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When we begin treatment with a woman who has been sexually involved with her former therapist, we are immediately faced with certain kinds of problems. First there is superimposed upon the problem that originally led the patient to seek treatment the burning issue of sexual activity with her previous therapist. Establishment of rapport and trust between the patient and her present therapist takes place, or fails to, around discussion of the issue of the patient's sexual affair with her former therapist. Some patients feel they must protect the old therapist and may as a result be unable to register any negative reactions to the sexual encounter. Other patients may be altogether consumed with negative reactions to their old therapist and may then be unable to investigate any part that they may have played in establishing the sexual connection.
A second crucial problem is the countertransference reaction of the present therapist to the events of sexual involvement of the patient and her previous therapist. Of course, countertransference reactions occur to some degree in any treatment, but in this situation they spring up almost immediately and more strongly than usual. Potentially, therefore, such reactions can be injurious to treatment, preventing an easy beginning of the solid affective connection between therapist and patient that is so necessary to the work of therapy.