Transference and love in psychoanalytic therapy

¶ … transference and transference love, as it is manifest in the psychoanalytic environment. Different therapists have recommended different methods of dealing with this love, which range from simple, knowing transference to idealized transference, and erotic transference. These range from exploring such issues verbally, to the use of surrogates for sex therapy, to sexual involvement with patients. Certain factions within the therapeutic community advocate some or none of these methodologies.

Answering his own question, "What are transferences?" he wrote: "A whole series of psychological experiences are revived, not as belonging to the past, but as belonging to the person of the physician at the present moment.... Psychoanalytic treatment does not create transferences, it merely brings them to light.... Transference, which seems ordained to be the greatest obstacle to psychoanalysis, becomes its most powerful ally if its presence can be detected each time and explained to the person" (1895:116-120). Freud went on to note erotic manifestations of transference, which he deals with in his work on 'transference-love'in Observations on Transference-love (1915a), Freud comments on the paradox by which this form of transference is countered by resistance. However, it also offers the opportunity for "bringing all that is most deeply hidden in the patient's erotic life into her consciousness and therefore under her control" (1915a) through discovering the nature of the patient's most primitive object. It is obvious, however, that Freud had his groupies, as there was a certain brand of women "accessible only to the logic of soup, with dumplings for arguments" -- a rather unfortunate metaphor for those patients whom today we would describe as not sufficiently "psychologically minded." Freud prompted his audience of practitioners against the dangers of counter-transference, in which the therapist reacts to emotions related to transference in his or her patients. Later therapists established that these could be reciprocal or could even result in reprehension or disgust.

When Freud practiced psychotherapy in the early decades of the 20th century, he noted that his attentiveness to patients' needs and problems would illicit a positive response from his patients. He first used the word transference in 1895, in Studies on Hysteria, where he described transference as a "false connection" (Freud, 1895:302). The relationship between transference and love is far from well-defined. This is because the range of feelings harbored by one experiencing some manner of transference can be expected to be at least partially hidden from the analyst, if not from the patient as transference is usually unwitting and subconscious. Given this knowledge, transference could result in love even if this is not realized immediately by the analyst or the patient.

In The Dynamics of Transference (1912) Freud went on to distinguish positive from negative transferences; he then subdivided positive transferences into conscious, friendly, or affectionate feelings and unconscious, erotic positive feelings. For instance, a patient may feel that she is able to get along with her therapist in that he reminds her of a mentor from her childhood; she also can be unwittingly responding to simmilar sensory perceptions that accompanied a previous love interest. Whereas Freud considered positive, conscious transferences as aspects of a therapist-patient relationship that was conducive to recovery in that it built trust and respect; he described these feelings as admissible to consciousness and unobjectionable, persists and is the vehicle of success in psychoanalysis exactly as it is in other methods of treatment" (p. 105).

Freud believed that transference resulted from compulsive repetition. "The patient is obliged to report present material as a contemporary experience instead of, as the physician would prefer to see, remembering it as something belonging to the past. These reproductions... are invariably acted out in the sphere of the transference" (Freud 1920:18). He felt that the subject forgot the original object of strong emotions but that the process of creating these strong emotions remained with the patient. This made the analyst the new object of past libidinal interest.

To refer to this transference as 'love' would be to make several key assumptions about the nature of love. It is to say that love is not only the response to stimuli provided by an external source, but that the essential nature of this source that caused the transference was the perception of a recurring positive relationship. In that the conscience is unable to rule this out as merely a 'professional' relationship, it assigns sexual attractions to the psychoanalyst due to the subconscious need for another person. It can be said that a feeling chooses an object rather than having been inspired by the object.

In 1936, Anna Freud enumerated several transference phenomena, including the transference of libidinal impulses, essentially transference as viewed by Freud. Intense feelings of love, hate or anxiety, inappropriate in the context of a therapeutic relationship, were felt towards the analyst, which she referred to as "eruptions of the id." Secondly, the transference of defense, was a manifestation of defenses against perceived threats are passed to the analyst. The third type of transference she said, was "acting in the transference." This was seen as a reflection between defense transferences and others.

Many analysts contested Freud's work; for instance, some said that a patient's communications as transference. (Strachey, 1934) Others confirm that Freud is correct in assuming that transferrence is not restricted to the relationship between the analyst and the patient. This is especially evident in the way that neglected children relate to members of the opposite sex, which I will discuss at length later. Some contend that such matters are of a different nature altogether, and that transference itself should be limited to the experience of analysts who are affected by this through their patients. Robert Waelder (1956) says: "Transference may be said to be an attempt of the patient to revive and reenact in the analytic situation and in relation to the analyst, situations and fantasies of his childhood.... Transference develops in consequence of the conditions of the analytic experiment, viz., of the analytic situation and the analytic technique" (1956: 367). In that a significant portion of any subjects relationships can be related to early familial situations, one might assume that transference is more specific to the professional environment than the name expressly implies.

