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by John Ryan Haule
Spring Publications, 1996
Review by Louis S. Berger, Ph.D. on Nov 4th 2005
Everyone--patients, licensing boards, the
legal profession, insurance companies, and most particularly therapists
themselves and their professional associations--"knows" that "no
aspect of sex in the context of therapy is ever justified"(p.
137). For example, in my own state, Texas, the licensing act simply prohibits
"any conduct that is sexual or may be reasonably interpreted as sexual in
nature" and even prohibits sexual relationships with any former patient or
What can one say about these kinds of
formal rules, laws, sanctions and the host of informal mores and simplistic
jargon (discussed in chapter 2) pertaining to sexual conduct of therapists? First
of all, they obviously are indiscriminate, rigid, absolute, totalizing; they
are intended to cover any therapy. Second, these kinds of positions on
sexual matters are seen as self-evident; what reasonable person would challenge
them? Accordingly, they are just stated and accepted uncritically,
dogmatically. Third, the ethos implicitly or explicitly assumes that an
imbalance of power exists; the Texas rules, for example, specifically refer to
"actual or perceived power or undue influence they [therapists] hold over
current and former patients and clients".
The clear assumption is that the "doctor"-patient relationship
necessarily is tilted and has a one-way potential for victimization (doctors
can't be victimized, but patients can; therapy cannot be a balanced
relationship). In sum, these are the shallow simplistic views of the
"collective consciousness" (Jung), of "the 'persona field,' the
world of social roles and expectations, with its well-advertised but largely
unconscious and frequently contradictory ideals and taboos" (p. 59). It is
a world of smug, complacent dogma, where everyone knows and militantly defends
the self-evident true rules.
John Ryan Haule opens his book by saying
that "most essays on therapy, Eros, and sex, are treatises on what one should
do or not do, and why. This one is not. My aim is to open up a way of
seeing" (p. 9). The standard
dogmatic approach signals a problem: "virtually every school of therapy
since Freud agrees that stereotyped thinking about a subject betrays an 'unresolved
issue' and requires airing" (p. 65).
Haule wants to unfold "an adequate and detailed understanding of human
meetings as erotic enterprises" (p. 15), and he does. His exploration of
the subject is thorough, intricate, meticulous and rich; I will highlight what
I see as the central points, but urge the interested reader to go to the work
I want to stress straight away that
although he does not emphasize the point, the author's exploration is most
relevant to one particular class of therapies, those that are "experienced
as a human relationship of central importance in people's lives" (p. 10).
Specifically, he is speaking of a psychodynamically informed, long-term, highly
complex, in-depth process--broadly, Freudian and/or Jungian--which
these days is seen at best as an archaic anomaly, at worst as passé,
ineffective, sexist, misguided, an unscientific enterprise based on wild
theories unsupported by empirical data, an approach to be shunned.
Thus, this subtle, complicated, clinically highly sophisticated and nuanced
examination of the erotic in psychotherapy probably will have little interest
for those (especially the therapists) involved in the mundane,
neurobiologically oriented, managed-care driven (ten-minutes-once-a-month
medication checks, or perhaps several insurance-approved "talking"
sessions, or teaching of behavioral management, or "skills
training"), symptom-removal focused
"therapies" that dominate the mental health scene. In these
mainstream approaches, the therapist is essentially a technician, a mechanic
who fixes the patient's "disabilities", and for those involved in
these kinds of medical-model following therapies (therapists, patients and
their families, insurance companies, licensing bodies, the legal system), the
widely accepted naive ethos and codes probably are quite appropriate and even
necessary. Eros is best kept out of the picture.
