Volume 14 l Issue 3 l Autumn 2014 Mutual Desire in the Therapeutic

Relationship by Antonia Colom-Timlin

Introduction rotic transference (ET) and Ecountertransference (ECT) have received media attention through the series ‘In Treatment’ and movies such as ‘Mr Jones’, ‘Basic Instinct’ and ‘A Dangerous Method’. They dramatically portray therapists breaking boundaries and entangled in sexual relationships with their clients, over-simplifying the often misunderstood concepts of ET and ECT. Even amongst therapists there is an apparent tendency to view ET/ ECT as sexual attraction only, when in fact they are so much more. Understanding the word ‘erotic’, derived from the Greek term ‘Eros’ (love), is key to fully grasping the true meaning of ET/ECT, which also include feelings of unconditional love and affection (paramount to building the therapeutic relationship). In fact, Mann (1997) views love and ET/ECT as one and the same. Yet in the literature, ET/ ECT have been described as “erotic effectively (which proved hard to understanding of ET/ECT to feelings horror” (Kumin, 1985), “concepts find) are laid out, as well as some of sexual attraction. While they do that have long been difficult and current perceptions and research. include sexual feelings, constraining mysterious” (Rachman et al., 2009) Finally, a small research study erotic phenomena to these would or “the taboo which silences” is presented (with a total of 63 be doing them a great disservice. (Stirzaker, 2000). Research participants), which explored the Therefore, an exploration of the consistently shows that ET/ECT attitudes of accredited therapists in concept of Eros seems important are commonplace; yet cause Ireland towards the concepts of ET and necessary to clarify the vast uneasiness and avoidance amongst and ECT. array of dynamics (not only sexual) therapists, even from core trainings. Eros and the erotic that occur in the ET/ECT. Eros There is an apparent and surprising In popular culture today, the word (Greek god of love) is a complex lack of guidelines on how to deal ‘erotic’ is arguably and primarily term, which can be hard to define. with ET/ECT effectively. In this linked to sensuality and sexual Mann (1997) clarifies the meaning article, the concepts of ‘Eros’ and pleasure, which could limit our of ‘erotic’ and sees no distinction the ‘erotic’ are explored in order to clarify any over-simplifications of ET n the meaning of ‘erotic’ [there is] no distinction and ECT, together with a review of I between erotic transference and normal love, the literature. Some recommended viewing them as one and the same. guidelines in dealing with these