Rudolph Loewenstein argues that psychoanalyisis is so unique in terms of relationship between psychoanalyst and patient that, although transferences do occur in a non-analytical environment, that those prompted by the analytical environment are of a separate nature; "In brief, transference in analysis is not identical with kindred phenomena outside it" (1969: 585). It might be argued that this is a semantic argument predicated on what Freud meant when he described a certain situation. In that the analyst has more direct experience with transference in the analytic environment than he or she does as a non-analyst, the discernment of the exact nature of the difference presents itself as a daunting prospect.

Greenson defined transference as "the experiencing of feelings, drives, attitudes, fantasies, and defenses toward a person in the present which do not befit that person, but are a repetition of reactions originating in regard to significant persons of early childhood, unconsciously displaced onto figures in the present" (Greenson 1967: 155).

Therefore, transference may be described in terms of displaced emotions, but is specific to people and to the early childhood with respect to what emotions are being transferred. If seen outside the context of people and expanded beyond early childhood, we can see this phenomenon everywhere in human society; for instance, when one chooses to adopt a new religion or develops a political philosophy, he or she often takes the seminal values or ideas created earlier and transfers them, such as the focus on Christian 'selflessness' that one finds prominent in communist thought.

The ability to transfer emotions from one could be biological in nature, as animals that 'imprint' on one particular animal such as birds do jeopardize their survival by assuming the risks of the other animal. This is characteristic of human sexual behavior; whereas one may have several partners throughout his or her life, it is usually the case that humans consider themselves to be 'in love' with one person at a time. Human emotions such as love or owed ness, usually felt towards family, friends, and love interests, can be just as easily transferred to pets. This is the largest reason why psychiatrists to have found pet ownership to be therapeutic; a pet listens and provides attention in much the same way that a psychoanalyst does.

Recent opinions on transference have been more circumspect, negating the absolutist maxim that perceptions of others that are faulty are always based on transferred emotions; "The proportions in which the patient's experience of the relationship is determined by the past, or the present, vary widely and may change markedly from point to point in the analysis. But the idea of an attitude determined solely either by the past or by the present is an abstraction.... No matter how inappropriate behavior is, it has some relation to the present, and no matter how appropriate it is, it has some relation to the past" (Gill, 1982; 85-86).

According to Rockland, love transferences are almost ubiquitous. They only are seen as the products of psychotherapy or of psychoanalysis because the regressive process that is stimulated in psychoanalysis (less so in exploratory psychotherapy) "encourages increased conscious awareness of primitive, infantile transferences which are otherwise latent, though hardly inactive." He goes on to say the effects of the past are omnipresent: "We all contain within us the distorting prisms of our individual histories and internalized object images, which affect our perceptions of others." (Rockland, 1989; 104)

Rockland claims that there are three types of transference; the 'unobjectionable positive transference,' the 'mildly and moderately libidinized, positive transferences,' and 'the idealized, positive transference.' The first of these has been called 'mature transference' (Stone, 1961), and more recently has been thought of alongside the concept of a therapeutic alliance, or working alliance. However, even the unobjectionable positive transference have some libidinal and aggressive aspects. This is one reason why transference can be thought of as a form of love.

Moderately libidinized transferences, according to Rockland, are usually left untouched in supportive psychotherapy. They are powerful motivating factors in the relationship, underscoring both positive regard for the therapist and a wish to gain his or her love, or to emulate him or her. Such transferences are the most simmilar to conventional love, and provide the most effective motivation for catalytic change in psychotherapy; Rockland notes that they are particularly important in supportive psychotherapy. (Rockland, 1989; 106)

Such therapy consciously promotes this kind of transference; both unobjectionalbe and mildly libidinized transference are encouraged. For instance, if the patient is upset at the therapist, the therapist will ask 'what did I do to make you upset' instead of 'why do you feel upset,' as would an exploratory therapist. Such a relationship would have to be fostered in adherence with the strictest ethical standards; to encourage a patient to love her therapist is good for the therapist in that the patient is more receptive, however it is also good for the therapist in that it insures that the patient will continue to patronize his or her business. Rockland believes that such a relationship could be encouraged because: "respect for the therapist, admiration of the therapist, the feeling that the therapist is intelligent, skillful, and motivated to help the patient are all aspects of the mildly to moderately libidinized positive transferences that both keep the treatment going and give the therapist the ability to influence the patient and his or her behaviors." (Rockland, 1989: 107)

An extreme varient of transference exists in what Rockland calls "The idealizing positive transference." In this example, the patient idealizes the therapist. This is unacceptable in that it shifts the patient's locus of control to the therapist from him or herself. If the patient is prone to such actions, this is a problem in and of itself and counter-transferrance must be employed in order to break this compulsive behavior. As this is the product of the patient's history and attempt to use the psychoanalyst to fill pre-ordained roles, such an idealization can only result in failure as the psychoanalyst fails to fulfill those roles. Additionally, it can cause the patient to experience difficulty in his or her outside life. At such a point, transferrance becomes obsessive and is probably indicative of other obsessive behavior demonstrated by a patient.

