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by John Ryan Haule
Spring Publications, 1996
Review by Louis S. Berger, Ph.D. on Nov 4th 2005

The Love Cure

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 client.[1]

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".[2] 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)[3]. 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 itself.

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[4]--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.[5] 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.[6]

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)

            We 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)

Haule 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,[7] 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.[8] 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)

Here, 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[9], 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.

 



                                                                         NOTES

[1]. Psychologists' Licensing Act and Rule and Regulations of the Texas State Board of Examiners of Psychologists, July 1, 2005, pp. 67, 60.

[2]. Licensing Act, op. cit., pp. 67-68.

[3]. 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).

[4]. Even 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 psychoanalytic dogma.

[5]. 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."

[6]. The role of Eros in these therapies could be the subject of another book.

[7]. 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, 1992).

[8]. 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. 

[9]. 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

 

Louis S. 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.