Increased Intimacy, Transference, and Countertransference

The intimacy created in traditional therapy in comparison to psychedelic-assisted therapy sessions is different for varying reasons. Entering an alternate state of consciousness by taking a psychedelic medicine generates a unique relational alliance between the health professional(s) and client.

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Transference and Countertransference in Psychedelic-Assisted Therapy

There are several instances where transference and countertransference can occur during psychedelic-assisted therapy where it may be less likely to occur in traditional therapy.

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Psychedelic-assisted therapy sets the stage for enhanced transference and countertransference to occur in the therapeutic relationship. Ultimately, it is the health professional’s overall well-being and level of self-awareness that prevent countertransference from negatively impacting the client and the therapeutic process through unconscious therapeutic enactments. As with enhanced intimacy, health professionals are encouraged to:

  • Consistently employ dual awareness to monitor how the session may be impacting them

  • Engage appropriate after-care

  • Seek supervision as needed to navigate and resolve any countertransference that may arise.

Unchecked countertransference can lead to therapeutic impasse via enactment and potential harm to both client and health professional.

Countertransference and enactment will inevitably happen in both traditional therapy and psychedelic-assisted therapy. However, traditional therapy sessions are much shorter that psychedelic-assisted therapy sessions and there is increased space between sessions for the necessary steps to process countertransference reactions and enactments through supervision, peer groups, or self-reflection. For this reason, it is imperative that health professionals learn to notice and observe not only their own mind but the state of their body. Together, the mind and body will be the greatest resource for detecting signs of countertransference or enactment that may be occurring in the therapeutic alliance.

Health Professional Tip

Reflect on three past experiences of countertransference. What sensations did you notice? What did you learn from each experience?

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Some examples of signs that a therpist can monitor, which might suggest countertransference is likely taking place, are:

  • Feeling flattered, paralyzed, triggered, concerned, outraged, desperate for the client’s change, angered towards someone in their life, pressured to "fix" the client, infatuated, persistent, state-regression, or shame

  • Feeling like they are working harder than the client

  • Somatically-oriented sensations which may include leaning forward, pulling away, avoiding eye contact, tension in the body, constricted breathing, changes in vision and hearing, increased heart rate, or other individual markers.

The health professional being able to acknowledge and hold awareness of potential countertransference or enactments occurring is vital to the success of the therapeutic relationship because, when left unnoticed or unacknowledged, both lessens the health professional’s capacity to self-regulate as both lead to increased stress.

As mentioned previously, psychedelic medicines can have a disinhibiting effect that can make it easier for the client to speak about topics that typically bring forward shame. If we are to acknowledge that a client's sense of shame may be inhibited, it is within an ethical framework to consider topics that are stereotypically silenced by shame by stereotypical societal standards.

Sexuality is highly shamed in our society and tends to be unspoken and unacknowledged in therapeutic education settings. The alternate state of consciousness a psychedelic medicine creates can increase one’s vitality: vitality and sexuality commonly are grouped together. Therefore, it is not uncommon for clients to express sexual energy implicitly and explicitly to the health professionals or to express sexual energy in general.

Health Professional Tip

For this reason, we encourage our health professionals to explore and expand their awareness of human sexuality so that if or when a client brings forward sexually charged content in session or experiences somatic states that relate to sexuality (such as arousal, desire, lust, or even orgasm) that you feel prepared to be with the client in these states of being.

The client might also not be familiar with these modes of self-expression. To ensure safety for the client and the health professional we advise that:

  • All health professionals set clear boundaries ahead of time

  • Get comfortable with human sexuality (e.g. seeking education)

  • Have language to validate sexual arousal in the context of trauma coupling dynamics

We also advise that all health professionals hold the awareness that any sexual energy arising from the client is not personal to the health professional regardless of what the client states. It is imperative that health professionals hold strong sexual boundaries. Holding such boundaries also means that if a health professionalexperiences sexual arousal that they seek supervision. We suggest seeking supervision from a Certified American Association of Sexuality Educators, Counselors, and Therapists (AASECT) supervisor.

Case Study

A client in a psychedelic session starts to feel energy of sexual arousal and tells the health professional this is happening and ponders if they are maybe feeling sexually attracted to the health professional.

The health professional tells the client that sexual energy and attraction is not welcome in the therapeutic setting, giving the client a message they are doing something wrong or having a wrong or shameful experience.

The health professional acknowledges and validates the client's experience with curiosity and non-judgement. Health Professionalanswers client's question directly and with psychoeducation, reminding client of discussion regarding sexual energy and expression in preparation: "It's natural and okay for sexual energy to open up under the effects of psychedelics. It's also understandable that you might think it could be connected to me and my presence here with you. Even if it were, what's most important is for me to help you explore what this sexual energy has to do with your intention and goals for healing, and why the inner healer is bringing forward this experience of it right now. Remember, you and I will never exchange sexual energy, but I'm here to help you work with that energy in you, in service to your healing."

Learn More

By pursuing continuing education (CE) on the topic of human sexuality, sex therapy, and other topics, you can be more prepared for topics that arise in sessions. Visit Sexuality Courses to learn more.