Catherine Jensen, MA, LPC, is a psychoanalytic psychotherapist working in private practice in Colorado. She sees adult individuals and couples in treatment.
“The following complex statement has to be made. The infant can employ a transitional object when the internal object is alive and real and good enough (not too persecutory). But this internal object depends for its qualities on the existence and aliveness and behavior of the external object. Failure of the latter in some essential function indirectly leads to deadness or to a persecutory quality of the internal object.” DW Winnicott
In Winnicott’s “Playing and Reality,” he describes the importance of the transitional object in the life of an infant or small child (Winnicott, 1971, p. 1). The transitional object (stuffed animal, blankie, etc) mediates between the internal life of the infant and the harsh realities of the external world. As the infant becomes a toddler and starts to individuate from her mother, a transitional object, imbued by the infant with powers of warmth and affection, can help the small child navigate the external world with less anxiety.
It would be cruel to insist to a small child that their beloved transitional object is not “real.” It would be equally cruel for a caregiver to treat the transitional object in every way as a sentient being. To shriek with horror and panic if the transitional object were torn, as if the object were in actual pain. This would be confusing and terrifying to the infant. Thankfully, most caregivers intuit, without having to be told, that the appropriate way to interact with the child’s transitional object is in the realm of “as if.” A playful suspension of reality without complete denial of it.
This realm of transitional space, an “as if” relationship, is vital within the psychotherapeutic relationship, as it allows for helpful exploration of all transference and countertransference dynamics. An essential aspect of effective psychotherapy is the consistent focus on exploration of the patient’s thoughts and feelings, in service of greater self-understanding. Part of this exploration includes the patient’s thoughts, feelings and fantasies about the therapist. The patient should be able to freely express what they imagine the therapist is thinking and feeling about them, at any given moment. For these possibilities to stay alive, the therapist must deploy great caution when disclosing any of their own feelings towards the patient, so as not to shut down this explorative space.
Which Sexuality? Which Self?
In Roy Barsness and Brad Strawn’s chapter from Core Competencies of Relational Psychoanalysis, “Core Competency Seven: Courageous Speech/Disciplined Spontaneity,” Barsness shares an instance in which he disclosed erotic feelings to a young female patient (2018, p. 94). He describes the patient as having grown up in a religious household where sexuality was seen as bad/sinful, thereby creating shame within the patient around her own sexual feelings.
Barsness disclosed out of a hope that his expressed attraction towards the patient would be experienced as affirming of her adult sexuality. While an understandable intent, the article does not discuss how overconfidence around the motivation for such a disclosure could prohibit the therapist from exploring other, more unconscious motivations. It also does not discuss the possible negative consequences of disclosing in the midst of a strong Oedipal transference.
In the article, Barsness and Strawn argue that countertransference disclosures may serve the therapeutic function of affirming a patient’s budding adult sexuality while simultaneously not exploiting it (2018, p. 194). Yet a safe parent knows that sexual feelings between parent and child are the feelings, perhaps more than any other, that must stay in the “as if” realm. Gabbard notes, “a father would not tell his daughter that he had sexual feelings for her, even though the daughter might sense such feelings through interactions with her father. The fact that a father does not disclose such feelings towards his daughter allows her to engage in an important developmental task involving a complex fantasy about him as a love object, knowing there is an aura of safety to do so, created by the boundaries the father establishes (2004, p. 142).”
Psychoanalyst Jonathan Slavin highlights this aspect of the parent-child relationship rarely discussed outside of analytic literature, due to the incest taboo: namely, that there is a sensual, affectionate, playful relationship most parents naturally develop with their young children that can contain erotic elements (2002). He emphasizes that while this relationship can feel meaningful for both parent and child, a parent must (obviously) never exploit it by making the relationship overtly sexual, as we all know the worst tragedies and traumas unfold from that violation.
Likewise, there can be a mutual, unarticulated knowing of erotic connection between a therapist and patient. But an argument can be made that the therapist is like the parent in this specific regard (Gabbard, 2004, p. 142), tasked with upholding firm boundaries in service of the more vulnerable, less powerful other. The patient gets to share all they want about their desires, feelings and fantasies; and the therapist upholds the relationship by exercising restraint, in order that the patient’s exploration of their feelings can continue without having to worry about whether the therapist will violate or contaminate the space with their own longings.