Irish Association for Counselling and Psychotherapy 19 Volume 14 l Issue 3 l Autumn 2014 between erotic transference and ros is at the heart of all curiosity and desire, all normal love, viewing them as one E creative activity, all commitments to sustain and and the same. All expressions of enhance life, all attempts to share who we are with love generally come under the umbrella of Eros and “Eros leads others, all community building. us into development, complexity ET as a client’s open declaration of ET on a scale ranging from the and unity. It binds, bonds, creates love to the therapist. It is ‘unreal’, milder type (positive fondness/ and is also the ‘mischief maker’ entirely induced by the analytical affection) to the most severe, which (Freud, 1923)” (Mann, 2012, p. situation, and a manifestation of he called eroticised transference 11). It is the longing and desire that the client’s resistance. He views (intense sexual obsession with the drives us to transcend ourselves it as powerful analytical material therapist). This suggests that ET/ towards completion, seeking union that has to be worked through to ECT can be a positive and necessary (Harvey, 1997) and is intimately get to its unconscious roots. He condition for therapy to succeed. related to the term ‘agape’, on defines ECT as the therapist’s Mann (1997) agrees, suggesting that, which Rogers (1962) based his erotic/amorous reaction to the apart from eroticised transference, concept of unconditional positive client, considering it a direct threat ET is an essential part of therapy regard. Ahlgren (2005) defines Eros to analysis, advising therapists and life; an ever-present dynamic beautifully: to repress it. He is clear on the in every relationship regardless of The deeply human urge dangers of reciprocating the client’s gender or age, and one of life’s most to form connections, … to ‘unreal’ love, and warns that there transformative experiences. He work together, to reach is not a therapist who experiences believes that working through ECT beyond oneself and dissolve this who would “find it easy to retain can enable the client to experience boundaries of selfhood, to bind his grasp on the analytic situation” a different and transformative up wounds and restore life, (p.161). Some believe that Freud’s reaction, facilitating change and to move … toward wholeness, demonization of ECT has prevailed development. Bridges (1998) ... Eros is at the heart of all for almost a century, which put description of eroticized transference curiosity and desire, all creative a lid on future examination of is useful: therapeutic Eros, keeping it hidden activity, all commitments to Clinical work often evokes under a veil (Mann, 1999, Stirzaker, sustain and enhance life, all strong feelings including 2000, Bodenheimer, 2010). Eickhoff attempts to share who we are attraction and sexual arousal, (1993) argues that this was as a with others, all community in our patients and ourselves. building (p. 37). direct result of Freud’s worries over the many ‘transgressions’ of It is to be expected. Often, Is this not, precisely, what we are his male contemporaries with their these feelings signal important trying to achieve with our clients? female patients, referred by Springer information about our patients’ If the ‘erotic’ is ever present in (1995) as ‘incest on the couch’. development and relational the intimacy of the therapeutic He believes that Freud’s paper on difficulties, and about relationship, then we need to transference-love might have been a ourselves, and the therapeutic understand it and address it openly direct reaction to Jung’s affair with work to be done (p. 218). as a force that is a very natural part his patient Sabina and to Ferenczi’s It could be argued, in relation of our work; not something that with his patient Elma (and later with to eroticised transference, that should be avoided. This broader Elma’s mother Gizella!). Freud’s often clients’ experiences of love view of the ‘erotic’ (which goes stance on ET/ECT remains unclear (in childhood and beyond) might way beyond just sexual attraction) though; he does state, in a letter to not have been healthy. Love may normalises and expands the much- Jung in 1906, that psychoanalysis have been confused with sex, avoided and often misunderstood is a cure effected through love, manipulation, idealisation, power, concepts of ET and ECT, defined but he never elaborates on this pleasing, etc. Therefore, working next. thereafter. This, again, reinforces through whatever erotic feelings Erotic Transference and that erotic phenomena goes way (whether loving or sexual) might Countertransference beyond just sexual attraction. be present in the room could be a The concepts of ET and ECT In the more recent literature, huge facilitator for growth, hopefully originate from Freud’s (1915) paper the role of ET/ECT has been helping clients to love (themselves on transference-love. He describes demystified. Blum (1973) classifies and others) in healthier ways.

