Love and Psychotherapy

Manhattan_at_Dusk_by_sloneckerHappy Valentine’s Day! Valentine’s Day is often associated with love, especially romantic love.  Yet love is much more expansive than romantic love, for love encompasses care and connection, and it does not require romantic feelings.  In the days leading up to February 14th this year, and while looking at the bright red lights on the Empire State Building right in front of our office windows, we at CTC began conversations about love and psychotherapy.  For example we discussed things like: what role does love, if any, have in psychotherapy? Do we and how do we love our patients? Should we? Could we?

Google scholar generates about 372,000 results on the topic of love in psychotherapy. A random sampling of those articles reveals that most, like most therapists, adopt an impersonal and clinical approach to the question of love in therapy.  Although the articles discuss the multiple complexities of being in therapy, and things such as erotic love, countertransference, etc., the question of how do we, as clinicians approach love in sessions with our patients is avoided, if it is even recognized.

Love is an essential human emotion present in countless daily interactions of care, solicitude, empathy and solidarity.  Yet, our society seldom talks about love without connecting it to sex or romance.  Our contemporary society recasts relationships of love and responsibility such as those of parents to children as relations of authority; it recasts relationships of empathy and solidarity, as charity for those less fortunate.  Society – according to the dominant capitalist ethic – has shifted the focus of care from another, whom we love and want to share things with, to an erotic or romantic fantasy to be consumed and possessed – a fantasy that is easier to market and turn to profit.

For our patients, love is often a complicated topic.  Having survived long histories of trauma and abuse, coupled with the fact that we live in a world that seldom talks about cooperation, mutuality and love, it is no surprise that the topic of loving is difficult.  Yet, it is there, always already present in our daily interactions, oftentimes unrecognized, “like a seed beneath the snow, buried under the weight of the state and its bureaucracy, capitalism and its waste….” to borrow a phrase from Colin Ward (1973).

Reading through the countless articles on the subject of transference and erotic love as it enters the therapeutic hour does not offer much guidance, serving only to highlight how much more complicated is the study of the reality of non-erotic love.

As Bodenheimer (2011) points out:

There are many reasons not to discuss or study the reality
of non-erotic love in the psychotherapeutic relationship.
These include conceptual struggles regarding the actual
meaning of ‘‘non-erotic love;’’ linguistic difficulties that
are byproducts of the evocative tenor of the word ‘‘love’’
itself; and the obstacles produced by researching a concept
that is so largely defined by its subjective nature. But
perhaps the most powerful reason to avoid the complicated
presence of love in the therapeutic relationship is the very
reason it must be deeply understood and scrutinized: It is
an ethical minefield (p. 39).

Perhaps this minefield comes from the fact that to talk about love in psychotherapy from the therapist’s perspective, is to talk about ourselves, and our professional boundaries, it requires honesty and a lot of self-awareness and reflection.

For Freud (1993), although recognizing the importance and centrality of love in our lives, love was seen as a distraction and he wanted to practice therapy free from what he saw as a counter-transferential emotion.  When urged by Ferenczi (De Forest, 1954), to question his beliefs regarding the role of love in treatment, Freud quickly rejected Ferenczi (Cabre, 1988).  Perhaps Freud’s reluctance at the time, might be explained as fear, since he was writing his 1905 piece called Fragment of an Analysis of a Case of Hysteria, where he explored the case of Ida Bauer, or ‘‘Dora.’’ This case was difficult for Freud, especially since his own countertransferential feelings were not fully processed or analyzed.

Ferenczi went on to speak about love in psychotherapy, and in 1920 at the Hague he discussed his own approach to therapy.  He understood “the progress of the cure bears no relation to the depth of the patient’s theoretical insight, nor to the memories laid bare.’’ (Stanton 1991, p. 133).  Instead, his method was ‘‘developed to the fullest when he recognized that genuine sincerity and empathic attunement were the essential ingredients to reach a traumatized individual’’ (Rachman 1998, p. 265).

Ferenczi believed that unless the therapist is willing to bridge the distance between him/herself and the patient, cure is impossible.  Whereas Freud saw distance as part of the therapeutic technique, Ferenczi saw it as a defense.  He argued that most of our patients, are often deprived of love and care, and indeed it is through an experience of love and care that cure and healing is possible.  He believed that treatment outcomes were directly related to the amount of love given by the therapist to the patient.

Since then, research on this mutuality has flourished, especially within the interpersonal field of psychoanalysis.  And Shaw’s (2003) historical analysis of the understanding of analytic love brought him to the belief that ‘‘analytic love is indeed complicated and dangerous, and like all loving, carries the potential for devastating disappointment… [But], he goes on to say: “at the heart of this endeavor, I believe, for both analyst and analysand, is a search for love, for the sense of being lovable, for the remobilization of thwarted capacities to give love and to receive love’’ (2003, pp. 252, 275).

