agreement about their working alliance: Associations with attachment styles. Journal of Counseling Psychology, 66(1), 83–93. 

Sauer, E. M., Rice, K. G., Richardson, C. M. E., & Roberts, K. E. (2017). Influence of client attachment and gender on therapy transfers: A multilevel examination. Training and Education in Professional Psychology, 11(1), 33–40.

QUESTION 6
What are four warning signs that a client may be vulnerable to an abusive balance power? To select and enter your answer go to Test.

Test
Section 7
Table of Contents
Top