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Managing Erotic and can be initially startling and of transference phenomena” (p.267). Transference and disorientating for trainees; educated Spilly (2008), in her own literature Countertransference to listen to their physical sensations review, learns that the therapist What do we do when we experience in the room (emotional stirring, heat, should find a proper balance between strong feelings of love or attraction arousal in the body); offered models empathy and objectivity (Gabbard, for a client? And when a client has of therapeutic action; facilitated in 1994) and accept the transference these feelings towards us? Whereas increasing their ability to tolerate without seducing the client or there is a vast amount of literature and work through intense sexual avoiding the subject all together dedicated to managing general states; and assisted in considering (Kumin, 1985). She recommends transference, it was surprisingly how to deal with the ECT (whether therapists achieve a level of comfort difficult to find a set of clear to discuss openly with clients or not). with erotic dynamics, as well as guidelines in relation to managing Bridges suggests a list of helpful seeking support through supervision, erotic phenomena safely and questions, such as: ‘What do these peer groups or personal therapy. efficiently, and even less on how to feelings tell you about your client’s Hudson-Allez (2006) link ET/ deal with erotisised transference developmental issues, needs and ECT with attachment and suggest (ie: when a client falls madly in love wishes?’ ‘Do these feelings defend knowledge of attachment theory is with their therapist). Freud’s (1915) against more difficult feelings such as needed. advice was therapist abstinence, rage, terror, denial of vulnerability? Current Perceptions and believing therapists should interpret ‘Do these feelings represent an Research the patient’s ET (without satisfying unconscious desire to love and be In a UK study on therapists’ loving/ it or rejecting it) by behaving like a loved?’ ‘Do they signal a reenactment erotic feelings for clients, Stirzaker detached expert, and suppress their of earlier trauma or abuse by a (2000) sent 107 questionnaires ECT completely. But research shows trusted other?’ and encourages and only 4 were returned, with that this only increases the chances supervisors to share their own ET/ some of the comments stating of breaking boundaries or ending ECT experiences with supervisees. that his study was ‘abusive’ and therapy prematurely (Schamess, She advises that discussing this ‘unethical’. Yalom (1980) also 1999). Jacobs (2004) seems to material directly with clients requires acknowledges that Eros can make view ET in terms of sexual attraction skill and sensitivity, as it is likely to therapists “squirm” (p. 407). only, stating that “a responsible frighten the client. She also warns Schamess (1999) found, from counsellor will not drop the client that there is not enough evidence surveying a class of Social Work when the going gets tough ... (and) to support direct disclosure and students, that many felt attraction/ needs to be sure he can handle a that clients could be burdened or love towards their clients but client’s strong feelings ... such as traumatised by it. However, Bond were uncomfortable addressing sexual desires for the counsellor” (2000) suggests that exploring it. Rodgers (2011) refers to (p.137). Yet he seems to give no openly (with clients) what their findings of 78% of counselling clear guidance on how to actually needs might be from a sexual psychologists acknowledging manage it, except for his reference relationship with their counsellor is loving/erotic feelings (Giovazolias to the “triangle of insight”, whereby a facilitator for growth. Not breaking & Davis, 2001) and 70% to 90% an insight into the transference boundaries is paramount and “the of health professionals claiming links the current dynamic in therapy work (should) remain exclusively sexual attraction (Fisher, 2004). to dynamics in the client’s past, within the domain of fantasy and Moreover, Pope et al. (2006) find and/or to dynamics in the client’s words” (Koo, 2001, p.31). that 95% of men and 76% of other present relationships (p. Spilly (2008) provides an women in their study had been 139). However, this seems to refer exceptionally useful review of the sexually attracted to at least one to managing ‘general’ transference, literature on ET/ECT management. client and felt uncomfortable about not ET/ECT. She concludes that knowledge it. Half of the respondents did Bridges (1998), an instructor in of contemporary psychoanalytic not receive any training around Psychiatry, places the responsibility theory coupled with building the this and only 9% described their on supervisors to educate connection, trust and safety of the training/supervision as adequate. supervisees, suggesting a strategy therapeutic alliance, is what is Martin et al. (2011) find in a UK where supervisees are: encouraged necessary. Rodgers (2011) agrees, study that therapists agreed to combat taboo and silence; taught warning that working ethically with about boundaries at the extremes, that mastering ET/ECT takes time ET and ECT “requires understanding but when it came to fantasising,

Irish Association for Counselling and Psychotherapy 21 Volume 14 l Issue 3 l Autumn 2014 flirting, or touch, opinions varied. 8.40 years, with the majority being open about these issues in recent They found this might increase the accredited for less than 10 years, times or it could be related to more chances of breaking boundaries, and with the range going from 1 openness in Irish culture in general. highlighting the importance of to 25 years. Almost half (46%) Their reported levels of comfort training and supervision. Rodgers’ had trained to Diploma level in telling their peers (Figure 2) is lower (2011) UK study observes the the field, and only one person had though and concurs with other need for better access to training achieved a PhD. Finally, in terms studies, with 63% stating various and that participants had a strong of participants’ preferred working levels of discomfort. In all, only motivation to learn more on the styles, under half (43%) described 32% stated they felt comfortable subject. themselves as Client-Centred, disclosing their sexual attraction In relation to gender, the findings followed by 21% indicating an towards clients to both supervisors of Abramowitz et al. (1976) suggest Integrative approach. and peers, which concurs with that female therapists actively avoid The response rate of 43% was findings that ET/ECT create treating attractive male clients. positive and unexpected, seen discomfort in therapists. Gibson and Pope (1993) found that as it did not match Stirzaker’s Gender appeared irrelevant male participants were more likely (2000) experience of receiving regarding participants feeling to view feelings of sexual attraction only 4 responses, or that love/ both love and sexual attraction towards clients, disclosing sexual erotic feelings in therapy are taboo (with 40% of men and 39% of attraction to clients and becoming (Stirzaker, 2000; Pope, 2006; women). Although for the 84% of sexually involved with former clients Boddenheimer, 2011). This could participants who had felt either as ethical. They quote findings that possibly suggest that, either the love or attraction or both, 70% of male therapists were significantly more likely to approve of and linical work often evokes strong feelings engage in sexual activities with or C including attraction and sexual arousal, in our about a client (Pope et al., 1986; patients and ourselves. It is to be expected. Often, Pope et al., 1987; Gabbard, 1989; these feelings signal important information about Pope and Vetter, 1991). It is in light of these findings and of the our patients’ development and relational difficulties, literature review that the following and about ourselves, and the therapeutic work to be study was undertaken. done.