Barsness and Strawn bring an interesting question to the fore: in noticing co-occurring erotic and parental feelings towards the patient who has an eroticized transference, is it therapeutic to disclose one’s erotic feelings directly? If the intent is to facilitate the emergence of the patient’s adult sexuality, a worthwhile goal, what are the pitfalls? Psychoanalyst Jody Davies warns against disclosing erotic countertransference in the midst of a drawn out, Oedipal enactments. She explains, “from within a model of therapeutic action that equates analyst with Oedipal parent, the sharing of any kind of erotic countertransference by the analyst can be viewed only as a parent sharing sexual desire with an Oedipal-age child—a seductive acting-out that undermines the patient’s already ambivalent strivings to relinquish ultimately unsatisfying infantile ties” (1998, p. 754). Barsness was hoping his disclosure would help his patient’s emerging adult sexuality. However, disclosing during a period in the treatment when the female patient was experiencing intense, erotic Oedipal longings towards her therapist, according to multiple analytic writers (Davies, 2018; Celenza, 2017; Gabbard, 1994), would be a seductive acting out on the part of the therapist.
A more restrained and protective response to a patient’s erotic transference, compared to Barsness and Strawn’s arguments, can be seen in Jonathan Slavin’s article, “The Innocence of Sexuality.” In it, Slavin writes of a male therapist’s work with a female patient who expresses erotic transference, mainly, that she would like to know, “Do I turn you on?” (Slavin, 2002, p.70).
He takes great care not to shut down flirtation or erotic longing as expressed by his patient. Importantly, he also does not shut down these erotic feelings nor impulses within himself. However, rather than verbalize them, the therapist instead allows his own feelings to exist within the transitional space of the therapy room without directly disclosing them (Slavin, 2002, p. 69).
An important reason for this kind of restraint is that when it comes to countertransference disclosure, we can never be certain which “self” within the patient will be impacted, or in what manner. As Gabbard explains, “I cannot be certain if the patient’s sexuality I am disclosing to is pre-Oedipal or Oedipal (1994, p.10 ).” As psychoanalyst Philip Bromberg articulated, we are not one unified self. Rather, the younger, more regressed and traumatized self-states remain a part of us, even if dissociated (1993). Long-term psychoanalytic therapy often puts patients in touch with aspects of the self that have long been dissociated or repressed. Many of these self-states may feel traumatic when unearthed (Davies 1994, p. 92). Therefore, every therapist must tread carefully with their disclosures, knowing that a patient’s response may be very “adult” and mature-seeming, while more regressed or traumatized reactions remain hidden from the therapist’s view.
When it comes to countertransference disclosure, we can never be certain which “self” within the patient will be impacted, or in what manner. Long-term psychoanalytic therapy often puts patients in touch with aspects of the self that have long been dissociated or repressed.
Sex and Gender
Heterosexual male therapists with female patients are in a uniquely fraught position vis a vis this subject, given the sociocultural context both patient and therapist are imbedded in. While many contemporary analytic writers have offered provocative and necessary criticisms of the gender binary (Saketopoulou, 2023; Hansbury, 2017), along with its repressive sex and gender norms, we still must hold the “reality principle” in mind regarding the world our patients live, work and love in. A reality that includes the recent #metoo movement, which brought to light how widely prevalent sexual harassment and assault of women still is, and how widespread is the act of men violating the ethics of their professions.
Even more recent to the news cycle, the sordid details of Jeffrey Epstein’s sexual crimes against women and girls, and the many powerful men who were complicit. For the analytic community to assume that because the average analyst or analytic candidate is progressive and queer affirming means that talk of “women and men” and power dynamics within this binary is outdated or gender essentialist seems reckless to this author. And yet, that is some of the critique I have received from colleagues when broaching this topic. Is there a defense at play here, perhaps covering a fear? One cannot know for certain, but it has left me curious.
