Psychotherapy: A special kind of love

Secrets of psychotherapy:

• Psychotherapeutic Eros is a unique form of love

• This flow of love from therapist to client releases the client’s potential for positive change

• Every client wants to and fears change

• Love often requires the therapist to do the opposite of what the client expects

• The notion of transference is a way of denying real feelings

• Clients should shop smartly to find the right therapist

• Therapists can’t help someone who has the same problems they have, or whose value system fundamentally conflicts with theirs

• Conversely, therapists do love the unlovable – when they connect with the client’s vulnerability

• Fees are one of the characteristics that distinguish psychotherapeutic Eros from other forms of love

• The purpose of therapy is to free clients to love themselves and other people

• Therapy love, while flowing from therapist to client, is also reciprocal, and has positive effects on the therapist, too

Love is difficult to define though everyone thinks they know what it is. Throughout life we need to receive love, and we need to give love. We first learn what love is in our parents’ arms. 

As we grow, we learn more about love. We see and experience love in the behaviour of family members and others. With the proper foundation of being loved as a baby and child, we grow to adulthood able to give love and also to feel worthy of receiving it. We’ve learned to love ourselves, the prerequisite for being able to love others.

Love is care, nurture, support and affection.

No finer definition of love (or therapy) has been formulated than that of St. Paul:

“Love is patient and kind; love is not jealous, or conceited or proud; love is not ill mannered, or selfish or irritable; love does not keep a record of wrong; love is not happy with evil, but is happy with the truth. Love never gives up. Love is eternal.”

The Unexpected

People who give and receive such unconditional love are rich indeed. Unfortunately, they are also rare. Many of us grow up love-poor; our first experience of unconditional love may only come when, dissatisfied with life or ourselves, we seek psychotherapy. And then we are likely to be surprised by the therapist’s love. Often, we first become aware of this love when the therapist does not respond the way we expect.

If you were like Corrina, for instance, you’d expect disapproval and a lecture, maybe even physical punishment, if you spoke of your sexual impulses.

Corrina was a 21-year-old woman who, throughout her childhood and adolescence, had been physically abused by her puritanical parents. Now, as an adult living on her own, she felt guilty about anything that brought her enjoyment, especially sexual activity.

She was torn between her desire for a man with whom she wanted to spend a casual weekend, and the recriminations her parents would heap on her if they knew about her “dirty” holiday.

Her surprise and relief were evident when the therapist did not react with horror and condemnation. He encouraged her to make her decision by thinking through what she felt would be right, taking into consideration her religious values, the consequences of sleeping or not sleeping with the man, and whether this would be a repetition of previous intimate relationships after which she felt used and unsatisfied.

Love heals

The absence of love is most apparent in sexual abuse of a child by his or her parent.

Often the pain, shame, guilt and fear suffered by the victim do not end when the abusive act itself is over.

To survive the horror, many betrayed children block out the experience while it is happening. A psychological defence mechanism takes over: the child escapes into an imaginary world in his or her mind, or blanks out.

So effective is this mechanism in its survival power for the child that many abused children, now grown up, have no conscious memory of the violations their little bodies suffered.

Yet, as adults, a wide variety of problems plague such survivors. Phobias, insomnia, destructive relationships, sexual dysfunctions, obesity, alcoholism, drug addiction, are a few examples.

The victimised child has absorbed the perpetrator’s guilt and anger. Often the child feels somehow to blame, that they must be a bad person for Mummy or Daddy to do these things. The self-blame continues into the survivor’s adult life, poisoning relationships and shattering self-esteem.

Prior to therapy, Gail had persistent bowel problems; she half-jokingly referred to herself as “a pain in the ass.” Gail had suffered the real-life nightmare of her husband, Peter, sexually abusing their children. When Gail’s suspicions were aroused the children were 3, 5 and 6.

Youth Protection social workers, and other professionals, were charmed by the handsome, erudite father. The authorities did not believe Gail’s allegations.

The children’s accounts of Peter’s molestations were ambiguous. Even the testimony of Peter’s now-adult sister that he had raped her when she was nine years old did not sway the investigating social workers.

They suggested that Gail herself had probably been abused as a child and was projecting her own trauma onto her children.

To her mixed dismay and relief, therapy helped her recover repressed memories -- Gail’s grandfather had raped her anally when she was five years old. No one at the time, especially her mother, had been willing to believe her.

When the enormity of the trauma now hit home, she felt shame, disgust, guilt, anger and fear. Most of this turmoil was directed at herself.

Gail’s relief when the therapist refused to accept her self-condemnation was palpable. She began to look directly at the therapist, instead of at the floor, her face muscles relaxed; she even managed a real smile.

