The “Sex” of Therapy and the Road to Erotic Transference

The internet is filled with worried psychotherapy patients: worried over their therapists. They are brimming with fear of being discarded, frustrated at their inability to get closer: wanting a permanent relationship, a kind of family tie, or the therapist’s touch. Much of the day is preoccupied with worries involving the counselor, a fresh slant on the distress that brought them into the consulting room initially.

On offer today is the likeness between the “desire” implicit in the client’s wanting the safety and secure guidance of a caregiver … and the romance and caring of a new love.

Treatment begins with a “getting to know you” phase, entirely one-sided, except for the therapist’s way of interacting, the knowledge he imparts, and the questions he asks and answers. But there is more:

  • his attention, concentration, intensity of focus
  • the tone of his voice
  • his physical state of being
  • the office setting (if he approved the decoration)
  • his consideration and understanding
  • the comfort he offers
  • his “presence”

The contact is not so different from meeting a new, potential romantic interest, and going on a date. An appointment is made, a limited time is expected, and the initial stage of acquaintance with “who he is” is part of the agenda. Many questions after the first contacts will still be unanswered in both situations. The newness makes it electric, whether the charge is one of excitement or trepidation.

As feelings unfold, therapy offers a kind of seduction or foreplay: a back-and-forth in conversation, a dance without movement. If there is a desire for physical contact, then the patient experiences the ache before touch, enlarged because he cannot touch: a yearning magnified by the boundary the doctor will not cross (assuming he follows a therapy model insisting on such an invisible moat). The appeal is ancient: the forbidden fruit in the Garden of Eden.

Allowing the therapist inside is an intermediate goal of psychodynamic treatment: to permit release of material in need of expression, of grieving, of working-through. Transference is expected: the development of feelings about the counselor similar to those tied to significant people in the client’s past, including parents. Without the patient “exposing himself” and dropping his guard, a dynamic therapy will be unsuccessful. To continue the many metaphors here, you are giving yourself over to the other, putting yourself in his hands.

Jealousy may develop. There are significant-others in the counselor’s life, known or unknown: lovers, children, and friends. He also maintains a practice full of patients, competitors for his time. The weekly session is but a mini-slice of him, something shared when you are starving and have shared too much in your life already. In the course of working-through the transference, such feelings diminish. The counselor steps more “off-the-pedestal” than earlier, if not fully off. Only, that is, if the transference has been resolved.

Not all treatment models include enough time, in my opinion, on launching the patient into the world. Outside, sympathetic others represent a more appropriate target for strong and continuing attachment once the client is ready.

Part of the reason therapy is often eroticized is because of our instinctive desire for contact and kindness, a buffer against the inherent loneliness of the human condition. We want permanence and protection to face the transitory inevitability of life. Many of us wish to crawl into another’s skin, not be the solitary creatures we are, manufactured by nature into different sausage casings. We yearn for merging and this yearning is easily sexualized because intercourse involves momentary joining.

The illusion of the perfect therapist can create something of theĀ honeymoon period. The blindness of new love enabled our species to survive. We need the illusion to bond in both treatment and everyday life. A persuasive mirage is not inevitable, but the risk of it is.

Powerful emotional attachment, assuming it happens, is maintained (in part) because of the distance and lack of consummation. Marriage, in contrast, involves consummation, routinized closeness, and repetitive exposure and over exposure. The illusion disappears, at least to some extent. The honeymoon ends and marriages fall into the world of reality from the lofty plateau of apparition and romance. Without a continuous fight against this gravitational force, starry nights and champagne morph into partly cloudy daylight and carbonated soft drinks that have lost their fizz.

A couple of additional thoughts: not everyone develops the sort of attachment I’ve described. Nor is there a way for those vulnerable to enchantment to protect themselves against it. Remember, however, some therapy models depend on the development of strong transference for ultimate healing.

Life teaches us we can’t have everything we want, nor forever keep what we have won. Yet our time here offers the possibility of joy even though many wishes are denied. We adapt. We must adapt.

If impermanence is the nature of things, the sooner one accepts that truth, the sooner one will come to appreciate and enjoy what is still possible here: on a rich, confusing, dark, but dazzling place called Earth.

Two versions of a Starry Night, above: the first by Van Gogh and the second, Edvard Munch. Both come from WikiArt.org.

What to Expect in Your First Therapy Session

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Going to therapy for the first time takes some courage. You are about to talk about some very personal things to someone who is a complete stranger. What can you expect?