Contained in each of us is the polymorphous and perverse, the male and female, the heterosexual, bisexual and homosexual. Characteristics considered traditionally masculine and feminine, to varying degrees integrated, exist in each psyche; shaped by genetics, the early caregiving environment, and society. A female therapist is also capable of mishandling erotic countertransference and scaring or overstimulating a patient of any sex/gender identity. Any sex or gender dyad could fall prey to the concretization of erotic feelings in the therapy room. My hope, by focusing on one specific gender dyad, is to provide an opportunity for close examination of particular dynamics. Who really has the phallus, after all? Can a woman, queer or transgender analyst, wield their power in the therapy relationship in a harmful way? Could they indulge in their own narcissism or sexual desires, or intervene to soothe their own anxieties, to the detriment of a treatment? Of course.
Mutual Yet Asymmetrical
Several Relational analytic writers, on the topic of erotic countertransference disclosures, have emphasized the need for mutuality in the treatment (Bonovitz 2010; Barsness & Strawn 2016, Davies, 1994). To disclose is to offer the patient an opportunity to know the analyst, to experience a healing and authentic relational intimacy, and to integrate their experience of the therapist with the therapist’s own self-reports. The “blank screen” has been helpfully deconstructed by Relational writers, forcing psychoanalysts to contend with their own subjectivity, and the inevitability that patients will notice things about them, whether stated explicitly or not. Yet we must wonder when a stance towards mutuality may veer into unhelpful, even traumatic.
For the “as if” nature of the therapeutic relationship to remain in tact, the therapy must remain asymmetrical. Lewis Aron talked of the mutual, yet asymmetrical, relationship between therapist and patient (1999, p.245). Mutuality exists, and is important. The therapist shows up in an authentic way, is committed to listening, remaining as neutral as possible in regard to the patient’s own conflicts, and brings with him an attitude of care, genuine affective engagement and often, over time, love. The therapy relationship, however, is also asymmetrical. The focus of any given session is on the feelings, thoughts, desires and fantasies of the patient. The patient has come to receive help for something; the therapist is tasked to help. Insofar as any countertransference disclosure is concerned, it must always be in service of the patient.
Christopher Bonovitz is one psychoanalyst and writer who has provided us a vignette, an example of how the therapist’s desire to provide a mutual experience for the patient can result in a jettisoning of the asymmetry which holds the therapeutic frame together (2010, p. 636). His case example in the article “The Interpersonalization of Fantasy: The Linking and De-linking of Fantasy and Reality” brings to the fore questions of how to balance mutuality with asymmetry, and whether traumatic reenactments can ultimately be helpful to the patient. In it, he describes a disclosure of erotic countertransference which was experienced by his patient, Martha, as a traumatic impingement (2010, p. 638). The clinical vignette is moving, with Bonovitz paying attention to his patient’s reactions, devotedly working through the fallout from the disclosure with her. What I would like to challenge are some of the ideas around mutuality found in this piece. Bonovitz states, regarding countertransference disclosures that are received poorly by the patient:
“The analyst feels hoodwinked, filled with shame, and the patient feels imposed upon by the analyst’s unhinged desire. The fantasies, what had felt to be mutual, devolve into a concrete reality devoid of imaginings and symbolic potential; the bridging of subjective experience in patient and analyst becomes reduced to blame and misattributions (p. 636).”
The claim I want to make here is that within a Relational framework where mutuality reigns, and the intersubjective matrix is seen as perhaps the main vehicle for change, the reasons why asymmetry is so important can become obscured. An overemphasis on mutuality may create a therapeutic environment in which the therapist’s own feelings in response to the patient are assumed to be more valuable than they are to the process. Countertransference, in this paradigm, may start to take on an almost magical quality, presumed to always tell us something of the patient. Ironically, this can take the therapist out of the “as if” relationship. If the therapist cannot tolerate the uncertainty involved in not fully knowing the patient’s mind, let alone their own, the transitional space can collapse under the weight of the therapist’s assumptions.