As already intimated, Haule's position is
that the role of love or Eros in therapy is a highly intricate and very
important matter that deserves careful, clinically-informed exploration in
spite of the usual assumption that the subject has been dealt with adequately
and is closed. But "inhibition [of acts] and erotic energies are not
mutually exclusive" (p. 26). Human meetings in general are erotic
enterprises, and especially the erotic in psychodynamically-informed dyadic
therapy deserves, requires, much more than the stereotypic responses and
applications of simplistic, behavior-centered rules. This deeply experiential
encounter is erotic in the sense that it is permeated by presence of Eros, the
dual-faced Greek god of attraction who binds in friendship but who is also the
god of sexuality. Haule highlights this distinction, emphasizing that commonly
these two aspects of the erotic are conflated. This distinction (admittedly
often difficult to make, elusive, but nevertheless meaningful) and all its many
implications for therapy is a key element in Haule's critique.
Haule explores the relations between
these two facets in general, but especially as they manifest in the therapeutic
field. The erotic energies of which Haule speaks and which he deems a central
ingredient of therapy may well have
a sexual flavor.... But insofar as
they come unbidden and are observed and tolerated without our fastening on
them, emphasizing them, or "acting them out," we may locate them
in the realm of "the erotic" rather than in that of "the
sexual." We want to keep a substantial distinction between these two
terms, erotic and sexual; for the one is essential to our work
while the other is highly questionable. (p. 77)
can also make a distinction within the erotic in therapy that pertains to human
development. In therapy we can distinguish between two broad modalities: those
addressing infantile remnants, and those belonging to maturity--roughly, the
parental, and the egalitarian. As to the former, Haule cites Freud as saying
that one needs to give patients "enough of the love which they had
longed for as children" (p. 85). As we know, most children suffer to a
greater or lesser extent from serving various pathological (especially,
unconscious) needs of parents, siblings, and later, those of many others (e.g.,
teachers). They rarely grow up having been seen clearly and deeply by important
others, seen as who they really are--that is, of having been "met"
sensitively as unique individuals that have a unique, unfolding core. So, as
adults we usually have erotic needs that are manifestations of residues of
these less than ideal developmental experiences. Unwittingly we still long for
"a primal experience, the unquestioned acceptance and security with which
an adequate parent loves an infant dependent upon her in every way" (p.
87). In therapy that means that we do not want to be objects of the therapist's
dispassionate scientific curiosity or therapeutic zeal, or worse yet, to become
a therapist's "successful case".
Thus, for most patients the earlier phases of therapy revolve around
this erotic need. This love
is surely not kindness and good
intentions, nor is it demonstrated by gushing speeches.... [as patients we]
want to be taken seriously.... want the real thing.... We want to be someone's you, to be
valued for the unique individuals we are. (pp.85-86)
draws on the psychoanalyst Heinz Kohut's 'self psychology' for guidelines on
how to appropriately and effectively provide this binding aspect of the erotic,
that which Kohut idiosyncratically called "empathy" and which is much
like the important British analyst Donald Winnicott's notion of the "holding
environment"--a complex psychological analogue to physical holding.
As the patient's old developmental
lacunae become filled,
the emphasis shifts to the egalitarian, mature relationship. These relational
shifts are reflected in shifts in the therapeutic approach, and it is here that
further difficulties and complexities unfold.
Haule makes it very clear that as long as the patient is primarily enmeshed in
issues concerning holding, every form of sexual enactment is precluded (p.
129), but that this cut-and-dried rule now becomes untenable:
Sexual interaction is one modality among
many within the domain of Eros. Therefore, if sex is a kind of erotic
interchange and therapy is erotic from start to finish, we now find ourselves
in a more embarrassing position than we did before investigating the nature of
the love cure. We have established no definitive grounds for excluding sex from
the therapeutic temenos [sacred space].... (p.123) We may well be
suspicious that any form of sex in the context of any therapy will be
ill-advised and even counter to therapeutic intent. But we have reached the
point where we have to admit that the love cure, by its very nature, has to
consider sexual enactment as a very dangerous open question. This places us in
great discomfort vis-á-vis the persona field with its satisfying
certainty.... (p. 134) Because the love cure takes its guidance solely from the
emerging or unfolding self of the patient, it cannot accept rules that precede
the encounter with that unique individual. Therefore, the question of sexuality
has to be left open in principle.... [This] forces therapist and patient to
deal with an immense array of issues, many of which would have been prematurely
closed had the issue of sexual enactment not been left open. (p. 16)
Obviously just being naively permissive
in some simplistic way is an untenable position, for any number of reasons. So
at the very least, if we do not just rule out sexuality by fiat, it may be
considered only in advanced stages of the therapy and even then only when
"the unfolding of the patient's self seems to call for some kind of sexual
enactment, as part of the work itself" (p. 141). In chapter 7, Haule
meticulously explores and enriches by means of clinical examples the many and
complex considerations that arise for all concerned. Much attention is given to
the therapist's own dynamics, to aspects of the therapeutic process, to the
nature of the patient, and to the implications of possibly violating the
accepted dogma about sexuality in therapy. Comprehensive guidelines are
provided for the therapist.
