FROM THE COUCH TO THE BEDROOM.

Byline: Christopher Lehmann-Haupt The New York Times

Title: ``The Intimate Hour: Love and Sex in Psychotherapy''

Author: Susan Baur

Data: 309 pages, Houghton Mifflin Co.; $23.95

Our rating: Three Stars

``Nothing is so much to be shunned as sex relations,'' said St. Augustine, and American psychotherapy has lately taken up his cry, at least in regard to therapists' relations with their patients. Rightly so, says Susan Baur in her new book, ``The Intimate Hour: Love and Sex in Psychotherapy.'' But, she asks, if everyone opposes it, even to the point of making it a crime, ``Why do sexual intimacies continue among persons who say they are against them?''

Baur continues, ``We have a group of professions whose members are united in condemning sex between therapists and their current clients - 98 percent say it is wrong - yet among the 1.2 million or so individuals out there who offer advice in consulting rooms, hospitals, clinics, churches, prisons and halfway houses, many more than 2 percent enter into erotic relations.''

Could it be that sexual feelings are part of what makes a successful therapy possible? As the author asks, ``How do two people sit across from each other in therapy, becoming closer and more intimate by the hour, without sometimes giving in to the full and natural expression of love?''

Seeking answers to these questions, Baur, a clinical psychologist, explores the literature of patient-therapist relations and finds mostly cases of sexual exploitation and misunderstanding. Books about Carl Jung and Sabina Spielrein; the diaries of Anais Nin and Etty Hillesum; a biography of Friedrich Perls, the Gestalt therapist: All these describe what Freud in another context called ``laboratory explosions,'' inevitable ``in view of the kind of matter we work with.''

More recently, she finds, reports grow scarcer, more formulaic in describing predatory males who prey on vulnerable females, and more one-sided in their condemnation. But, she writes, with the increasing feminization of the therapeutic professions, abuse is likely to diminish. And with the rise of managed care, the rules against transgression are hardening. So strict is prohibition growing that ``serious considerations of the physical attraction that develops so often between doctor and patient'' are getting ``swept under the rug'' and becoming ``undiscussable.''

This distresses her because even in some of the most extreme cases she considers, she can't help detecting certain benefits in the intrusion of sex. As often as patients feel abused, they also feel cared for, she insists. And as much as they are hurt, they are also helped. In short, as she writes in a footnote, ``to say love makes a mess of therapy is not the same as saying it doesn't exist.''

This is not to suggest that Baur believes ``that sex can coexist with therapy.'' She warns, ``Some readers will confuse my desire to understand what happens when doctor and patient are strongly attracted to each other with approval of such liaisons, and others will be so certain that men are always abusive or women always hysterical that they will have difficulty imagining a story that can respect the feelings of both.''

But she is also afraid that the imposition of stricter rules and regulations will inevitably backfire. She writes, ``As teachers, therapists and clergy bid a distracted farewell to intimacy, and as both the helper and the helped feel the frustration of being in a managed relationship instead of a real one, it is possible that the rate of blatant sexual exploitation could rise rather than fall.''

Her message might command more attention were it not quite so muddled in its expression. The author of three previous books - ``The Dinosaur Man: Tales of Madness and Enchantment in the Back Ward,'' ``Confiding: A Psychologist and Her Patients Search for Stories to Live By'' and ``Hypochondria: Woeful Imaginings'' - Baur is good at dramatizing case histories, whether they come from well-known books or from her own original research.

But drawing coherent conclusions from these stories seems to tie her prose in knots of dangling participles and tiresome repetition. Particularly distracting are her lists of attributes nearly impossible to distinguish from one another (like ``insensitive clinicians'' vs. ``dumb and misguided therapists'') and her offhand references to cases she doesn't bother to detail adequately (like Dr. Margaret Bean-Bayog's ``unconventional treatment of Paul Lozano, the Harvard Medical School student who subsequently killed himself'').

All the same, the message of ``The Intimate Hour'' is important. Baur reports that one major problem with psychotherapy is that whatever causes improvement in patients remains indeterminable. Nor, she adds, is there any known correlation between the cure and the kinds of training therapists received.

By the testimony of many practitioners, what seems to matter is some indefinable quality they refer to variously as ``attraction,'' ``mutuality,'' ``hospitality'' and an ``an undeniable bond.'' Baur calls it love in various guises, ``parental, fraternal and romantic,'' and concludes ``that love and possibly sexual attraction are supposed to be part of serious therapy and are supposed to remain unfulfilled.''

What is essential, in her view, is that feelings be acknowledged without being acted out. This sounds like the ability ``to hold two opposed ideas in the mind at the same time, and still retain the ability to function'' that F. Scott Fitzgerald defined as first-rate intelligence in ``The Crack-Up.'' The trouble, as Baur spells it out in her dysphonic but ultimately worthwhile book, is not that dangerous feelings are aroused in therapy, but that they either go unacknowledged or get wrenched into dangerous and untimely reality.

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Photo: no caption (Book cover - The Intimate Hour: Love and Sex in Psychotherapy)