In long-term therapy, part of what we may be called to help the patient bear is the opacity of the Other’s mind. An important aspect of good reflective functioning is the ability to tolerate that we cannot read another’s mind (Fonagy, Bateman, 2008). Being able to accept that we never have the full picture, when it comes to another’s thoughts and feelings about us, is a key indicator of healthy psychological functioning. In order to assist our patients in growing this capacity, we must also be able to bear this opacity. When we insist to ourselves that what we are feeling, the patient must also be feeling, we may be at the mercy of our own poor reflective functioning. We may, as therapists, assume a mutuality as a way to soothe our own anxieties. This risks pulling a patient into an enactment where they feel pressured to reciprocate in a way that feels either inauthentic or intrusive.
The opacity of the mind is particularly relevant to human sexuality. Repressed awareness of sexuality has been theorized to be the root of the unconscious (Laplanche, 2007, p. 202). For the therapist to disclose feelings directly could be seen as a demand to be known and seen in a particular way, which may be experienced as a traumatic reenactment, evoking an infantile terror in the patient. It may also pressure a patient into agreeing with the therapist’s experience of the relationship. It may leave a patient feeling overexposed. As Avgi Saketopoulou states, “something in us always resists being grasped and understood, and in that sense, opacity may be seen as a sturdiness in us... that connects to self-sovereignty (2017, p. 8).”
The opacity of the mind is particularly relevant to human sexuality. For the therapist to disclose feelings directly could be seen as a demand to be known and seen in a particular way, which may be experienced as a traumatic reenactment, evoking an infantile terror in the patient.
A mutual yet asymmetrical relationship in the therapy serves to protect the patient from feeling pressured into communicating love to the therapist. All speech, Jacques Lacan claimed, is a bid for love; a desire to be understood (2001, p. 418). Psychoanalyst Bruce Fink elaborates on why self-disclosure on the part of therapist can be seen as an unhelpful flip of roles: “Analysts must not speak much in their own names or talk about themselves so as not to demand to be loved in return by their analysands (2015, p. 97).” The analyst, Fink states, needs to be able to love the analysand without expecting love in return (2015, p. 91). We must be careful with how we, as therapists, handle what Lacan referred to as our lack: the inner emptiness in all of us and its concomitant longings. No time in treatment will rid an analyst or therapist of this lack; the best we can do is accept ours enough to not burden the patient with it.
Psychoanalyst Andrea Celenza states, “the asymmetry in the analytic relationship is not an asymmetry of desire, but an asymmetry of the communication of desire” (2017, p.75). A therapist may communicate their desire for the patient, with the conscious intention of facilitating an understanding within the patient of a mutual desire existing in the room. What can be neglected are the dangers of unintentionally or unconsciously pressuring the patient into sharing only of their desire and not of their sexual disgust, fear, rage or hatred. In what ways may the patient protect the therapist in these situations, or ingratiate, in order to preserve the Good Object? In what ways may a therapist unconsciously find themselves honing in on erotic feelings in the dyad, as a defense against more hateful feelings that exist in the treatment room?
On Narcissism
The occupation of psychotherapist is isolating. Glen Gabbard and Andrea Celenza have both discussed the profile of the therapist most at risk of committing sexual boundary violations: the narcissistically needy or lovesick analyst: often male, middle-aged and either single or unhappy in his marriage (Celenza, 2007, p.210; Gabbard, 2007, p.90). It is perhaps a comforting fantasy to imagine such therapists who commit violations as outliers or sociopaths. Yet this is not what the research shows. Up to ten percent of male therapists commit sexual boundary violations at some point in their career (Celenza, 2007, p. 209). Most express remorse and profound guilt in the aftermath. This is not the portrait of an antisocial predator. It is a description of a narcissistically vulnerable, sexually lonely therapist. If such a significant percent of male therapists commit sexual boundary violations, it isn’t a great leap to imagine that a not insignificant portion of male therapists may disclose sexual or a romantic feelings towards a patient in a moment of overwhelm, desperation or arousal: in a way that is narcissistically gratifying and harmful.
In regards to the therapist’s unconscious motivations, Gabbard writes, “The problem is that we cannot know in any thoroughgoing way what we are up to when we decide to engage in self-disclosure. Our capacity for rationalization and self-deception in analytic work is remarkable (p. 10, 1996).” Every analyst must inspect his motivations carefully, with particular respect paid to the power of unconscious wishes and feelings, along with the therapist’s own defenses against acknowledging embarrassing or shameful parts of the self.
