Romantic or erotic feelings toward the clinician are par for the course in any long-term psychiatric treatment and tell you nothing diagnostic on their own. Acknowledge them without colluding, reciprocating or exploring fantasies, say plainly that your job is the patient's well-being, and lean on the frame. If it cannot be moved past in medication management, raise a transfer of care kindly, and get supervision or risk management involved early.
What it is
These feelings are par for the course in any long-term treatment, and especially long-term psychiatric treatment.
“all the feelings and thoughts that people may be having these issues are unfortunately core par for the course for any long-term treatment and in particular any long-term psychiatric treatment”
1:20When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 Any treatment where two people meet regularly takes on echoes of early parent-child relationships and relationships with significant others.
“any relationship treatment relationship where you have two people who meet regularly it's going to take on echoes or going to be informed strongly by early parent-child relationships and relationships with significant others”
22:34When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 Transference can be positive (projecting enjoyable past relationships onto you), negative (projecting painful ones) or erotic.
“there's positive transferences where the relationships, they are projecting positive, enjoyable relationships of their past onto you. There's negative where painful or less desired emotions are projected onto you”
25:06When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 In healthier patients it shows up gradually and in disguised forms. They are a bit ashamed or embarrassed and can look at it with curiosity and self-reflection.
“the erotic transference presents gradually. Often, it Like it occurs in more disguised forms. The patient will be a little bit ashamed, embarrassed. They'll be able to look at it with more curiosity and more self-reflection”
29:21When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 In the borderline range it can appear rapidly, is often fear-driven, tests boundaries hard and escalates quickly.
“patients who are in the borderline range of psychological functioning, it can present rapidly, it is often fear-driven, it's testing boundaries majorly, these things escalate really quickly”
29:57When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025
How we handle it
Acknowledge what is going on without encouraging enactment: recognize the feelings, but do not collude, reciprocate or reinforce the fantasy.
“you're acknowledging what's going on without encouraging enactment at all. You're recognizing the feelings, but not colluding, not reciprocating. You're not reinforcing the fantasy”
39:39When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 If a patient cannot agree with you about what is real, refer back repeatedly to the frame and the plan. If it gets to that point in plain medication management, you are in hot water: call risk management.
“Refer back repeatedly to the treatment frame, to the plan, and do whatever you can. To be honest, if it gets to that point for just a plain medication management, not for a psychotherapy, you are in some hot water, my friend, the clinician, and I would begin to call your risk management”
39:11When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 If you cannot move forward without it getting in the way, say that the best thing for them is to find a new doctor.
“If we can't move forward together without this getting in the way of focusing on your treatment, it's the best thing for you if we can find you a new doctor”
41:34When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025
Talking to patients
When a patient declares feelings: I'm not feeling those feelings. What I feel is care for your well-being as a patient, and that is my job as long as we work together.
“I'm not feeling those feelings. And what I feel is care for your well-being as a patient. That's my job here. And that's always going to be my job as long as we're working together”
35:28When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 When a patient shares something like a sexual dream about you, normalize it: it is very common to develop feelings that might not make sense about a treatment provider, it does not mean they are real, and treating them as anything other than a sign of underlying thoughts and feelings would interfere with treatment.
“it's actually very common to develop feelings that might not make sense about your treatment provider, including myself, doesn't mean that it's real. And certainly it would interfere with your treatment if we take it as anything other than a sign of your underlying thoughts and feelings”
57:52The Treatment Frame in Action: Lessons from ‘I Fell in Love with My Psychiatrist’Sep 2025
Pitfalls and myths
An erotic transference on its own gives no diagnostic information about someone's psychological functioning.
“Just because someone has an erotic transference is no diagnostic information about their psychological functioning”
29:01When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 Exploring sexual fantasies is not part of medication management. Doing something markedly different with one patient than with the others is a red flag.
“exploring sexual fantasies is not a normal part of medication management right and if you are starting to do something in the medication management that is markedly different from what you do with other patients that's a red flag”
32:03When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 Unless you have a very clear idea of what you are doing, seek supervision.
“Unless you have a very clear idea of what you're doing, I highly recommend that you seek supervision”
33:53When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025
From these episodes
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.