1. First of all, expect to be at least a little bit nervous at the beginning. But even before you get inside the therapist’s office, you will have to fill out some paper work. You will also receive a written description of the therapist’s practice, including such details as whether the therapist accepts your medical insurance and how he handles that. Additionally, he will give you information about how your medical records are safe-guarded and the extent to which those records are confidential.

2. The therapist should greet you, bring you into his consulting room, and sit face-to-face with you. Therapists generally want to convey “openness.” It is therefore rare for a therapist sit behind a desk, with you on the other side.

3. After a few “ice breaking” words, the counselor will ask you why you have sought treatment. If you already told him some of this on the telephone, he will want you to fill in the details.

4. Don’t feel that there is a particular “correct” order in which to tell your story. Simply tell it. Initial sessions should generally allow enough time for you not to be rushed. The therapist has probably scheduled at least 75 to 90 minutes to spend with you.

5. If it makes you feel better, it is entirely appropriate to bring an outline of the topics about which you wish to talk, and to consult this outline or read directly from it whenever you need to.

6. The counselor is likely to have some questions for you. He should want to know about your background, not only about the concerns that exist in your life at the moment. Unless he knows about that background, he won’t be able to fully understand how you came to have the current difficulties and whether they represent a repetitive pattern in your life.

7. Among the topics you might be asked about are such things as a description of your parents and their approach to rearing you, relationships with siblings, the educational and social history of your school years, whether you changed residences with any frequency as a child, past and current health concerns for you and your family, the presence of any traumatic events in your life, your dating experience, the place of friends in your life, work background, alcohol or drug use, current medications, present family relationships (spouse/children), financial concerns, and past or current depression or anxiety issues.

Additionally, expect to be questioned regarding any evidence of mood fluctuations, sleep, digestive problems, headaches, caffeine use, suicidal or homicidal thoughts or actions, attentional problems, hyperactivity, hallucinations, delusions, hobbies, religion, how you feel about yourself, whether you are able to be assertive in your life (say “no” or ask for things), diet and eating/weight problems, obsessive thoughts, compulsive actions, and what you hope to get out of therapy.

Of course, there may not be time to touch on all these areas in the first session.

8. You should not feel that you must talk about topics that are too uncomfortable for you. A sensitive therapist will give you permission to cover only the ground you wish to, and a sense of control over the progress of the session, so that you don’t become overwhelmed.

9. The therapist might well ask you what challenges you’ve had in life and how you have managed to overcome them. This kind of question helps the therapist and you to know what strengths you have and to help you remember that you have surmounted past difficulties and therefore can rely on those strengths to help you surmount the current problems.

10. By the end of the session, the therapist should provide you with some feedback about what you have said. In part, this is to help you and the therapist know if he has heard and understood what you have been saying, and whether his initial impression of you seems appropriate.

11. The counselor, to the extent that he offers interpretations of the material you have presented, ought to let you know that this is a first impression and therefore not necessarily perfectly accurate. Any good therapist needs to hear your concerns about him personally, his ideas, the therapy approach he is recommending, and his effect on you. Such a person will not be offended by your concerns and actually wants to hear from you what feels right and what doesn’t feel right about the therapy process.

12. The counselor will normally allow a good deal of time to answer any questions that you have of him and his approach. It is not essential that you make another appointment at that time, although most people usually do. If you already believe that this therapist is not the right one for you, it is perfectly appropriate to say so and to ask him for a referral to another professional.

13. By the end of the session you ought to have a sense of direction and at least an initial treatment plan as articulated by the counselor. The therapist is likely to remind you of the importance of regular attendance and that your dedication to your own healing is essential to obtaining the results you want. Therapy, unlike medical intervention such as brain surgery, requires effort and activity on your part. It is also essential that you have the courage to look at yourself honestly, recognizing that in order for your life to be better you will have to be willing to change some things about yourself.

14. At the end of the first session you might feel exhausted, in part because talking about big emotions is hard work! You are likely to be less anxious than you were when you came into the session. You may feel some amount of relief at having talked about things that you have rarely if ever discussed before. If the therapist has done his job, you should have a sense of hope.

15. In the days following the first psychotherapy encounter, you might well find yourself still processing the material you discussed. This can be unsettling, but it is quite normal. Additionally, a person new to therapy can feel that he has said too much and made himself too vulnerable to the therapist, especially if he (the patient) is a private person. Some people will therefore not return to therapy after the first session. If you have this hesitation, however, remember that it is in your interest to persist despite your discomfort if you sincerely wish to change your life. Good luck!

The above image is the entry to Sigmund Freud’s office at Berggasse 19 in Vienna, Austria. It originally was posted to Flickr by James Grimmelmann and was sourced through Wikimedia Commons.