I am a veteran with PTSD, depression, anxiety and marital discord. The Veterans Affairs Department has been paying for me to see a therapist. At my last session, I shared with my therapist that I’d had a sexual dream about her. I did not share any specifics about the dream, and I did not say or suggest that I have a crush on her. (I do not.)
My therapist blew up at me, saying that this is something you should not bring up to a therapist. The next day I felt so bad about the incident that I texted the therapist and apologized. I told her I was embarrassed and would never share something like that again. She did not reply.
Two days later, I received a phone call from her receptionist telling me that my therapist was terminating therapy with me.
For the record, the therapist never told me any topic was off limits. In fact, she told me that therapy was a safe place to share any issues I wanted to bring up. I remember asking her, “I can tell you anything?” and she said, “Yes, anything.”
I feel confused and abandoned. She was the only person I could share anything with and not feel judged. This is how a lot of vets feel if we share anything terrible we had done or failed to do while on active duty. I don’t think I will ever trust a therapist again.
I feel lost, alone and hurt. Can you offer any guidance?
From the Therapist:
I’m so sorry that this happened to you, because you did absolutely nothing wrong. Instead, your therapist’s wrongdoing has left you in a deeply upsetting predicament. A therapist should create a truly safe space, and it’s devastating when trust in your therapist is broken. What you’ve experienced — especially after sharing something so delicately personal — is not only hurtful but also destabilizing.
In therapy, you have every right to bring up a dream — even if it’s about your therapist and even if it’s sexual — and to trust that the therapist will handle whatever you bring into those conversations with skill, compassion and professionalism. Before I suggest how to navigate this breach, I think it might help you to understand how this disclosure should have been handled.
When people go to therapy, two dynamics typically emerge — transference and countertransference. Transference occurs when patients direct feelings related to a person in their lives onto the therapist. If, for example, you have a problematic relationship with a family member who you feel is controlling, you might transfer those feelings of being controlled onto your therapist whenever she suggests an intervention for you to try.
These feelings can range from anger to adoration, and romantic or erotic transference can occur when a therapist reminds a patient of a past romantic partner or love object, or when an earlier need is being fulfilled by the therapist: unconditional acceptance, a safe environment, emotional intimacy, or feeling seen or valued or protected. Dreams are often the subconscious mind’s way of processing complex emotions, and transference can be very useful if the therapist helps the patient identify this process as a way to gain insight into underlying feelings.
But something seems to have interfered with your therapist’s ability to do this. In training, therapists learn to recognize their own feelings of transference toward the patient — what’s known as countertransference. A therapist whose patient reminds her of her impossible-to-please mother may start to feel helpless and begin to resent this patient. Or a therapist may overidentify with a patient who struggles with a similar issue to one that the clinician dealt with in the past (divorce, an alcoholic parent), and become unable to disentangle the patient’s feelings and experiences from the therapist’s own.
As with transference, countertransference needs to be brought to light and processed. But while transference is discussed in the therapy session, therapists process their countertransference by receiving feedback from other clinicians (or their own therapists) to avoid muddying the work they’re doing to help their patients.
We have a saying in therapy: If it’s hysterical, it’s historical. Generally when people have intense reactions, there’s some history at play. It sounds as if your therapist had a strong emotional reaction to your dream but didn’t adequately explore what was underlying it. She made your dream the issue, instead of understanding her problematic feelings about your dream. In doing so, she violated the sanctity of the clinician-patient relationship by shaming and then abandoning you, causing you pain, preventing you from processing this disturbing experience and leaving you without closure or continuity of care.
Your therapist’s sudden withdrawal reinforced the very fear many veterans who are managing PTSD, depression, anxiety or trauma experience: that vulnerability leads to abandonment.
But this experience, though deeply painful, doesn’t mean that you should give up on therapy altogether. You deserve a therapist who will walk alongside you and give you room to process whatever you’ve been through, without judgment or fear of abandonment. Your therapist’s actions have rocked the foundation of your trust, but I believe you can rebuild it with the right support from a different clinician.
You can start by sharing your experience with the appropriate mental health resource coordinator, who can discuss your options on how to handle the situation with your former therapist (for instance, by filing a complaint so that other patients won’t have to endure something similar) and provide you with referrals to a new therapist who has been thoroughly vetted.
Interview two or three therapists by requesting a consultation before you begin treatment, and tell each of them what happened to you and the effect it had on you — that you are grieving the loss of the relationship you had, feel betrayed by a person you trusted, are hesitant to open up to a therapist again and are seeking someone who can help you to move forward from that experience and heal the wounds that brought you to therapy in the first place. See how each therapist responds, and notice with whom you feel most comfortable.
Finally, I want you to know that you’re not alone. Although it may feel that way right now, there are people who understand the layers of what you went through and will be there to support you.
Want to Ask the Therapist? If you have a question, email askthetherapist@nytimes.com. By submitting a query, you agree to our reader submission terms. This column is not a substitute for professional medical advice.
