When the Therapist Loves and Hates

• The Embrace
• Hate
• Lucy
• The Breakthrough
• The Primacy of Love

That creatures must find each other for bodily comfort,

that voices of the psyche drive through the flesh

further than the dense brain could have foretold,

that the planetary nights are growing cold for those

on the same journey who want to touch

one creature-traveler clear to the end;

that without tenderness, we are in hell.

—Adrienne Rich

 

The Embrace

She looked deeply into his eyes and he looked into hers. Their bodies were very close, melding with one another. He touched her breast, grazing, and then holding it. Responding with her all, breathing in his fragrance, she embraced him. They were enthralled with one another, the love chemical flowing with the delight that they shared.

Although this may sound like a description of lovers in the first phase of their sexual relationship, it is a description of a mother-infant embrace. Many mothers, myself included, can easily call to mind and re-experience the intensity of having newborn infants. Longing for skin-to-skin contact, needing to engage in the reciprocal dynamic of breastfeeding (the baby needs her empty belly to be filled, the mother needs to have her swollen breasts emptied), the baby’s absolute dependence on the mother and the mother’s experience of total responsibility for the baby—in the earliest days between mother and child, only the other exists.

This “altered state” of consciousness, shared by new lovers and the mother-infant dyad alike, is also commonly experienced by the psychotherapeutic “couple” in much the same way—with longings for contact, a desire to feed and be fed, and the shared experience of total dependence on the other, as if no one else exists during the therapeutic hour. Yet unlike the merging love experienced by mother and infant, this love between therapist and client remains somewhat taboo in therapeutic culture. Because of this, clinicians often unwittingly (and unconsciously) let their clients carry all of the loving feelings for the dyad. We’ve all heard many stories of therapists abusing their power and acting out sexually with clients in the name of “love.” But what of the damage inflicted by avoiding, denying, or otherwise minimizing love in the therapy relationship?

Hate

And then there’s hate.

We have all felt critical, angry, hateful, and exasperated toward others at some point, so it only makes sense that therapists have both hateful and loving feelings toward our clients. We need to be flexible feelers, comfortable with the variety of feelings we experience and also wiling, when appropriate, to express these feelings with clients. But feeling hateful toward clients is extremely uncomfortable for therapists; it is defensive in its very nature when we are expected to be open, undefensive, unreactive, thoughtful.

In the history of psychoanalytic ideas, aggression has generated enormous controversy and continues to be the subject of sustained and intense interest. Sigmund Freud wrote extensively about aggressive impulses and, for him, they were more than a mere branch of human motivations. In Civilization and Its Discontents, he characterized antagonistic tendencies as the primary, dominating, “central and abiding part of human experience.”

Like love, hatred is enormously complex, and warrants serious reflection when it comes up with clients. Without self-awareness, hateful feelings can lead us to hurt and blame our clients, to harm them. How therapists understand and relate to aggressive feelings is critical in the clinical setting, but too often we suppress and repress them, just as we do with love.

In my experience, making room for—welcoming, even—our deepest feelings of love and hate for and with our clients is what makes the relationship truly transformative. If we can bear the vulnerability (which, frankly, we should), our work can be deeply healing for both our clients and ourselves. I present my therapy with Lucy to illustrate the depth of feeling that arises in our work, and to caution against repressing and denying these feelings out of a mistaken belief that we are somehow serving our clients by staying more “neutral.”

Lucy

My new patient was a hooker. She spit this out right after my conventional introduction of “Hello, I am Chris Peterson. Please come in.” There it was, right up front, as if Lucy needed to get past this, deal with whatever she might have expected my reaction to be, and move on.

I felt an immediate liking for Lucy. She was 30, beautiful in a Bohemian way, and sported multiple piercings on her ears, eyebrows, and nose. Her face looked younger than her years, her eyes sparkled, and she practically bounced with energy. She talked about the various men she serviced in lurid detail in an attempt, I surmise, to shock (and test) me. I was rapt, but not ruffled. This was the third time a sex-worker had found her way to my consulting room and, like the others, Lucy was dealing with a past that included abuse, abandonment, and conflicted relationships. All such patients struggle with their own histories, which can include an abusive parent or parents, a competitive relationship with their mothers, and/or leaving home at an early age to escape further pain or degradation. These women want to be loved and to be healed, but are often “looking for love in all the wrong places.” Growing up in an emotionally volatile and abusive family, Lucy had little experience with feeling loved and nurtured. Love came to her through pain, abuse, and incestuous boundary violations.