Gabbard writes, “The problem is that we cannot know in any thoroughgoing way what we are up to when we decide to engage in self-disclosure.”
One scenario where narcissistic vulnerabilities can lead the therapist astray involves the everpresent desire for appreciation and satisfaction in our work. An unacknowledged need within the therapist to be admired or appreciated can be acted out in myriad ways. It could make a therapist too eager for the patient to accept an interpretation or disclosure, or even unconsciously seek to justify acting out: if it feels good, it must also be good for the patient. But effective therapy often does not feel good in the moment, and this is true for the therapist as much as the patient.
For the therapist to be helpful, he must be capable of receiving and containing negative, unmetabolized affects from the patient. He must be willing to tolerate repeated criticisms and projections.If a patient has been repeatedly critical and devaluing of the therapist, would erotic transference not feel like a very welcome departure from this demoralizing norm? Is it not possible that a therapist may find himself indulging in the erotic transference and countertransference dynamics, justifying mutuality and the “real” relationship along the way?
Therapists are human, flawed like everyone else. We may have intense feelings or urges erupt in session which leave us feeling ashamed; a pull to sexualize a negative transference when we are discomfited by the patient’s hatred (Celenza 2007, p. 12); a wish to merge with a patient in our loneliness (Gabbard, 2007, p. 76); incompetence in the face of a therapeutic impasse; a want to feel desired (Fink, 2015, p.102). While none of these countertransference reactions are inherently shameful or “bad,” it is imperative that we acknowledge them to ourselves; or at least, acknowledge their possibility.
One clue that narcissistic vulnerabilities are at play when it comes to erotic countertransference disclosure, in particular, is that no one seems to advocate disclosing sexual disgust towards the patient. Perhaps that is because it is universally intuited that such a disclosure would be deeply humiliating and potentially traumatic to the patient. How can we be so confident that a disclosure of our attraction and arousal, the other side of the same coin, couldn’t also be experienced as humiliating and traumatic? Desire and disgust aren’t mutually exclusive, after all (Saketopoulo, 2023) and we can never be sure that one feeling won’t follow the other.
One clue that narcissistic vulnerabilities are at play when it comes to erotic countertransference disclosure, in particular, is that no one seems to advocate disclosing sexual disgust towards the patient.
The Relational Turn
An openness within some analytic communities towards the use of disclosure of erotic countertransference is a partial outgrowth of the Relational turn in psychoanalysis. A number of psychoanalysts who identify with the relational tradition have written about the positive uses of countertransference disclosure within the therapeutic dyad (Maroda, 1994; Davies, 1994; Aron, 1991). When used judiciously, these analysts describe how disclosure of certain affective states can help: facilitate mentalizing, break through an impasse, clarify an enactment, and promote deeper self understanding within the patient.
Jody Messler-Davies has written perhaps the most well known Relational psychoanalytic paper detailing a disclosure of erotic countertransference, in her 1994 paper titled “Love in the Afternoon.” It is a particularly compelling case example of the possible therapeutic benefit of sexual countertransference disclosure. It is also diverges from the examples involving male therapists referenced earlier in this paper, in important ways.
Foremost, Davies disclosed in a state of irritation and exasperation, not arousal (1994, p.165). She seemingly was not seeking to name some sort of mutual attraction in order to minimize overwhelm over her own desire. Rather, she was at a loss in regards to her male patient’s insistence that she could never return his feelings. He was unconsciously determined to not recognize Davies’ sexuality as a traumatic reenactment of the Oedipal dynamics in his childhood. This refusal was not only creating an impasse in the therapy, it was ruining his romantic life. So, Davies made a chess move. In stating directly yet decidedly not flirtatiously, that she has had sexual thoughts and feelings about him, she essentially forced her patient to face reality (1994, p. 165).
