I am a veteran with PTSD, depression, anxiety and marriage discrepancies. The Veterans Affairs Bureau pays me to meet my therapist. In the last session, I shared with my therapist that I had sexual dreams about her. I didn't share any details about my dreams and I didn't say or suggest that I was in love with her. (I don't.)
My therapist exploded at me and told me this shouldn't be brought to the therapist. The next day I was so sick about the incident that I texted my therapist and apologized. I was embarrassed and told her I would never share such a thing again. She did not reply.
Two days later I received a call from her receptionist and told me that she had finished the treatment with me.
For the sake of the record, the therapist never told me that the topic was off limits. In fact, she told me that therapy is a safe place to share the issues I want to raise. I remember asking her, “Can you say anything?” And she said, “Yes, anything.”
I'm confused and abandoned. She was the only person I could share anything, but I didn't feel judged. This is how many vets feel when they share the awful things we did or didn't do while in their active service. I don't think I'll ever trust my therapist again.
I get lost and hurt alone. Can you provide guidance?
From the therapist:
I'm so sorry that this happened to you because you didn't do anything bad at all. Instead, your therapist's misconduct has left you in a profoundly upsetting predicament. Therapists should really create a safe space and when your trust in your therapist is broken, it is devastating. What you've experienced will not only hurt, but also unstable, especially after sharing something very sensitively and personal.
In therapy, you have all the right to cultivate a dream, that even if it's about your therapist, even if it's sexual – and that the therapist trusts you to process anything that you bring to those conversations with skills, compassion, professionalism. Before suggesting ways to navigate this violation, I think it will help you understand how this disclosure should be handled.
When people go to treatment, two dynamics usually appear – metastasis and inversion. Metastasis occurs when the patient directs the therapist to the person in life's emotions. For example, if you have a problematic relationship with a family you feel controlled, whenever you suggest an intervention you try, you may transfer the feeling of being controlled by your therapist to your therapist.
These emotions can range from anger to worship, and romantic or erotic metastasis occurs when the therapist reminds the patient of a past romantic partner or object of love, or when previous needs are met by the therapist. Dreams are often a subconscious mind's way of processing complex emotions, and metastasis is very useful if the therapist helps the patient identify this process as a way to gain insight into the underlying emotions.
But something seems to have hindered your therapist's ability to do this. In training, therapists learn to recognize their own feelings of metastasis, or what is known as reversal, to the patient. The therapist, whose patient reminds her of an impossible mother, may begin to feel helpless and resent this patient. Alternatively, the therapist can overequalify patients who struggle with similar problems with patients who have previously addressed (divorce, alcoholic parents) and are unable to unravel the patient's emotions and experiences of the therapist.
Similar to metastasis, the inversion must be brightened and treated. However, metastasis is being discussed in the treatment session, but therapists handle the reversal by getting feedback from other clinicians (or their own therapists) to help patients without getting muddy.
We have a saying in treatment: if it is hysterical, it is historical. In general, there is some history when people have a violent response. It sounds like your therapist had a strong emotional response to your dreams, but he didn't properly explore what underlie it. She made your dreams a problem rather than understanding her problematic feelings about your dreams. In doing so, she violated the sanctity of the clinician-patient relationship by abandoning you in shame, causing you pain, preventing you from dealing with this disturbing experience, and preventing you from closing or leaving the continuity of continuity.
Your therapist's sudden withdrawal has been reinforced in fear of many veterans managing experiences of PTSD, depression, anxiety, or trauma. That vulnerability leads to abandonment.
However, this experience, although deeply painful, does not mean that treatment should be given completely. You deserve a therapist who walks with you, gives you room to process anything you have experienced, and gives you space without fear of judgment or abandonment. Your therapist's actions have shaken the foundation of your trust, but I believe you can rebuild it with the right support from another clinician.
You can start by sharing your experiences with the right mental health resource coordinator. A suitable mental health resource coordinator can discuss options with previous therapists about how to handle the situation (for example, by filing a complaint that other patients do not have to endure similar things).
Interview two or three therapists by requesting consultation before starting treatment, telling each of them what happened to you and that they are grieving the loss of the relationship you had, feel betrayed by someone you trust, and are hesitant to open up to the therapist again, and are looking for someone who can help you move forward from that experience. See how each therapist responds and notice who you feel most comfortable with.
Finally, I want you to know that you are not alone. It may feel like that now, but there are people out there who are there to understand the layers of what you've experienced and support you.
Do you want to ask a therapist? If you have any questions, please email askthetherapist@nytimes.com. By submitting a query you agree to the Submission Terms of Use. This column is not a substitute for professional medical advice.