Gail’s rock-bottom self-esteem, which placed her in soul-destroying employment and relationships, was not rebuilt overnight. Her sense of self-worth had been severely damaged by the childhood abuse (which also included betrayal by her mother who had not intervened) and by Peter’s verbal abuse of her and sexual abuse of the children.

Counterbalancing these horrors was the therapist’s love: their acceptance of her as a person, their refusal to agree that she was evil, and especially their validation that her perceptions were true, all contributed to her growth in self-confidence and self-acceptance.

Love versus fear

Every client going into therapy seeks change, yet fears it. The fear arises from not knowing how to be free from a bad habit, or to feel powerful, or to be able to love, or to be thin, or to succeed, or to leave home, or whatever is the stated aim of the client.

The therapist’s love helps the client tackle the fear of becoming a new person.

Fear also flows from the terror of accepting responsibility for one’s self. Frequently, it is far easier, and it certainly feels safer, to blame someone else for one’s predicament. Richard is a sad example.

He flitted from therapist to therapist, never quite able to develop enough courage to persist in facing up to his rage and guilt. He wouldn’t allow himself to accept the therapist’s love.

Perhaps that would have seemed to be a betrayal of his desperate need for his widowed mother’s approval. The same mother who had sexually abused him until he was eleven years old.

Now 27, Richard sought therapy because his wife had threatened to leave him. She was tired of his accusations, tired of his jealousy, tired of his moodiness.

Unfortunately, she had no insight into her role in maintaining his inner rage and so refused to participate in joint counselling.

Richard was afraid his rage at women would one day erupt into violence against his wife. He acknowledged, but refused to face, that his rage was really directed at his mother. The years she had summoned him to her bed, used his limbs to masturbate herself to climax, and invited him to explore her, had left him shamed, enraged and guilt-ridden.

Not unexpectedly, he’d chosen a wife who proudly proclaimed her premarital broad experiences with many men. In therapy, Richard would not allow himself to examine his rage toward wife or mother. He despaired of ever ridding himself of self-loathing. He particularly despaired of ever being fully accepted or really loved by his mother.

Love as not giving

Giving can be far from love, and is often not motivated by love. The therapist who coddles a client (by, for example, frequent phoning to check on how the client is doing) is “giving” of time and attention; yet the unspoken message to the client is “you probably can’t manage on your own.”

Or, as one client did think, “Oh, my, if she [the therapist] is calling so often maybe I’m worse off than I thought.”

A true act of love would be to leave that client the freedom to draw upon their own strengths to manage life and to call the therapist out of choice.

Love and the lonely

No therapist can work for long without being impressed by the number of people who say they have no one they can talk with. This includes not only the socially isolated but clients who are married, clients who have lots of friends, clients who have families large and small.

Perhaps it is as psychoanalyst Arthur Burton wrote: “In a society which no longer cares, and certainly does not care deeply for its deviants, the therapist remains the one person who really cares about the atypical, the gauche, the awkward, and the crippled” (Burton, 1976, p.134).

Yet therapists of the psychoanalytical school are taught to maintain emotional distance from clients and to refrain from showering them with love. This wisdom is often attributed to Sigmund Freud, the Viennese doctor who created psychoanalysis in the 1800s. Then, as now, other therapists disagreed with him.

Freud’s friend and confidant, Sandor Ferenczi, advocated a style of therapeutic loving that included care, friendship and affectionate contact. His intentions were honourable: he offered clients the love he could see they desperately needed.

Freud, despite his pronouncements on the dangers of such involvement, also became warmly linked with clients. Kissing and fondling as practised by Ferenczi were, however, definitely not acceptable.

Officially, a psychoanalyst was to be detached, objective, simply a neutral screen upon which the client would project their emotional life. The theory holds that frustrating the client’s desires for a more natural interaction will force them to work out their inner conflicts, and grow up. In fact, though, the psychoanalyst does not remain neutral -- on the contrary, he slowly indoctrinates the client in the Freudian faith.

Rogerian love

Freudian loyalists may scoff but many modern therapists agree with American psychologist Carl Rogers that all that is needed to conquer hate and other debilitating emotions is for therapists’ caring to take the form of ’unconditional positive regard’ and ’accurate, empathic understanding’ of the client’s private world. This is known as supportive therapy.

A Rogerian dialogue might sound like this:

Client: “I can’t bring myself to eat in the company cafeteria. I just can’t face all those people."

Therapist: “Mmm. You feel uncomfortable in front of a crowd."

