The therapist’s love – Kerry Thomas-Anttila

Introduction
Freud considered the therapist’s love to be one of the most, if not the most dangerous elements in psychotherapy, and that this area posed a direct threat to the evolution of his new science. To this end he wrote ‘Observations on Transference Love’ in 1915. It has been conjectured (Eickhoff, 1993) that the impetus to write this paper came from Freud’s concern over Jung’s relationship with his patient Sabina Spielrein, and also from Freud’s correspondence with Ferenczi about Ferenczi’s patient, Gizella (who Ferenczi later married), and also his patient Elma, Gizella’s daughter, with whom Ferenczi had a brief relationship, before marrying her mother.

In ‘Observations on Transference Love’ Freud stressed that the patient falling in love with the therapist is not due to the “charms of his own person” but is induced by the analytic situation. He believed that the passionate demand for love is largely the work of resistance and is an impediment to therapy. He advised on the danger of returning tender feelings, writing that the analyst’s control over himself may not be as great as he or she may imagine it to be. Further, he recommended treating the transference love as “unreal”, as a situation which has to be gone through in the treatment and traced back to its unconscious origins.

For many years there was little or no discussion in psychoanalysis about the therapist’s love; it was as if Freud had successfully closed off this area of inquiry and as if the only love to be considered was that of “transference love”, that is, the love of the patient for the therapist. Hirsch and Kessel (1985) also point out that Ferenczi’s early experiments with mutual analysis and his belief in the curative power of the analyst’s love to heal the patient, led almost to a phobia about mentioning anything about the therapist’s love (p. 74).

There is still much anxiety about using the word “love” in psychotherapy, in particular when applied to the love that a therapist might have for his or her patient or client. Coltart (2000) writes that the very use of the word ‘love’ in psychoanalysis is “often felt to be dangerous, or open to misconstruction” (p. 120). Bach (2006) writes that love in psychoanalysis is fraught with problems of transference and countertransference, the weight of social attitudes and collegial judgments, special ethical considerations, and even legal concerns (p. 126), and Lear (1990) notes that it is hard to take love seriously (p. 156) and that “love has become almost taboo within psychoanalysis” (p. 15).

Notwithstanding, with the increasing emphasis on relationality and intersubjectivity within the therapeutic relationship, there has been a movement towards considering the therapist’s love. In a review of mainly psychoanalytical literature (Thomas-Anttila, 2006) I explored the main themes that have presented themselves in this area. Questions I was interested in were, for example: Does the therapist love their patient or client in any way that is similar to what we might think of as love in other settings? Should the therapist love their patient? And whether or not they should, if they do then how might we describe that love? And what are the dangers and pitfalls in this area? This article highlights some of the findings of this research.

‘Parental Love’
Many writers have compared the therapist’s love to that of a parent. The qualities of this love include sympathetic understanding, affection, tenderness, empathy, patience, tolerance, punctuality, reliability, the ability to recognize the patient’s wishes as needs, containment, reverie, and so on. Ferenczi, Suttie, Balint, Winnicott are some of the theorists who write about the therapist’s love being akin to parental love. Much has been written about the value of the therapist’s “parental love”, particularly as it relates to the reparative nature of therapy, for example the importance of paying very close attention, that the therapist’s words and actions influence the production of hormones and neurotransmitters in the patient’s brain. Lewis, Amini and Lannon (2000) write that “psychotherapy alters the living brain” (p. 168) when the therapist is able to really listen and attune to the patient, that is, to provide a quasi-mothering function where the patient is nurtured emotionally and can rely and depend on the therapist. The longer a patient depends, they argue, the more stable they become, until they are able to gain their independence.

I think there are a few areas to watch out for in this area of parental love. One is that of course we are not the patient’s parent; the ability to observe the countertransference and to step out of it are intrinsic to the therapy process, and quite different to how we are as parents to our own children. The therapist’s love must be somehow detachable and more fluctuant than a parent’s.

Another area is to be aware of is that of hate. Love cannot be a sentimentalized thing devoid of its counterpart, hate, and in fact this is where Ferenczi became unstuck, as he realised some time down the track. In his keenness to be a perfect parent he realised that he was desperately fending off hate. He wrote of one patient “In actual fact and inwardly, therefore, I did hate the patient, in spite of all the friendliness I displayed” (Gabbard, 1997, p.8). He came to amend his original belief in the therapeutic benefit of disclosing love and affection to a belief in the therapeutic benefit of disclosing any emotion that the patient asks to have verified in one form or another.

Another area is that of the individual patient’s needs. Some patients may need more “parental love” than others. In any case, it is unlikely that even those who seem to need it the most will need it all the time, and it is unlikely that a one-size-fits-all approach is going to work.