I focused intensely on her stories, trying to understand her perceptions of herself and her fear of and longing for relationships with others and the greater whole of life. She seemed to have a sense of engagement with me and it seemed like she was open when we were in session, but for many months there was little carryover from one session to the next. She struggled with exposing herself and being vulnerable, and so did I.

I often found myself frustrated—sometimes to the point of utter exasperation—with what seemed like the snail's pace of Lucy’s progress. The stagnation and endless repetition of highly predictable and ritualized patterns in each session were difficult to tolerate. When she was feeling vulnerable and too dependent on me, she would attempt to control the situation and create distance between us by moving into a blatantly seductive role. She would arrive to session dressed in provocative attire, and when the end of the session drew near, she would jump up to leave, announcing that both of us had someone waiting.

This kind of behavior happened most consistently when there was a break in our usual session time or when I left on a scheduled vacation. I wondered aloud with her about how she experienced these changes and absences. Initially she responded to my queries with a look of stunned astonishment, a negation of the importance of the break, followed by a cavalier comment discounting any connection between our separation and her behavior. My attempts to connect with her in a loving way were effectively blocked, and I was aware of how I began distancing myself from her.

After many months of treatment, however, I grew more optimistic and heartened by the increasing depth and overall sense of warmth and engagement that began to evolve in many of our sessions. Lowering my own distancing defenses—and my heightened awareness and sensitivity to how these functions served Lucy—helped me to do a better job of helping her modulate her responses, which in many instances recapitulated her early childhood traumatic experiences and painful feelings. At the beginning of treatment she knew no other way to respond to invitations of what she thought was intimacy; she knew no other way to survive. Yet gradually she developed an awareness of the sources of her difficulty in maintaining relationships.

These obstacles to relationship intimacy had begun during her earliest childhood, followed her through her grade school years, and continued into adulthood; consciously she did not recognize the empty and often self-degrading aspects of her encounters with others. Lucy had been a prostitute for close to 15 years, having started at the age of 15 in a desperate attempt to survive in a very primary way. With few exceptions, her experiences of sexual intimacy were comprised of her being penetrated in an abusive manner. Sexual vulnerability and human dependency carried risk for Lucy and challenged her sense of her capacity to survive.

The Breakthrough

In the real world of therapy there are few “breakthroughs” of the Hollywood kind. However, Lucy and I did experience such a moment in our work, which we both continued to recreate in later sessions. In the beginning of the third year of our work, following a month of increased focus on her longings for and terror of close and loving connections, a silence fell on us during one session. It was not an awkward and painful silence; rather, we both felt it as a deep and meaningful stillness. As we sat together, she looked up at me and I met her gaze directly. We held this gaze for several moments, both enthralled with each other, both moved to an almost orgasmic connection. The long months of avoiding emotional attachment began to give way to a new and intimate connection between us. The energy she had so desperately needed to use to hold me at arm’s distance was now more available for the task at hand—to begin to get critical needs met and to experience a safe, nurturing, and healing relationship.

Throughout the course of my work with Lucy I was brought to the brink of both love and hate. We had to navigate through both extremes in the service of helping her first allow dependence and then to separate. As a psychotherapeutic “couple” we both longed for contact, wanted to feed and be fed, and initially feared one another, but with time enjoyed the occasional shared experience of total dependence on each other. I came to understand the frustration I felt initially as my longing to have her work at my pace and to accept me quickly as a safe and reliable mother. Her defenses against that kind of merging were difficult for me to withstand. I wanted her to taste how sweet and warm my breast milk was and to know I would feed her well—to trust me and depend on me. Her resistant defiance enraged me at times, and as much as I intellectually understood some of what had occurred in her life to create this defensiveness, emotionally I felt rejected. She triggered feelings in me of inadequacy and powerlessness—feelings that, I came to appreciate, she had carried throughout her life. With time we could begin identifying what feelings were hers, mine, and ours.

The more loving feelings arrived gently, but grew steadily. These did not completely replace the hateful feelings, but balanced them in such a way that while both were in play, they were more tolerable and open to a deepening analysis. Lucy initially enacted a bit of sadomasochism in her mode of relating with me, creating pain for both of us. In response, I felt her resistance to my attempts to care for and nurture her, which triggered a sense of impotent, hopeless rage in me.

Lucy and I were able to explore the sexualization of her aggression, along with its possible roots. She recalled moments of intense longing for her withholding mother. The transference-countertransference enactment that occurred early in treatment was interesting and demonstrated an aggressive but essentially erotic interplay. When I was able to ask what she noticed when the seductive behavior took over, she could only say that she worried I was frustrated with her (and I was) and seduction was her way of dealing with that worry. In time, we were able to explore this. Lucy was moved to frustrate me or make me angry in some way so as to defend against the longings she felt at the beginning of many sessions. She also added that she became more certain of where she stood with me if she made me angry.

