Therapist's rescue fantasy

The therapist rescue fantasy is a psychological phenomena characterized by therapists seeing themselves as altruists, imbued with the belief that it is in their power to heal their patients. They perceive that the others in the lives of their patients are the cause of their difficulties and suffering. The theory presents the rescue fantasy as composed of three elements: romantic self-idealization, therapeutic omnipotence, and demonizing of the guilty party (Berman, 1993, 2003).  The rescue fantasy is considered one of the most common motivations for choosing a helping profession and is a key element in the indispensability of the therapist and therapy. However, if the fantasy is too intense, it may harm all involved in the therapy process, especially when there is limited awareness of its existence.

Despite the importance and centrality of the therapist rescue fantasy in the therapeutic world, until now only one study has examined the phenomena. That research, which was qualitative, left three questions unanswered: (l) What variables are likely to explain the rescue fantasy and its varying intensity among therapists, (2) is the fantasy one unitary phenomena or are there differences between its three elements, and (3) is the level of the rescue fantasy and its explaining variables dependent on the career stage of the therapist?  The present study was undertaken with the aim of exploring these questions.

Based on Atwood’s (1978) theoretic model, five personality variables were chosen: attachment, vulnerable or grandiose narcissism, splitting defense mechanism, cognitive or emotional empathy, and caregiving. In addition, the contribution of professional variables, such as participation in psychotherapy, being the recipient of guidance in professional matters, and seniority were examined.

The research cohort included 226 social workers working an average of 11 years directly with clients and 101 undergraduate social work students in their second year of practical training. Since this is the first such study, a self-reporting questionnaire was developed to measure rescue fantasy among therapists. It was divided into three parts.

The research results show that the three elements of the rescue fantasy did not correlate with the variables in the same way. The most substantial differences were found between demonizing the guilty party and the two other elements – self-idealization and therapeutic omnipotence. It was found, as hypothesized, that self-idealization and therapeutic omnipotence were positively correlated with cognitive empathy and negatively correlated with caregiving deactivation. Contrary to the hypothesis, a negative correlation was found between them and splitting defense mechanism. In contrast, demonizing the guilty party was found to be positively correlated with anxiety attachment, vulnerable narcissism, and hyperactivated caregiving. All three elements of rescue fantasy were found to be positively correlated with grandiose narcissism.

Regarding the association between the elements of rescue fantasy and the professional variables, it was found that, as hypothesized, participation in psychotherapy negatively related with self-idealization, however, it did not relate at all with therapeutic omnipotence or demonizing the guilty party. In addition, it was found, in contrast to the hypothesis, that as the number of years of guidance increased, levels of therapeutic omnipotence rose. An especially surprising finding indicated that high seniority strongly correlated with high levels of self-idealization and therapeutic omnipotence. Demonizing the guilty party was not found to be associated with any of the professional variables.

When examining the association between professional career stage and rescue fantasy, differences in intensity of the fantasy were found between experienced social workers and students. The level of self-idealization of the students was higher than that of the experienced social workers. Variances were also found in the variables that explain its intensity among both students and experienced professionals. The regression analysis found that hyperactivated caregiving contributed to explained variance in the three elements of the rescue fantasy only in the student cohort, and that deactivated caregiving and avoidant attachment contributed to explained variance between self-idealization and therapeutic omnipotence only among the experienced professionals.  Additional variances between the two cohorts were also apparent for demonizing the guilty party, with the two narcissistic types contributing only to the explained variance among the students, and anxiety attachment contributing only to the explained variance among the experienced social workers.

Results of the research showed that even though the therapists’ rescue fantasy is an archaic phenomena in primary object relations, it can be measured by a self-reporting questionnaire. The discussion relates at length to differences found between the elements of the fantasy in light of the theory on which the phenomena is based. The limitations of the study and suggestions for further research are also discussed.