The gender/sex dynamics of this disclosure are paramount. As Jessica Benjamin has argued, for a boy to recognize that his mother has her own subjectivity is the next developmental achievement following rapprochement. If this achievement is never realized, misogyny flourishes (1988, p. 64). Women are forever seen as objects more than subjects. This is likely still of particular importance for men, as we continue to live in a society and culture where women are seen as the desired and men as those who desire. For a woman to share that she has her own sexual feelings and thoughts apart from the fantasies and imaginings of a man is an assertion that she is a whole object and subject. In a world where a man is largely assumed to desire, a disclosure from a male therapist to a female patient holds very different connotations.
Relational psychoanalysts often discuss the turn from a “one person” to a “two person” therapy relationship, or a transition from a sole focus on the subjectivity of the analysand to a treatment focus that also takes the analyst’s subjectivity into account. Barsness and Strawn, in their article advocating for the use of erotic countertransference disclosure, interpret the “two person” approach as non-heirarchical. Barsness argues that the patient deserves access to the analyst’s mind (2018, 190). This stance confuses mutuality with symmetry (Aron, 1991) and is an abnegation of the power dynamics inherent within the therapeutic relationship. Andrea Celenza cautions that an egalitarian attitude towards psychotherapy “is an assertion made solely from the therapist’s conscious point of view, essentially sidestepping the perception and experience of the therapist’s power from the patient’s point of view” (p. 61). This power differential is heightened within the male therapist/female patient dyad, given the patriarchal power structures imbedded within our cultural and systemic contexts.
In a “two person” psychoanalytic therapy, the therapist, of course, still has obligations and responsibilities to the patient. With the freedom to disclose countertransference comes great responsibility. In a more classical analytic treatment, the analyst could hypothetically retreat behind the safety of the “blank screen,” attempting to remove a portion of their subjectivity with a more rigid analytic stance, which included an almost total lack of deliberate self-disclosure. By comparison, a therapist operating out of an intersubjective or relational stance must think about, deliberate, and practice discernment around countertransference, arguably even more, with even greater care; with a sizable dose of self-doubt, and a profound respect for unconscious forces and motivations always present within themselves. If an intervention is on the table, it must be deliberated carefully, especially when it comes to the erotic.
Barsness and Strawn state, “as there is no such thing as a blank screen, everything we do is some form of disclosure, so it seems wise to talk about it, rather than try and convince ourselves that we can hide it” (2018, p.139). This articulation assumes that the primary reason a therapist would decide against countertransference disclosure is in an attempt to “hide” themselves from the patient. This excludes another option, one in which the therapist creates an environment where the patient can explore endlessly, without fear of being shut down. Ideally, a space in which the patient can feel, think and say anything, and the therapist can feel and think anything.
As Gabbard points out, “There is, however, a vast middle ground of exploratory activity between inaction or projective disavowal, on one hand, and open disclosure of erotic feelings on the other” (1996, p.10).
Another argument Barsness and Strawn make for disclosure is that to share one’s feelings is to be authentic. They state, “when an authentic response is offered, the patient is able to gain a greater sense of what his/her actions mean” (2018, p.139). Unfortunately, this perspective is at risk of conflating authentic with intrusive; even lascivious. Curiosity can be authentic. What of playful, transitional space? What of an allowance of the patient’s flirtations towards us, without either overtly rejecting or reciprocating them? Are these reactions to erotic transference really inauthentic, or a show of good clinical discernment and self-restraint in service of the treatment.
The Trauma of Sexuality
The caution I am advocating for here is informed by Laplanche’s theory that we are traumatized as infants by our caregiver’s sexuality (2007, p. 201). While the very existence of unconscious sexuality in the parent becomes traumatic to the infant, a more severe and harmful trauma occurs when there is sexual abuse or violation. Then, the sexuality of the person who has more power in the relationship is experienced as a traumatic intrusion, which has the power to fragment the child’s psyche. I believe there is a powerful parallel between the caregiver/infant dyad and the therapist/patient dyad in the case of sexuality and countertransference disclosure.