Her seductive relating was a defensive effort to change negative experiences into positive ones. As noted by Harriet Wrye and Judith Welles in their book The Narration of Desire: Erotic Transferences and Countertransferences, this idea is based on an associative model, which claims that both positive and negative experiences occur together in childhood and can become fused so that seduction (sex) is in the service of an irresistible pull toward a destructive interplay. This destructive interplay had been the only way Lucy could make contact with people, and her aggression projected the illusion of strength. It summoned the armor surrounding and hiding her vulnerability, making her feel self-protected rather than relying on my goodwill. But, to paraphrase Ellen Liegner in The Hate That Cures, although at times the therapeutic relationship might be characterized by a mutual hatred, the patient wants a positive relationship. The therapist must not act upon his/her own feelings of outrage, vexation, or exasperation, but through self-analysis recognize her intense emotions and use them in the service of authentically understanding and connecting with the patient.

Lucy’s feelings of hate subsided and, in time, were replaced by feelings of appreciation. She began to act like a loving person. It is likely that the narcissism of her early caretakers and their failure to act in mature and loving ways toward her were responsible for the development of her pathology.

The Primacy of Love

Why is it challenging to honor the healing potential of loving feelings in psychotherapy? What gets in the way of valuing and expressing love? Is it easier to abandon the issue than to be vulnerable and do the self-reflection and analysis that such feelings call upon us to do?

The capacity for love and concern on the therapist’s part is actually evidence of a healthy and thriving individual, and was considered by Winnicott to be an accomplishment that “develops out of the simultaneous love-hate experience, which implies the achievement of ambivalence, the enrichment and refinement of which leads to the emergence of concern.” In other words, a clinician’s ability to love is vital to the therapeutic endeavor, no matter what theoretical model is being used.

If we as therapists value others and are genuinely interested in serving their well-being without displacing or diminishing our own, we don’t respond first from within a theoretical model—we respond with our hearts and let love guide us. Having our needs felt by an influential and trusted other is critical when we are children, and dynamic, loving relationships remain important throughout our lives. Healthy dependency is embedded in Winnicott’s capacity for concern; it is needed to prevent psychological rigidity and to foster a willingness, and even enthusiasm, for being influenced by others. Loving is a distinct way of perceiving and being with our patients, ourselves, and others. It is rooted in vitality and wonder, and in therapy this feeling comes alive in an emotionally interactive, mutually transformative dance.

People have been grappling with definitions of love for thousands of years and there is no uniform agreement on what exactly love is. Erich Fromm defined loving as commitment of oneself to another without a guarantee. That is hard work. It means trying again and again despite pain and hurt, teaching others how to help us, extending a helping hand toward others at the exact moment we need a hand extended toward us. Is it possible that love is often sidelined in our field not because it is ineffective, but because it is so demanding?

Whereas there is considerable lip service given to what Carl Rogers referred to as “unconditional positive regard,” it is often misconstrued as neutralized affect, not the deep and authentic love and caring Rogers meant it to be. There is an undercurrent flowing steadily through many psychoanalytic tributaries that whispers, “Care less, keep your distance, don’t work too hard.” The implication is that if we as therapists care too much, believe too readily, or get pulled in too deeply, we are foolish. But love is an experience of a deep human connection—on an unconscious as well as a conscious level—that involves generosity, recognition, acceptance, and something like forgiveness.

Being with patients in the therapy room, allowing for an intimate exchange (intercourse, in fact), holding them with words rather than with arms, and containing their intense feelings as they learn how better to contain these themselves is the very essence of my work. It is important that we as therapists devote our clinical, educational, and personal consideration to our love for the client within the therapeutic context as an essential and valuable element of effective therapy, regardless of our theoretical orientations. Psychoanalyst Judith Vida, when asked how love contributes to psychoanalysis, responded:

"It is not possible for me even to enter my office in the morning of a clinical day without the hope and the possibility of love. How can I say what it 'contributes' when it is not an option or a conscious choice whether it is there or not? This is like saying, 'Does it contribute to the therapeutic action that the analyst draws breath, has a blood pressure, and a pulse?' For me, the proper question is not 'whether' or 'if' but 'how.' How is love present—and absent—in the therapeutic situation, and how is it manifested?"

In essence, it is love that makes psychotherapy work. It is the element, beyond theory or technique, that makes transformation possible. And there is no love without hate, as they are inexorably linked. We must we willing to experience all of it so that our clients can too.

© 2014 Psychotherapy.net, LLC