Chapter 8 thoughtfully and insightfully
explores "Marrying the patient." Professional ethics codes are
inconsistent on this subject:
Some absolutely forbid any form of social
contact at any time. Others set more lenient limits whereby social encounters
must be scrupulously avoided for two, three, or five years after termination.
As a society, we are clearly doubtful about friendships and marriages between
individuals who have had a therapist/patient relationship. But we are reluctant
to forbid them utterly. (p. 154)
too, Haule identifies and addresses the many complexities concerning this
matter; he also includes stringent criteria that very few therapist-patient
pairs could meet.
Anyone who is open to the issues
addressed in this excellent, courageous book will gain from reading it, but I
believe that it is clinicians who will profit most. I know that it has been and
continues to be very helpful in my own work. As to philosophers, they can
ponder a variety of issues raised implicitly, such as those concerning ethics,
the philosophy of mind,
and, most especially, questions raised about the limitations of the usual kind
of cognitive, logical-rational, analytical philosophical thinking when one is
dealing with the human dilemma.
Licensing Act and Rule and Regulations of the Texas State Board of Examiners of
Psychologists, July 1, 2005, pp. 67, 60.
Act, op. cit., pp. 67-68.
. In their
interesting The Guru Papers: Masks of Authoritarian Power (Frog, Ltd.,
1993), Joel Kramer and Diana Alstad "view the degree to which a culture is
authoritarian as a barometer of its dysfunctionality" (p. 4).
psychodynamically oriented therapies typically treat manifestations of sexuality
and the erotic within therapy dogmatically, seeing and interpreting them as
pathological transference and countertransference. However, as Haule shows in
chapters 4 and 5, Freud, Jung, and Kohut have provided major exceptions to such
. I have
addressed the conflicting views of different classes of therapy in a number of
publications, especially in Substance Abuse as Symptom (Analytic Press,
1991) and in Psychotherapy as Praxis (Trafford, 2002) in which I dub the
mainstream, problem-fixing approaches "technotherapies."
. The role of
Eros in these therapies could be the subject of another book.
. The idea is
that the belated maturation follows, in Kohut's language, "a program laid
down by their [the patients'] nuclear self" (p. 101), the self that is
already manifested in a rudimentary form in the womb (see Allesandra
Piontelli's From Fetus to Child, Routledge,
. In my view,
the emphasis shifts from primarily providing a holding environment to primarily
engaging in what Paul Gray calls "Defense analysis using close process
attention" (The Ego and Analysis of Defense, Jason Aronson, 1994;
"Undoing the lag in the technique of conflict and defense analysis," Psychoanalytic
Study of the Child, 1996, 51: 87-101); see also Berger, 2002, op. cit.,
especially chapter 5.
. A multitude
of ontological and epistemological issues about the nature of self are raised
indirectly (see my The Unboundaried Self , Trafford, 2005).
© 2005 Louis S. Berger
Berger's career has straddled clinical psychology, engineering and applied
physics, and music. His major interest is in clinical psychoanalysis and
related philosophical issues. Dr. Berger's publications include 3 books (Introductory
Statistics, 1981; Psychoanalytic
Theory and Clinical Relevance, 1985; Substance
Abuse as Symptom, 1991) and several dozen journal articles and book
reviews. His book Psychotherapy As Praxis was reviewed in Metapsychology in January 2003.