Client: “Yes. Even when I know there’s nothing to be afraid of; these are people I work with. But I just can’t shake the feeling they’ll think I’m ridiculous. It’s the same when there’s a party. I’m sure everyone is going to look at me and I know I’m going to make a fool of myself."

Therapist: “You feel all eyes are on you."

Client: “That’s it."

* * *

[Weeks later]

Client: “I’m less self-conscious, able to enjoy social gatherings now."

Therapist: “You feel confident about yourself."

Client: “Yes. I’ve come to realise that I’m as valuable as anyone else. And I’ve learned to relax. It doesn’t bother me at all to eat in public now. And I’m actually looking forward to giving a speech next week at the company’s Employee Recognition Day."

Therapist: “You’re sure of yourself, you’re in control; sounds like you feel pretty pleased with the changes you’ve brought about."

Client: “You said it."

Although there is no question that some change can be brought about in the behaviour, even the beliefs, of some people by technical means, by threats or by persuasion, personality change requires more.

We shall see that only a therapist who offers love as defined by Carlos Seguin and Paul Tournier can be the synergist who helps a client bring that about.

The steady concern of such a therapist, their consistent empathy, helps to release the client’s inborn capacity to love. As this brings about changes in the client’s daily life, especially their interactions with other people, motivation grows for further therapeutic changes.

In the words of Carl Rogers: “The client moves from the experiencing of himself as an unworthy, unacceptable, and unlovable person to the realization that he is accepted, respected, and loved, in this limited relationship with the therapist. ’Loved’ has here perhaps its deepest and most general meaning -- that of being deeply understood and deeply accepted.” (Sorokin and Hanson, 1953, p.130).

A suicidal client who had been repeatedly betrayed (mostly sexually) by her mother, psychiatrists, and several men, felt she was less than worthless. One of her few outlets for her despair was writing. She kept a diary and she also wrote stories about her fear and her pain. Even this creativity was discounted by her as unimportant.

When the therapist, a published author, expressed interest in her writing and subsequently was genuinely impressed with her skill, the client was visibly astonished.

Her father had always sneered at her desire to write. The client now felt emboldened to share her wish, not only to write, but to be published. The therapist’s encouragement helped the client to change her self-image; she became not only a published writer but a strong person in many other areas of her life.

Transference: denial of love’s reality

“Transference” is a concept invented (followers would say discovered) by Freud. A client whom he had just hypnotized threw her arms around him. In explaining her actions Freud modestly dismissed any suggestion that she was actually attracted to him.

Freud postulated that the client must have been repeating an earlier, affectionate, relationship. Thus Freud was unwittingly thrust into the role of the client’s former lover. This ingenuous convolution was more likely a way for Freud to protect himself from the real-life affection the woman felt for her helper.

Nearly a century later a psychoanalyst claimed: “Freud fashioned the concept of transference as the guarantor of analytic abstinence, as the magic formula against both sexual and ideological temptation” (Lothane, 1987, p.103).

If the concept of transference does protect the therapist, it thereby provides a means for the therapist to maintain a semblance of objectivity – a kind of neutrality which enables him to be truly loving in a therapeutic sense.

Without this concept, the therapist could flounder in the throes of passion, aggression, affection, sentimentality, guilt, rage, etc. – in short, all the customary patterns of “ordinary” human relationships.

An illustration of transference is provided by the former General Secretary of the International Association of Hypno-Analysts:

"The client starts to take an unusual interest in the analyst. He is fascinated by him, tends to over-value his qualities and bores everyone about how clever and wonderful his shrink is – that is, unless the transference has taken on an erotic tinge, in which case he usually, but not always, goes quiet about it (particularly if it is a male client and male analyst).
Bit by bit, emotion by emotion, the analyst is changing in the eyes and mind of the client. In fact, subconsciously, the analyst is becoming somebody else, somebody from the client’s past, sometimes only an imaginary person from the client’s past.
One thing you must appreciate about transference is that it . . . does not take any account of normality, or that which is considered normal. Thus, if the analyst is male, seventy and ugly, he is still likely to observe his client (say, female, eighteen and beautiful) falling into the grip of an erotic fascination for him; or, if the analyst is female and thirty, she is still likely to observe her female client (of, say, fifty) beginning to treat her as though she was the client’s mother.” (French, 1984, p.110).

Transference is supposed to act like a kind of psychological magnifying glass. As one practitioner explains:

"What makes the transference especially revealing is that this superimposed view of the therapist sheds light on the patient’s way of perceiving himself. For instance, he may expect us to come down hard on him for mistakes, the way his father did. Implicit is his sense that he himself is really on the edge of acceptability and had better not make a mistake. It is valuable to think of transference as not merely a way of looking at the therapist, but also as an expression of the patient’s self-appraisal” (Weinberg, 1984, p. 134).

