When The Therapist Is Unsure What To Do

What can the therapist do when he or she doesn't know what to do? The book Sexual Feelings in Psychotherapy (Pope et al., 1993) suggests a ten-step approach to such daunting situations, which are summarized here. A repeated theme of that book is that therapists lack easy, one-size-fits-all answers to what sexual feelings about patients mean or their implications for the therapy. Different theoretical orientations provide different, sometimes opposing ways of approaching such questions. Each person and situation is unique. Therapists must explore and achieve a working understanding of their own unfolding, evolving feelings and the ways in which these feelings may play a helpful role in deciding what to say or do next. Cookbook approaches can block rather than foster this process.

The approach outlined here places fundamental trust in the individual therapist, adequately trained and consulting with others, to draw his or her own conclusions. Almost without exception, therapists learn at the outset the fundamental resources for helping themselves explore problematic situations. Depending on the situation, they may introspect, study the available research and clinical literature, consult, seek supervision, or begin or resume personal therapy. But sometimes, even after the most sustained exploration, the course is not clear. The therapist's best understanding of the situation suggests a course of action that seems productive yet questionable and perhaps potentially harmful. To refrain from a contemplated action may cut the therapist off from legitimately helpful spontaneity, creativity, intuition, and ability to respond effectively to the patient's needs. But engaging in the contemplated action may lead to disaster. When reaching such an impasse, therapists may find it useful to consider the potential intervention in the light of the following ten considerations.

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