Have you ever thought on what grounds you choose “your specialist”? To what extent is your choice a conscious one and which part is subconscious? It is said that you can “feel” the right person but what does it actually mean? In a therapeutic relationship, just like in any other relationship, we replay certain relationship dyads. Sometimes they are activated quicker in the presence of a person of certain sex, age or even appearance.
A therapeutic relationship is, in its nature, unequal because the patient, apart from their observations, is unable to gain any information regarding the private life of the therapist. It may lead to the patient experiencing fear or anxiety because they know nothing about the views, sexual orientation or marital status of the person they are talking to.
This content remains in patient’s imagination which manifests itself naturally during a session. We dislike emptiness and try to fill it in with content, therefore this need is followed by projections. Let’s get back to the original question: does the sex of the therapist really matter? The answer is yes because the discomfort related to the inequality of the therapeutic relationship is experienced differently with the person of the same sex. Moreover, a therapy is based on reliance where the patient becomes dependent on the therapist in terms of the place, the hours and the setting of the therapy and also emotionally.
It is worth noticing how we usually experience being dependent on others in our private life. Think about the way you deal with commands given by your boss when it is a man or a woman. Do you start a relationship with a supervisor differently depending of their sex? Do you notice a difference in the way you experience this reliance? Do you find it easier to form a relationship with a certain sex, it takes less to close the distance in it whereas it is the opposite with the other sex? The topic of dependence is quite vast and it is related to every relationship we enter.
Both women and men wish to know the perspective of the other sex. It is often one of the key reasons that motivates a person to begin a therapy.
Male patients usually feel safer in a therapeutic relationship with women since they perceive them as more gentle, emphatic and sensitive. Such qualities often bring about the feeling of being understood, safe and accepted. When interacting with a male therapist, men may bring up topics of rivalry and low self-esteem, especially visible in relation to the members of the same sex. The men who experience problems of a sexual nature tend to choose female therapists since it seems easier for them to discuss such topics with someone who exhibits sensitivity and empathy. The understanding and acceptance they get from their female therapists provide them with more hope and optimism in relation to future relationships they are hoping to start with a woman or to their present partner, in view of their problems connected with sex.
When it comes to couples therapy, women tend to choose a male therapist if they have a certain level of trust towards the therapy process, hoping that their partner will reflect more on what he is going to hear from a male therapist since he won’t feel attacked by two women at the same time. Of course, it is not a rule and there is a large group of female therapists who work with couples. It is worth mentioning that women constitute a majority among psychotherapists. There are fewer male therapists and therefore, for some, it is more prestigious to have a therapist of this sex.
Women generally look for a protective object in a therapeutic relationship, in a form of a mother, a father, a friend or a partner. Placing the therapist in one of those roles may reveal certain desires or deficits from the past. I have observed, from my own experience, that LGBT+ patients usually choose a specialist of the opposite sex or those who support LGBT+ community. It is due to the content which frequently appears during sessions related to gender identity and sexuality. A research into the therapy of a LGBT+ patient showed no corelation between the therapist’s sex and the outcome of a therapeutic process.
Not only sex, but also age matters.
Regardless of the sex of the therapist we choose, when selecting an older specialist we will probably treat them as parental objects. The most striking theme in such relationship is re-enacting the primary relationship with a parental object. At the same time, an older therapist may invoke fear in the patient, reminding them about parental prohibitions from the oedipal phase. In case of the therapist being much younger than us, it may be easier for us to devalue them, especially in stressful or difficult situations. It may be tempting to defend ourselves by declaring the therapist as being less experienced than us than to accept difficult truths about ourselves. Similarly, older therapists can be perceived as not up to date and conservative, omitting their valuable component of life and work experience. Devaluating a therapist is quite common among patients. It is worth exploring, however, to what extent we are willing to give ourselves enough ground to follow up on our desires.