In critical therapy, love develops over time.  In the early stages of therapy, as patient and therapist discuss issues related to family history, intrapsychic conflict, sexual desires, the transference develops.  In line with traditional psychoanalysis, and Freud, the therapist in the early stages of treatment maintains a certain distance from the patient, who invests power with the therapist. This investment of power is necessary to facilitate transference relations, much needed for the intrapsychic part of the analysis.

Transference is an important part of this therapeutic phase. The patient’s feelings for the therapist, who slowly becomes a significant figure in the patient’s life, are used to show how the patient understands, interprets, and responds to present relationships and situations in similar ways s/he responded to significant persons in the past.  By understanding how this past behavior influences and determines present behavior, the patient can learn to make more appropriate decisions.

Establishing trust is also an important part of the therapeutic process, especially when working with highly traumatized individuals (such as survivors of violence, sexual abuse, persecution, and other forms of trauma), who have been deeply wounded and lost faith in human relationships.  To achieve trust, the therapeutic relationship needs to encompass a level of accompaniment and transparency (Fabri et. al., 2009).  The practice of accompaniment challenges traditional clinical boundaries (Fabri, 2001) because it criticizes the stance of a neutral therapist.  Accompaniment is an umbrella term that includes a family of related practices: equality, listening, seeking consensus, and exemplary action” (Lynd, 2013; 2012).  It literally means “to walk with, or alongside people” (Gates, 1988).  In simple terms it’s a praxis of being with the patient, rather than being for the patient.

As the therapy develops, and the relationship deepens, there is a switch towards more collaboration, a sharing of power and a practice of overcoming authoritative tendencies – located within the initial therapeutic set-up, as well as within the patient, the therapist and the world at large.

The notion of love and mutuality emerges.  And in the last stage of critical therapy, much in line with Ferenczi, love becomes more apparent, as it is one of the ingredients of therapy.  Having spent countless hours together, sharing stories, developing trust, interrogating the world together, love is part of a real connection between patient and therapist.  Love with another, love for the world, and for humanity.  At this stage, the therapeutic dialogue is built upon humility, faith in each other’s humanity and love, as the therapeutic relationship becomes one of cooperation, where two subjects meet to name the world (Freire, 2000, p. 167). Through this process of naming the world together, both patient and therapist change.Hearts in San Francisco

Love for the patient and with the patient is the ultimate gift of therapy. Both patient and therapist change as a result of this intimate relationship developed over time and withstanding stories of honor, anger, shame, fear, as well as beauty, hope and healing. Communicating, learning how to be with an Other in the therapeutic hour is the blueprint of the art of loving; the art of being with someone, of accepting the perfect imperfections of anOther, of being together.

In closing, we at CTC want to thank all our patients for the trust you give us and the love we share.  Merry Valentine!

 

References

Bodenheimer, D. (2011). An examination of the historical and current perceptions of love in the psychotherapeutic dyad. Clinical Social Work Journal, 39(1), 39-49.

Cabre, L. (1998). Ferenczi’s contribution to the concept of countertransference. International Forum of Psychoanalysis, 7, 247–255.

De Forest, I. (1954). The leaven of love: a development of the psychoanalytic theory and technique of Sándor Ferenczi.

Fabri, M. R. (2001). Reconstructing safety: Adjustments to the therapeutic frame in the treatment of survivors of political torture. Professional Psychology: Research and Practice, 32(5), 452.

Fabri, M., Joyce, M., Black, M., & González, M. (2009). Caring for Torture Survivors: The Marjorie Kovler Center. New Humanitarians, The: Inspiration, Innovations, and Blueprints for Visionaries, Volume 1, Changing Global Health Inequities, 157.

Freire, P. (2000). Pedagogy of the oppressed. M. Bergman Ramos (Trans.). New York, NY: Continuum.

Freud, S. (1993). Observations on transference-love: Further recommendations on the technique of psycho-analysis III. The Journal of psychotherapy practice and research, 2(2), 171.

Freud, S. (1997). Dora: An analysis of a case of hysteria. Simon and Schuster.

Gates, A. (1988). Letter fromAlice Gates.

Lynd, S. (2013, 2012). Accompanying: Path to Social Change. Oakland, CA: PM Press.

Rachman, A. W. (1998, December). Judicious self-disclosure by the psychoanalyst. In International Forum of Psychoanalysis (Vol. 7, No. 4, pp. 263-270). Taylor & Francis Group.

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

Springer, A. (1995). Paying homage to the power of love. Journal of Analytical Psychology, 40(1), 41-57.

Stanton, M. (1991). Sándor Ferenczi: reconsidering active intervention. Jason Aronson.

Ward, C. (1973). Anarchy in action. George Allen & Unwin.

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