More has been written about resistances arising from aggressive impulses than those arising out of loving or sexual feelings towards the therapist. It is not the aim of this general chapter to enter into a detailed discussion of specific types of transference, but a few words on the erotic transference are perhaps indicated since it usually elicits considerable anxiety in the therapist.
Freud helped us to understand that love is not only problematic in life but also in therapy. Freud (1915b) demolished the boundary between transference love and real love, arguing that the difference between the two was a matter of degree rather than kind. Normal love shares many of the unrealistic aspects of transference love. Like transference love, it has infantile prototypes, it is repetitive and idealising. Freud proposed that when erotic feelings emerge in the therapeutic relationship, they represent an attempt to disrupt the therapeutic work by recruiting the therapist into being the patient's lover.
The intimacy of the therapeutic relationship can be very arousing, especially if the patient is otherwise quite isolated or has difficulty in sharing himself with others. When this kind of a patient finds a receptive therapist who listens to him and by whom he feels cared, this can give rise to a wish for the intimacy to go beyond the consulting room. When we consider the intensity and regressive features of the analytic experience, it is not surprising to discover that it has the potential to arouse very powerful, and often erotically charged, feelings in both patient and therapist. Loving and erotic feelings in the transference are ubiquitous. The neurotic versions of the erotic transference need to be understood, but they seldom significantly interfere with the analytic work - they are grist for the analytic mill. Absence of any loving and/or erotic feelings would in fact be unusual and may indicate the operation of resistance as if the patient cannot tolerate within himself the emergence of such feelings. However, the emergence of erotic feelings in the therapeutic relationship can be more problematic, and when it is, then it is usually referred to as the eroticised transference. The latter is more tenacious and resists interpretations as the patient becomes insistent on the gratification of his erotic feelings and fantasies. Such problematic transferences can develop, for example, when working with a patient who has been sexually abused or where his relationships in childhood were sexualised even if actual abuse did not occur.
The emergence of erotic feelings in the therapeutic relationship is problematic for both parties:
As psychotherapy offers an opportunity for the re-working of parent-child dependency issues, it follows that its erotic components will carry the illicit quality characteristic of incestuous feelings (Rosenberg, 1999:134).
Erotic feelings may thus be experienced as illicit or "bad" and may have to be suppressed. Yet, they typically continue to exert their impact on the relationship:
In the analytic couple, both members fear the activation of eroticism, and this renders the erotic dimensions of transference and countertransference one of the fundamental problems of analytic treatment (Kernberg, 2000: 877).
Effective exploration of sexual behaviour, phantasies - conscious and unconscious - and dreams is often hindered by resistances that affect both patient and therapist. This precludes an understanding of the meaning of such feelings and leaves the therapeutic situation at risk of impasse or of acting out: between five and seventeen percent of mental health professionals admit to sexual intimacies with their patients (Pope et al, 1995).
The confusion for us as therapists arises because the intensity and passion of the feelings that the patient may develop towards us is often compelling. Instead of being pleased for doing a good enough job, we may begin to feel like a long sought-after perfect friend, lover or parent. We may confuse being the object of realistic love and the powerfully seductive experience of being the object of the patient's idealisation, passion and dependence. These reactions, if unanalysed, can seriously compromise our therapeutic effectiveness. The lure of becoming the perfect partner who will cure the patient of his ills can lead us down the slippery slope of enactment. To avoid such enactments, we need to remain alert to the difference between the positive pleasure that we can derive in competent functioning and the ''illusory gains of omnipotent fantasy gratification" (Novick and Novick, 2000) that are an occupational hazard.
From a clinical point of view, the critical question is how we intervene when erotic feelings arise. In a general sense, we need to be receptive to any feelings that the patient experiences towards us, including erotic ones. Given that such feelings are also frequently associated with shame or fear, we help the patient if we can approach this exploration without judgement or anxiety on our part. Working with the erotic in therapy elicits anxiety, no matter how experienced we are. A very helpful discussion of these issues can be found in an excellent paper by Rosenberg (1999). For the purposes of this chapter, I am restricting myself to emphasising only a few aspects of working with erotic feelings:
• Notice the emergence of erotic feelings in your patient and/or in yourself and take them to supervision.
• Think about whether the erotic feelings have an infantile quality. This suggests that they probably reflect the emergence, in the relationship, of attachment needs infused with incestuous longings. For example, one of my patients who had been brought up in care developed a very strong attachment towards me. Six months into the therapy, he hesitantly declared that he loved me and that he often entertained conscious fantasies of the two of us living together. As we explored these feelings, it became clearer to both of us that he was giving expression to a wish for closeness to an attachment figure that he had never experienced in his life because of being placed in care. This wish was infused with more sensual feelings related to a fantasy of being held in my arms and soothed to sleep. This patient's longing for closeness with me had an erotic dimension, but these feelings and wishes originated from a more childlike part of him.
• Think about whether the patient is sexualising the relationship. In contrast to the patient I described above, the one who sexualises the therapeutic relationship is using sexual feelings and fantasies to attack the therapy and the therapist. Another of my patients who was very disturbed would often come to the session reporting the previous night's sexual exploits with young prostitutes. He gave me detailed descriptions of what he did to the young girl and I regularly found myself both repelled and intimidated by these revelations. I felt as if he was relating to me as the powerless young prostitute in relation to whom he felt powerful. This kind of sexualisation is very hostile. In the countertransference, it is often experienced as an assault or intrusion.
• Think about whether the type of relationship that the patient strives to establish is a defence against the erotic. For example, the patient's search for a more dependent, childlike relationship with us may be a defence against the activation of the erotic: the patient may defensively retreat into wishing to be seen as a child in relation to the therapist/parent and deny any sexual feelings that threaten to overwhelm him.
• Think about how erotic feelings are being used in the transference. The erotic transference can be used in many different dynamic ways, for example, as a cover-up for hostility or in an attempt to seek reassurance from us. Whatever its use, it denotes an attempt to seduce us away from our analytic role and this represents a form of resistance. Working through an erotic transference has important implications:
If the patient can tolerate sexual feelings while deeply accepting that they will not be gratified in the analytic situation, then mourning, working through... and sublimation may consolidate an intense relationship in the transference while helping both patient and analyst to begin their process of separation (Kernberg, 2000: 878).
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