Saturday, February 9, 2008

The Erotic

"In Treatment," HBO touts therapy

There is a man in my life. I hang on his every word. I observe his every gesture. When he lifts an eyebrow. When his breathing hastens. When his eyes smile. I want to know everything about him, who he is, where he came from, what his family is like. And I remember everything he tells me.

Is this not love? Would not this devotion engender love? (Remember that he is my

Not just because February is the month for Valentine's Day that I wanted to make a few remarks about the erotic transference that appears on Monday nights in this 9 week HBO series. When the male therapist is asked by his female patient (2-4-08 show) whether he thinks about her sexually, he hesitates, then lies, and says, 'No.'

The exploration of the transference, of the patient's fantasies about the therapist's thoughts, controversies over self-disclosure, etc. notwithstanding, when do we ever want to lie to a patient? Don't we want to do two important things in the therapeutic relationship:

*be part of an authentic, though mindful, relationship, and

*not repeat for a patient the experience of not being able to trust her own perceptions

Analytic therapy is a gift of listening, listening with an ear to understand, without judging. But what about the gift of relationship where we admit, at least to ourselves, our contribution to the experience. Isn't this relationship, despite any ideas on transference, also a unique relationship created by patient and analyst? Isn't the space between us, between just us as well? A space where play, in the Winnicottian sense, or hope ala Frank Summers, can happen? Do we really want to lie and inauthentically model to the patient that she has no effect on the world and on us?

I have heard many a colleague speak of love for a patient. Not so many like to acknowledge sexual feelings for a patient. (Of course, one is never to act on these feelings. ) I have also heard many a colleague talk about their anger, even momentary hatred, vis a vis a patient. Why the reluctance to admit to the erotic? This failure of bringing into the light this part of ourselves reminds me of parents who allow their children to watch movies/TV with violent, but not sexual, content.

Yes, the erotic feelings our patients have for us is transference and defense and the expression of gratitude and dependency and..., but is it not also engendered by and from us?

I would love to hear your comments.

Currently, HBO is offering free viewing of full episodes online at


Anonymous said...

While finding Dr. Alexander's commentary thought provoking, I would not feel comfortable posting, for all my patients to see, my part in the erotic transference. I will follow any comments about this intently.

Anonymous said...

This is an interesting and intriguing subject; one I have pondered for many years, not only as it applies to psychoanalysts, but to relationships between persons in other professional positions and those with whom they come in contact. These would include such relationships as teacher-student, minister-parishioner, medical doctor-patient, etc. We’ve all heard the horror stories that have evolved from sexual interactions in some of these situations (especially those involving minors), and the taboos mandated by professional ethics, have been accepted as proper ways to avoid the sometimes-devastating consequences.

However, here we are not talking about physical interactions, only feelings, and as Dr. Alexander-Guerra suggests, denial of one’s sexual/erotic feelings constitutes a certain dishonesty. In the therapist-patient relationship, this seems to go against one of the basic foundations of effective therapy: creating a sense of trust in the patient by being totally honest and urging the same from them.

For the therapist facing such a dilemma, the denial of erotic feelings can easily be written off as the supposedly benign “little white lie.” In non-therapeutic settings, such lies are usually justified as a bending of truth to spare someone grief or heartache, and are generally considered okay under the proper circumstances. The problem for most of us is that we sometimes stretch those concepts to include lies that can be harmful.

For example, how many of us parents have asked a child to answer the phone and tell someone we weren’t home? How many have told a 14-year-old to say they’re twelve in order to get a cheaper price at the movies? Both instances (and many others) are often considered to be harmless, however, they are not. In the sense of bringing up a child, what these actions do is tell the child it is okay to lie. Worse, they tell the child that his or her parent is a dishonest person who lies in order to gain some seemingly miniscule advantage in life or to avoid interacting with others.

In the case of the therapist, the “little white lie” of denying perfectly normal emotional feelings, may, in some cases, go undetected by the patient. However, one possibility that should be considered in these situations, is that the patient will sense a lie is being told. Most of us can sense when someone likes or dislikes us, even through the best of acting jobs. Likewise, we can often sense when some erotic spark has ignited between us and another person. Even in cases where a patient does not sense anything, there are other factors that may lead him or her to disbelieve. Take a patient who is physically attractive and knows this through interactions with others that have elicited sexual desire. Is this patient then to believe that the therapist, because of some uncanny (and almost humanly impossible) ability, can ignore physical beauty?

The point here is that denial of these perfectly normal feelings of sexual attraction can, and probably often do, erode the trust that has been established between therapist and patient, and that such an erosion can be detrimental to an ongoing, effective relationship.

Not being a therapist myself, I will freely admit that I am out of school here. However, speaking as a layperson, I will say that I consider honesty to be one of the most important facets of any relationship. Were I to sense (even without knowing for sure) that my therapist was being dishonest with me in any way, my inclination would be to think that such fibbing was okay for me as well. In the meantime, I would lose trust in the therapist and begin to wonder what other untruths were being told. Eventually, this scenario would lead to a deterioration of the relationship, rendering it less effective at best, and damaging at worst.

As tough as it may be, and even with the potential pitfalls, I would chose honesty in all cases. Of course, as I said, I am not a therapist, therefore I cannot speak with any authority on the cost/benefit aspect of total honesty in the case of sexual feelings. It may be that that, in such cases, the ends really do justify the means. I can only say that I am glad I do not have to make such rock/hard-place decisions myself.

Rick Boling
WordMerchant Publishing

Anonymous said...

I am not therapist, but a patient. I have loved all my therapists. But, it was that "love" and attachment which kept me alive. And it remains that love which has been my "holdfast" in
in churning waters. In healing from DID/MPD, survival has meant a little girl living within me loving the older therapist, an important attachment for my struggle to heal.