The last area I would like to highlight here is that the maternal or paternal paradigm can act as a possible defense against exploring erotic feelings in the relationship. It is often easier to take the role of “therapist as mother” rather than offering oneself as an object of sexual cathexis. It has also been pointed out that the “feminization” of psychotherapy is leading to a philosophy whereby the only permissible relationship is a nurturing one between therapist and client. There may be such fear that sexual attraction will lead to exploitation that many therapists will retreat to the safety of the parental framework (Baur, 1997, p. 222). It seems likely that although some therapy relationships need to be of a parental nature, that not all therapy occurs in this paradigm.

Sexual Love and Eros
Sexual attraction and sexual feelings have long been considered problematic within the context of the therapy setting. Samuels (1999) points out that whereas analysts have different opinions on almost all aspects of analysis, there is almost unanimous agreement that sexual behaviour in analysis and therapy is damaging to the patient (p. 150). Erotic or sexual feelings towards the patient only began to be written about in an open way in the late 1950s. Since then the subject has been dealt with in various ways.

One theme that emerges is that there has been a growing acceptance and understanding of the therapist’s erotic responses and how to work with these in the therapy for the patient’s benefit. As well, there is discussion as to the extent to which the sexual or erotic love felt by the therapist towards the patient is countertransferential in nature or not. Mann (1997 & 1999) in particular is adept in arguing that it is important to go beyond the term ‘countertransference’ in describing the therapist’s feelings, and that erotic fantasies and desires can be well thought about and used to the patient’s advantage, rather than being an indicator of pathology in the therapist.

Another theme is that in the last decade, in particular, some writers are writing more about Eros than sex. These writers describe the paradoxical, passionate and creative aspects of Eros, as well as its transformative nature in the therapy. The benefits to the patient include opportunities to progress their development, to expand their emotional repertoire, and to have a therapy that is alive and meaningful. Thanatos and its interplay with Eros is explored. Eros becomes what Lear (1990) describes as the “basic natural force” (p.181) in the therapy. In this paradigm, notions of the ‘erotic transference’ being always a resistance to the therapy are reviewed; there is room for this transference also to be viewed as a desire for aliveness and meeting in the therapy. And so, although sexual enactments do not belong in the therapy situation and are harmful for the patient, many writers have noted that the repression and denial of the powerful forces of sexuality and Eros do not bode well either for a patient’s treatment. Sex and Eros are part of the therapy, and are part of the therapist’s love.

Love as a “Thing unto Itself”
Whereas traditionally, and still, interpretations have been viewed as the manifestation of the therapist’s love, there are also descriptions of other ways of viewing the therapist’s love and how it differs from love in other settings. Coltart (2000) writes a list of qualities which she feels are essential in order to practise as an analyst, and sums these up by saying that they can all be subsumed under the name of love. Coltart’s love includes ‘being with’ patients, and being on their side (as opposed to taking their side) in the search for truth and health. She writes of an attitude which makes the patient feel important in the relationship, and of the necessity of the analyst being both open to herself and unafraid to love (p. 90).

She describes many qualities and I think it is worthwhile to list at least some of them here: endurance, understanding, not using transference or countertransference destructively but only to create greater insight between the patient and ourselves, not exploiting his or her dependence on us emotionally, intellectually, sexually or financially, patience, single-minded attention to what is happening while at the same time allowing the inner flow of free-associative thoughts and images, a detachment rooted in thorough self-knowledge to experience and examine the countertransference and our own feelings, as well as scrutinizing the transference, sharply focusing, and scanning, complex involvement in feelings, and cool observation of them, close attention to the patient and to ourselves, distinguishing our own true feelings from subtle projections into us, communicating insight clearly, yet not imposing it, willing the best for our patients and ourselves, yet abandoning memory and desire, steering clear of being judgmental…sense of humour, toughness, courage, kindness, enjoyment (pp. 116-118). She describes the analyst’s love as being “the only trustworthy container” in which to feel the full spectrum of feelings, including hatred, rage and so on (p. 121), and adds that love is the “moral infrastructure of our job” (p. 122).

Worth mentioning also is the connection between loving the truth of psychic reality and the ‘object’ (patient) whose truth is to be discovered. Steingart (1995), in particular, emphasizes a love of the patient’s mind, and all that it produces; he calls this “scholarly analyst love” (p. 118). Bach (2006) goes further and describes a “falling in love” process when the therapist pays the type of attention that he calls the “moral equivalent of a prayer” (p. 133).