While a patient will notice our sexuality in the room, our task is to help them translate what they experience into their own meaning, not to intrude with our own explicitly stated or acted out desires. While the arguments for disclosures I have referenced thus far would argue that the patient knows on some level about the therapist’s feelings, anyways, I would argue that it is often more helpful for the therapist to help the patient tolerate opacity in these scenarios. To explore with the patient their imaginings, arousal, excitement or terror regarding their own sexuality, in relation to the therapist’s. To help the patient find their own translations and meanings, while also learning how to tolerate the uncertainty always involved in relationships and sexuality. One can do all of this, while staying alive and fully human in the treatment room, without directly disclosing feelings in return.
How is sexual countertransference disclosure uniquely threatening to the “as if” relationship, thereby necessitating extra caution? For starters, the nature of sexual arousal is singularly excessive, shame-ridden, unsymbolized and potentially traumatic (Stein, 1998, p. 596). Davies has posited that sexual arousal is perhaps the only affect that parents do not symbolize for their children via language (2013, p.172), making the experience of arousal in the therapy room particularly prone to accompanying feelings of shame, overstimulation and/or threat. Many patients in psychoanalytic treatment come into adulthood with sexualities containing ancient unresolved elements of “power, control, feelings of being used and using, hurting and being hurt,” (Slavin, p. 51). Sexual countertransference disclosure may cause any number of these elements within the patient erupt to the surface in a traumatic and terrifying way.
Can Erotic Countertransference Disclosure within the Male Analyst/Female Patient Dyad Ever Be Helpful?
While I have spent this article criticizing several written defenses of the positive use of erotic countertransference disclosures, I would like to also include one example of disclosure from the psychoanalytic tradition which may be counted as the exception which proves the rule.
In Slavin and Rhamani’s article, “Moments of Truth in Psychoanalytic Treatment,” a vignette is shared in which the male therapist, Dr. S, is working with a young female patient with a history of childhood sexual abuse. There occurs a moment when Dr. S looks at his patient, noting to himself that he finds her sexually appealing (Slavin, p. 57). The patient notices the look, and frantically asks, “What are you looking at?” (p. 57). The disclosure already happened, and it caused an immediate rupture. Dr. S had an unfortunate choice to make in the direct aftermath of that moment. He could refuse to acknowledge the look, thereby leaving the patient in not only an extremely frightened state, but also in a place of doubt as to whether what she had seen was real. Or, he could affirm her perception, and ground her back to reality, albeit a frightening one. Dr. S chose the latter (Slavin and Rhamani, p. 58).
If we take the vignette of Dr. S in the Slavin and Rhamani article as the notable exception to the enjoinder for male therapists not to disclose erotic feelings to the female patient, the exception could be articulated as such: erotic countertransference disclosure may be necessary when the therapist’s erotic feelings have already compromised the “as if” relationship, due to non-intentional, indirect, yet obvious (to the patient) disclosure. In this case, it may be helpful to affirm what the patient has already noticed — if the patient is frightened and acutely distressed by the knowledge of her analyst’s feelings. Disclosure of erotic feelings in this specific instance may actually be necessary for repair, depending on the patient’s response to such an unintentional disclosure. This follows Celenza’s first guideline regarding erotic countertransference disclosures, that the patient already knows about the therapist’s feelings (2017, p.81). Interestingly, the Slavin and Rhamani example does not follow Celenza’s other guidelines, mainly that a disclosure may be beneficial only near the end of a treatment relationship in which the patient is at a high-functioning, post-Oedipal place in their sexual development. Yet, when a patient not only knows about a therapist’s erotic feelings and is frightened by them, the transitional space has already collapsed, and a “last resort” disclosure may be necessary.
Of particular importance here is the affective state of the patient. In Slavin and Rhamani’s vignette, Dr. S’s patient is acutely frightened. The “as if” relationship had collapsed, and the therapeutic space was filled with persecutory objects (Winnicott, 1971). Yet another important difference between Dr. S’s disclosure and the other examples discussed earlier in this paper is that there is no indication Dr. S disclosed his feelings in an enactment; or, in other words, to discharge his own intolerable affect. Dr. S’s disclosure did not seem to be the consequence of not being able to tolerate his own sexual feelings towards the patient. Notably, Dr. S also did not blame his patient for his sexual feelings or attempt to interpret those feelings as mutual. He also kept the focus of the disclosure on the patient’s reactions and perceptions, attempting to maintain asymmetry.