In the introduction to Love and Psychotherapy the author writes that Freud invented transference because he lacked the courage to fully face “the therapeutic significance” of affection between therapist and client, that Freud ended in a bundle of contradictions on the subject, without any facts to support his claims for the existence of transference:

"Freud assumed that the feelings the analyst and the patient experienced towards each other within the analytic situation were not really relevant to each other, but rather were directed towards the father or mother or towards some other childhood figures. [The feelings were projected] in order to avoid an emergence into consciousness of persisting incestuous, painful, or shameful relationships  . . . This transference hypothesis, however, is far from touching the actual nature of the doctor-patient relationship in psychotherapy. It is a completely unwarranted intellectual construct . . ."(Seguin, 1965, p.vii).

While many therapists believe the working through of transference is the essence of psychotherapy, Seguin claims the concept is “not just theoretically unprovable and untenable. [Freud’s] theoretical procedure also frequently has severe and disastrous consequences on the practical therapy. That is easy to understand, if one bears in mind that the ’transference’ hypothesis takes precisely what a patient experiences – his feelings towards the analyst – as the most authentic and valuable thing, and demotes them to the status of a mere fiction, to something inauthentic. And this with neurotics, who have already been made to doubt their feelings of self-esteem. Also deleterious for the psychotherapy is the doctor’s attempt to ’analyze away’ his own feelings of sympathy and love towards his patient, the so-called counter-transference, because he theoretically regards these too as merely ’transferred’ infantile affects which are of no import, and as even harmful in principle. Only noxious self-violation and an all-obscuring dishonesty can result” (Seguin, 1965, p.xi).

A doctor at New York’s Mount Sinai hospital is among those therapists who claim, “In actuality, there is no transference or countertransference. Each person comes with his own image-making tendency, his own moral and ethical values, his own special conditioning. What is important is that the perceptual distortion and image-making habit on the part of both participants be recognized consistently and conscientiously. This persistent effort is required so that the needs do not distort the true being together of the partners in the therapeutic endeavor (Epstein, 1981, p.187).

If transference means anything, it means much more than Freud acknowledged. And it is not necessarily guarding dark, dirty secrets.

Surely it is natural for a client to react to a therapist in ways similar to those they feel whenever they’re accepted and understood.

Such feelings may first have been experienced by the client in real life, such as with family, friends or teachers; sometimes, when there has been little or no actual love, the feelings result from daydreams triggered by movies, books, television, the Internet, or observation of other families.

Love limits of therapists

Even the smart shoppers, however, are probably unaware that a key ingredient in the help they receive has little to do with the therapist’s training and everything to do with their personality: i.e., the therapist’s capacity to love.

But since even the most loving of therapists are human, they do not find it possible to love every client who consults them. Even with the best of intentions, excellent education, and their own therapy, a therapist will not be able to fully love a client a) who has the same problem(s) as the therapist, or b) whose value system conflicts fundamentally with that of the therapist.

Loving the unlovable

Love grows as the therapeutic relationship develops. The client learns he can trust the therapist. But what enables the therapist to genuinely accept a person who, were she not a client, he’d find abhorrent? Vulnerability.

Vulnerability, i.e., the capacity to be hurt by words and thoughts, is a characteristic of being human. We are all afraid.

When the client summons the courage to speak of what deeply concerns them there is a poignant echo within the therapist. At that moment there is an inner recognition of our basic bond. The concerns, the fears, the biases probably differ in their particulars, but the underlying humanity is the same. A psychological, some would say spiritual, connection has been forged.

Once the therapist has this glimpse behind the client’s everyday facade therapy has begun. A special mixture of relief and excitement floods the therapist. It is going to be possible to help this client help themselves!

Therapeutic love is reciprocal

hat psychotherapy is a mutual ’adventure’ and love a reciprocal happening is emphasised by theologian and counsellor Paul Tournier:

"Not only, that is, do I have for the patient as much love as he has for me, but my own personal life is as committed as his to the common adventure of his treatment; our dialogue arouses in me, as surely as it does in him, a fruitful inner debate; the evolution of my own life is going to be affected as much as his – my own self-knowledge, my own liberation from complexes, as well as his . . . . Fine things are often said about disinterested love. But disinterested love is like the one-way charity of almsgiving, whereas all true love is reciprocal” (Tournier, 1965, p.65).

The reciprocal love in psychotherapy is unique. We have seen it is not the same as that between parent and child. But it also differs to the love between friends, between lovers, between teachers and their students.

— Dr Bryan M. Knight, MSW, PhD