Conclusion
While there seem to have been changes in the way therapists practise, and some inroads made into a more widespread acceptance of the concept of the therapist’s love, at the same time, most writers are saying that we can compare the therapist’s love with the love of a parent, a lover, a sibling or friend, but in the end the asymmetrical nature of the therapy relationship means that it is none of these and the comparisons do not hold in a satisfying way. The most convincing contemporary description, for me, in reading about the therapist’s love, and the one that speaks to me the most in terms of my experience with patients, is Friedman’s (2005) concept of being immersed in and at the same time distant from the patient’s experience, and how this creates a feeling of love in the therapist which is particular to the analytic situation. This description seems to include the possibility of all the types of love being present in both patient and therapist, and reflects the asymmetrical nature of the enterprise, where the therapist participates fully, and observes at the same time, in order to ensure the safety of the patient. This also highlights that the therapist’s love may be necessary but it is not sufficient: it is not the therapist’s love itself which is curative, but rather how the therapist uses his or her love.

Afternote
It is unlikely that this activity has in fact changed much since the beginnings of psychoanalysis. By its nature psychoanalysis has always been concerned with unconscious processes and the relationship has always been an intrinsic part of that. Many have pointed out that the so-called ‘blank-screen’ model was probably never practised by Freud himself, and Lewis, Amini and Lannon (2000) note that one of Freud’s strong points was never to take his own advice.

REFERENCES

Bach, S. (2006). Getting from here to there: analytic love, analytic process. London: The Analytic Press.

Baur, S. (1997). The intimate hour: Love and sex in psychotherapy. New York: Houghton Mifflin.

Coltart, N (2000). Slouching towards Bethlehem. New York: Other Press.

Eickhoff, F-W. (1993). A rereading of Freud’s ‘Observations on transference love’. In E.S. Person, A. Hagelin & P. Fonagy (Eds.), On Freud’s ‘Observations on transference love’ (pp. 33-56). London: Yale University Press.

Freud, S. (1915). Further recommendations in the technique of psycho-analysis: observations on transference-love. In The standard edition of the complete psychological works of Sigmund Freud, 12, 157-171 (London: Hogarth Press, 1971).

Freud, S. (1893-1895). The psychotherapy of hysteria. In The standard edition of the complete psychological works of Sigmund Freud, 2, 255-305 (London: Hogarth Press, 1971).

Green, A. (2005). To love or not to love: Eros and Eris. In A. Green & G. Kohon (Eds.), Love and its vicissitudes (pp. 1-39). London: Routledge.

Friedman, L. (2005). Is there a special psychoanalytic love? Journal of the American Psychoanalytic Association, 53(2), 349-375.

Gabbard, G.O. (1997). Challenges in the analysis of adult patients with histories of childhood sexual abuse. Canadian Journal of Psychoanalysis, 5, 1-25.

Hirsch, I., & Kessel, P. (1985). Reflections on mature love and transference. Free Associations, 12, 60-83.

Lear, J. (1990). Love and its place in nature: A philosophical interpretation of Freudian psychoanalysis. London: Yale University Press.

Lewis, T., Amini, F., & Lannon, R. (2000). A general theory of love. New York: Vintage Books.

Mann, D. (1997). Psychotherapy: An erotic relationship. New York: Brunner-Routledge.

Mann, D. (Ed.). (1999). Erotic transference and countertransference: Clinical practice in psychotherapy. New York: Brunner-Routledge.

Natterson, J. M. (2003). Love in psychotherapy. Psychoanalytic Psychology, 20(3), 509-521.

Samuels, A. (1999). From sexual misconduct to social justice. In: D. Mann (Ed.), Erotic transference and countertransference: Clinical practice in psychotherapy (pp. 150-171). New York: Bruner-Routledge.

Shaw, D. (2003). On the therapeutic action of therapeutic love. Contemporary Psychoanalysis, 39(2), 251-278.

Steingart, I. (1995). A thing apart: love and reality in the therapeutic relationship. London: Jason Aronson.

Thomas-Anttila (2006). The Therapist’s Love. Unpublished dissertation, Master of Health Science, Auckland University of Technology, Auckland.

Weinstein, R.S. (1989). Should analysts love their patients? The resolution of transference resistance through countertransferential explorations. In J.F. Lasky & H.W. Silverman (Eds.). Love: Psychoanalytic perspectives (pp. 192-199). London: New York University Press.

Kerry Thomas-Anttila was born in Christchurch and has lived in Auckland for over twenty years. She completed a Master of Arts in German language and literature at Canterbury University in her early 20s and then went on to work in the public health sector in the employee relations/industrial relations area. After a psychotherapy training at AUT (Master of Health Science) Kerry now works as a psychotherapist in private practice in Parnell (website www.cure.org.nz). She is also in her final year of a three year clinical training with the Australasian Institute of Psychoanalytic Psychotherapy.

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