Findings and Discussion level of comfort around these topics For this Irish study, questionnaires these were male and 30% female. has risen in general in the last were distributed to 150 Similarly, a higher proportion of decade, or that therapists in Ireland randomly-chosen accredited the male sample (76%) felt sexual are generally more comfortable counsellors/psychotherapists in attraction to a client, relative to around love and attraction in the IACP website (75 male and the female sample (36%). This therapy. 75 female). Permission was concurs with Pope et al.’s (2006) sought and obtained from IACP It was found that 52% of findings that 95% of the men and and the participants identities respondents stated to have felt 76% of the women in their study remained annonymous. In all, sexual attraction for a client. It had been sexually attracted to a 63 questionnaires and consent was asserted by 40% that they client. However, more women in this forms were returned. Of these, felt both love and attraction, while study stated they had no problem 25 were male and 38 female. The 84% felt either one or the other. discussing feelings of attraction majority (68%) were over the age These numbers are high and match with peers and supervisors than of 50, with 31% between 30-49. existing research. Surprisingly, men (36% of women compared to This could possibly be explained participants’ reported comfort 28% of men). It is worth mentioning because therapists tend to train levels in disclosing sexual attraction here the findings of Abramowitz et later in life. 70% of participants to their supervisors (Figure 1) was al. (1976) that female therapists were married, which could be higher than what other studies actively avoided treating attractive potentially related to the age profile suggest, with 56% stating they male clients, but these findings are of the cohort. The average years would have no problem. This could of 36 years ago and attitudes might of accreditation achieved was mean that therapists are more have changed since then.

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Figure 1: Participants’ Comfort Level in Disclosing (to their Supervisor) Sexual iven that ET/ECT Attraction Towards their Client. G encompasses not only sexual feelings but also feelings such as 60% love, affection, desire, 50% 56% connection, creativity 40% and transformation, it 30% 35% seems that understanding 20% and normalising it, 10% 0% 6% 3% together with building 0% I'd never tell Very Mildly No problem This is taboo the skills to deal with supervisor uncomfortable uncomfortable it appropriately, is of paramount importance.

Figure 1: Participants’ Comfort Level in Disclosing (to their Peers) Sexual these feelings effectively is striking, Attraction Towards their Client. given the lack of guidelines in the literature and the common 45% finding that ET/ECT is avoided in 40% core training. It is evident that 35% 40% achieving a level of competence 37% 30% around this could be an unusually 25% difficult task, especially with 20% erotisised transference. The fact 15% that participants self-reported could 10% be a limitation to this study. A pilot 5% 10% 6% 6% 0% study would be recommended in I'd never tell Very Mildly No problem This is taboo future, as well as a larger sample peers uncomfortable uncomfortable with participants from several accrediting bodies and posterior face-to-face interviews. In relation to how skilled (2006) and Rodgers (2011) that participants felt in dealing with show therapists did not feel skilled Given that ET/ECT encompasses a client who shared sexual in this area and did not receive not only sexual feelings but also feelings such as love, affection, attraction towards them, 89% adequate training. These results are desire, connection, creativity and claimed they would feel skilled also surprising given the difficulty transformation, it seems that enough to discuss this openly with that was encountered in finding any understanding and normalising it, clients and to work through these specific guidelines on managing ET/ together with building the skills feeling. The majority (68%) of ECT in the literature. participants said they learnt how to deal with it appropriately, is to deal with sexual feelings in the Conclusion of paramount importance to our therapeutic relationship during It is evident that erotic feelings clients. Using supervision, personal their core training in counselling are common in the therapy room therapy and achieving a clear and psychotherapy. Of these, only and still the levels of comfort are understanding of key concepts 38% claimed they would like further not that high. It is also evident in psychodynamic theory and training. Interestingly though, of the from the literature that ET/ECT is a attachment theory, combined with 89% that asserted feeling skilled natural and ever-present dynamic the use of a Rogerian approach, enough, 33% claimed they would that is a facilitator for growth seem to be the way to go in order to like further training too. These when dealt with appropriately. address ET/ECT safely and to help findings do not appear to coincide Participants’ reports of high levels our clients to love and be loved in with the findings of Pope et al. of competence in dealing with the way they deserve.

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(1997). A Handbook of Therapists’ Perceptions and Experience

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