To over-ride such notions, the therapist must instruct the patient to clarify what he or she thinks and feels and confront the patient with the nature of the therapeutic relationship and the therapist as a practitioner of psychoanalysis. The therapist then contextualizes the idealization by providing other examples of the patient's obsessive-compulsive behavior. The therapist might then illustrate how he or she isn't an example of the fantastic ideal that the patient has constructed.

Conventional psychology maintains that such dissociations are of immediate necessity when the patient makes the analyst an object of his or her sexual affections. This erotic transference is an attempt to turn a clinical relationship into an intimate and personal one, which undermines the therapist's ability to offer objective and proactive criticism. Although mild expressions can be ignored, consistent erotic transferences are corrosive and few analysts would be able to consistently operate in such an environment, as it tends to lead to the subjectification of the patient's problems.

Such transference can be responded to in the same manner as any idealization of the therapist, as it may result in enmity if it is not confronted. As with general idealistic notions, the patient must be guided to see these emotions in the perspective of his or her general experience with relationships. Parallels are drawn to simmilar instances in other professional relationships that the patient may have had. Erotic transferences may be common in histrionic or borderline patients who are prone to dramatic mood swings that characterize all of their relationships. Rappaport (1956), Blum 1994), Bolognini (1994), and others have also established several categories of transference-love, ranging from affection to perverse hostility. Three examples of transference which most resemble love are erotic, eroticized, and sexualized transference.

The erotic variant evokes the parent/child relationship and it is capable of recognizing the "as if" element described by Rockland that can eventually be referred back to the internal world of the patient. The eroticized transference mostly applies to borderline personalities; in such situations the therapist is idealized and also seen as persecuting. Such usually results in resistance and therapeutic goals are quickly sabotaged. A patient exhibiting sexualized may not only sabotage the treatment process but also attack the therapist, resulting in counter-transference. This is part of the reason why borderline patients are often referred to specialists. Sometimes it is possible for a patient to explore erotic love for the psychologist and also his or her feelings of jealousy and exclusion, and eventually to become aware of the true nature of the therapist's role.

Sue Johnson comments, "It is of the essence of the psychoanalytic process that transference-love in its erotic form should "undergo a transformation." In any of its manifestations -- be it compliance, hostility, seduction, identification -- it will always require that patient and therapist should go through the labours of maturation and mourning; and it is the therapist who must remain alert to the many vicissitudes. (Johnson, 1999: 149)

Some unconventional psychoanalysts use love as a form of therapy. Florence Rosiello, in Deepening Intimacy in Psychotherapy (1995) maintains that erotic love can be especially therapeutic in that many patients can only be healed through experiencing love. Mrs. Rosiello uses a variety of clinical examples to express her early experience with patients who developed erotic transference. Particularly of interest to her were the terminally ill, in that she found that terminally ill patients needed to feel loved in order to help them survive. Rosiello claims that her experience with AIDS patients "altered my understanding and clinical use of erotic dynamics between patients and therapist and began to view sexuality from a theoretical perspective that focused more on mutuality, including mutual emotional risk between patients and therapist." (http://www.florencerosiello.com/book.htm) McCartney (1966), was the best-known advocate of sexual relationship with patients, although such relationships were demonized as harmful to patients (Boas 1966; Marmor 1972b). McCartney quotes Boss's reasoning:

The female analysand begins to love the male analyst as soon as she becomes aware that she has found someone for the first time in her life who really understands her and who accepts her even though she is neurotic. She loves him all the more because the analyst permits her to fully unfold her real emotions within the safe relationship of the transference." In none of his writing does Boss put a limit on the extent to which the analysand should be allowed to go on expressing her needs.... I have found that 10 to 30% require some overt expression.... These patients not only want to think or talk about their relationship to the analyst, but also want to experience the newly discovered possibilities in the language of their emotions, as expressed by the body... (McCartney, 1966:228-29).

This contrasts completely with Freud's more apollonian approach to therapy; by engaging in a compassionate or actively erotic relationship with a patient, the nature of therapy changes altogether. Freud prescribed the use of 'sex surrogates,' which allows therapists to treat patients with sexual dysfunctions with a degree of relative objectivity.

In 1915 Freud wrote, in "Observations on Transference Love," "...Analytic technique requires of the physician that he should deny to the patient who is craving for love the satisfaction she demands. The treatment must be carried out in abstinence. By this I do not mean physical abstinence alone, nor yet the deprivation of everything that the patient desires, for no sick person could tolerate this. Instead, I shall state it as a fundamental principle that the patient's need and longing should be allowed to persist in her, in order that they may serve as forces impelling her to do work and to make changes, and that we must beware of appeasing those forces by means of surrogates."