Let’s consider the following questions regarding the choice of a therapist: Do we tend to pick a specialist with whom we instantly feel better? Do we look for weak points in our therapist in order to be able to devalue them to avoid experiencing discomfort? Answering them may give us insight about our functioning in relationships.
When we choose a therapist who is of the same age as we are, we may activate the need to push the patient-therapist boundaries and treat the specialist as more of a confidant, a friend or even a potential partner. Women tend to confuse the intimacy of a therapeutic relationship with a romantic relation which is described an erotic transference. Similarly, men may find it difficult to harness their sexual desires related to their female therapists. The sexualisation of the patient-therapist relationship is considered a form of defence against getting involved in such relationship.
A therapist is also a human being.
A huge influential factor, depending on the therapist’s age, is a possibility of a female therapist getting pregnant or the pregnancy itself. It may activate elements of oedipal rivalry and the fear of being rejected or abandoned. Pregnancy or illness makes therapists seem more real for patients who see them as similar to them, someone who experiences difficult emotions and has a private life, an element which is easily omitted or forgotten. Patients tend to dehumanize therapists by idealising them, perceiving them only as specialists and refusing to see them in a different context. The elements which reveal the private side of the therapists, such as a wedding ring, a pregnancy or an illness are a valuable part of the process. It may sound like the therapy is more about the therapist than the patient, but every relationship is about correlation of two and more people. That is why we call it a therapeutic relationship because, even though it is based on certain rules, it is still a relationship between two people.
Whether we want it or not, we do judge the book by its cover.
Appearance can influence our attitude towards another person, researchers claim. For instance, people with bad teeth tend to be perceived as less intelligent. Those who are overweight are seen as weaker, unable to control their impulses and maintain their borders. Women who are attractive may provoke jealousy or envy in female patients and arise desire in male patients. Good-looking, elegant and well-built male therapists can be perceived as narcissistic and wanting to compensate their deficits with their good looks. The examples above may be seen as negative and extreme but it is obvious that we like to live among nice, pleasant things, and it refers to people as well. Regardless of the fact whether good-looking people make us feel afraid or jealous, we choose to interact with someone who makes us feel good.
In our health centre we focus on the corelation between psyche and body and the way internal conflicts manifest themselves in our body. I believe that, on an subconscious level, it leads us to being judgemental. Since we may not have access to the way our mind corelates with our body, it is easier to observe this phenomenon in other people.
The importance of appearance in a therapeutic relationship gives patients a lot of content to introduce during their sessions. Our role is, after all, to fill in information gaps. The lack of knowledge about the therapist, the inability to ask them questions creates a possibility to fantasize about the therapist. After all, we do find it difficult to tolerate emptiness and uncertainty. A lot of elements, projections and experiences can be re-enacted in a therapeutic relationship. Sometimes it is accelerated by the presence of a person of a certain sex, but it can also resurface outside sessions. There are certain dyads we live in, in relation to certain types of people, and we take on certain roles in those settings. At the same time we experience those other people in a certain way. We can regress to the role of a child in relation to a strict parent, implement the oppressor-victim dyad, seduce, devalue and so on. Depending of the structure of our personality and the set of our defence mechanisms, the way we experience our therapists and begin a therapeutic relationship will have certain characteristics. That is why the examples described above are only a fraction of possible configurations which will manifest or intensify in therapy, depending on the problems patients face in their lives. The topic of sex in a therapeutic relation is also related to gender identity, gender roles, cultural behaviour or personal views.
One of the roles of a psychodynamic therapy is working with certain dyads which become activated in a therapeutic relationship. Being able to understand how and why we re-enact certain schemata in our relations is the first step to changing the way we experience ourselves and the world around us. According to object-relations theory, the patient-therapist dyad is a source of experiences which have great influence on resolving our subconscious conflicts. By choosing a certain therapist, we choose the dyad in which we feel the safest in order to deal with dependence. But that is another topic which I will explore in a different article.