Dr. S disclosed his feelings because he knew the treatment was hanging in the balance. He took responsibility for frightening his patient and knew that repair was necessary. The playful, expansive space of the “as if” relationship had already died. He made a decision to disclose what his patient already knew, in an effort to revive the transitional therapeutic space (Slavin and Rhamani, p. 58).
To disclose sexual feelings to a patient is to potentially turn the “as if” space of the therapy room into something too real and potentially frightening.
In summary, erotic countertransference disclosure on the part of the male therapist, towards his female patient, is a therapeutic action particularly likely to harm. To disclose sexual feelings to a patient is to potentially turn the “as if” space of the therapy room into something too real and potentially frightening. Disclosure of sexual arousal within the therapy space, with all of its intensity, along with the consequent affects of fear and shame, is not like “any other” affective disclosure. Its unique potential to obliterate the treatment must be respected.
For a proper level of restraint to be possible, the therapist must be sufficiently aware and tolerant of his erotic longings and sexual feelings towards the patient. To be comfortable enough with these feelings, so as for them to become neither disavowed nor enacted. He must be aware of the narcissistic vulnerabilities which can lead him down paths of grandiose fantasy and pull him into the patient’s unmet longings for merger. Lacan pointed out our universal lack (2015). This is a sense of incompleteness that the infantile, narcissistically wounded parts in us would rather avoid addressing. To see a patient in distress, enraged or even suicidal, expressing their need to know they are desired: what a comforting fantasy to believe that granting their wish would fill not only their lack, but ours. When the therapist cannot tolerate feeling inadequate, refuses to accept the limits on their power to help, thereby obstinately denying their lack, they will intrude on the patient to soothe their own anxiety, and collapse the transitional space.
When the therapist cannot tolerate feeling inadequate, refuses to accept the limits on their power to help, thereby obstinately denying their lack, they will intrude on the patient to soothe their own anxiety, and collapse the transitional space.
The male therapist must be accepting of sexual transference from the female patient and aware of his impulses to merge with or soothe the distressed female patient. While erotic countertransference disclosure is not necessarily a boundary violation, it is of fundamental importance for therapists to be ever aware of the possibility that disclosure of erotic feelings may unconsciously serve the need of the therapist. Gabbard has made the argument of the “slippery slope” in this regard: every sexual boundary violation has likely been preceded by an erotic countertransference disclosure (1994, p. 7).
Perhaps Jay Greenberg, one of the founding fathers of the Relational movement, summarizes it best: “There are always multiple perspectives on the participation of each party. This means that whatever is revealed is simply one person’s understanding at a given moment - never... the last word on the subject... I am not necessarily in a privileged position to know, much less to reveal, everything that I think or feel” (1991, p. 197).
See also:
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References
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I had never considered that there might ever be a time when such self-disclosure of a sexual interest is necessary, albeit in the course of a therapists failure to control their own expression of their internal experience.
One thing that seems to be missing though, is that there is research about the routine overestimation by men of women’s interest in or attraction towards them. I think this context should give even more reason for a male therapist to consider such self-disclosure as a “last resort”, to be used only when a therapeutic rupture is already quite likely. Another aspect is the profound betrayal experienced by many women when platonic relationships are discovered to not in fact be mutual, but to contain hidden motivations and expectations on the part of their male friends, colleagues, and other relationships. In a world where many, many women have experienced even deeper betrayal with CSA and abuse within their adult relationships, the establishment of a safe vulnerability with a man can be an incredibly healing container, even apart from any other work accomplished within. Much of our societal conditioning already sets our worth on our desirability and truly, on our utility to men, so this disclosure risks rupturing what may be the only safe male/female relationship a patient has ever had. The likely cost is simply too high for a perceived benefit that in its very nature is likely to be interpreted through a deeply flawed lens.
This must remain a very last resort, and even that with serious understanding of a likely need for an outside perspective and emergency support for both therapist and patient.
This article is a great argument for mandatory psychotherapy for anyone wanting to practice in mental health on a professional level. Thanks for writing it.