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Playing our cards face up: the positive power of acknowledging sexual arousal within the therapeutic setting.

From the outset we wish for the reader to know that (a) we place ourselves within the Relational School of Psychoanalysis and that our view of counter-transference, though built upon historical psychoanalytic theory, is reconceptualized in the Relational model as a co-created experience and is an essential part of the therapeutic dialogue, (b) all of therapy is disclosure or as will be clarified in this paper, acknowledgement of what is "known", (c) particular Christian sexual ethics may inhibit the idea of acknowledgment in the therapeutic setting (d) as it is also controversial among psychoanalytic theorists/practitioners, we contend that erotic arousal should be acknowledged in a psychotherapeutic encounter and will discuss the varied theories concerning this issue, and (e) using a Relationally Psychoanalytic stance in psychotherapy requires a reconsideration of ethical behavior when dealing with sexual arousal in the therapeutic relationship.

All Therapy is Disclosure

We believe that all therapy is disclosure. We define disclosure as acknowledging and speaking to that which is conscious, and unconscious, that has now emerged to awareness within ourselves and within the therapeutic relationship. There is no such thing as a blank screen, analytic neutrality or objectivity. Therapy is not about deciding when and if to disclose, because everything the therapist does and does not do is a form of disclosure. Therapy is therefore a readiness to speak to material that emerges in the relational dyad and the capacity to sustain the inquiry when the acknowledgement of what is happening is brought into conscious awareness. Bromberg (2006) writes,
   Because unconscious material is
   held to be co-constructed rather
   than revealed, the analyst's role is
   not to avoid personal participation
   in the process, but continually to
   monitor and use the immediate and
   residual effects of his personal participation
   as an inherent part of his
   stance. (p. 131)


The therapist's experience is linked to the patient in both subjective and intersubjective ways. Bromberg (2006) believes that unconscious affects, thoughts and fantasies are dissociated in both patient and therapist so they must be processed in order to bring them into "symbolization through language" (p. 131).

Transference-counter-transference enactment is the process by which patients' dissociated self-states, or what Bromberg (2006) calls "trauma-derived emotion schemas" (p. 136), make themselves known. But because conscious and unconscious affects, thoughts and fantasies are both co-created in the analytic dyad and non-linear, the therapist must put his/her own experience into words in order to make sense of the enactment. As Bromberg (2006) states, "patient's pressure to force the analyst to give up his right to privacy is organized not simply by a need to know the analyst, but by a wish to know what the analyst knows about the patient but has dissociated" (p. 145).

This creates a situation that Owen Renik (2006) refers to as flying blind. Flying blind is admitting that all we really have is our experience of being with the patient, and subsequently we don't know with certainty what will provide a corrective experience for him/her. While we can never know all our blind spots, make no mistake; patients will see many of them. For this reason, therapists must take their patient's feedback seriously. If patients' perceptions/feedback is ignored, interpreted away, or if patients are forced to explore without the therapists authentic response, dialogue is effectively shut down and the dissociated will stay inaccessible (Bromberg, 2006). Furthermore, therapists must place their perceptions of themselves, the patient, and their interaction on the table, which may require the "analyst to say a good deal about him or herself sometimes more than is comfortable" (Renik, 2006, pp. 54-55). However, when the therapist can play his/her cards "face up" it invites an opportunity for the patient and therapist to compare, contrast, and explore their perceptions. The dissociated becomes symbolized and the patient has the opportunity to explore their participation in this particular interpersonal relationship. This may be similar to the advice given by Karen Maroda (2004) when she suggests:
   The only tenable position for us to
   adopt is to focus on the nature of the
   interaction and the emotional states
   of the therapist and the patient at the
   moment to determine what approach
   is most genuine and humanly possible.
   (p. 21)


A Brief History of Countertransference Disclosure

The conceptualization of counter-transference has a long and complex history. Freud first considered counter-transference to be residual unanalyzed aspects of the therapist's past that threatened to interfere with the patient's transference and disrupt the therapy (Kahn, 1979). The goal for the therapist was analytic neutrality (i.e., not siding with the id, ego, or superego) and maintaining a blank screen (i.e., not disclosing anything that might interfere with the patient's "pure" transference).

Object Relations theorists re-conceptualized Freud's theory of the mind replacing biological drives with relational ones. While not entirely dismissing Freud's idea, they also understood counter-transference as a projective defense mechanism; the patient projecting unwanted aspects of the self into the therapist and then unwittingly identifying with these projections (Maroda, 2004). This occurred either through concordant counter-transference where the therapist feels what it is like to be the patient in his/her unique childhood, or through complementary counter-transference, where the therapist feels what other important figures in the patient's history have felt toward the patient (Racker, 1968). Contemporary psychoanalytic relational theories have taken the understanding of counter-transference to newer vistas. Based on changing models of the mind, such as multiple self-theory and the theory of intersubjectivity, Relational theorists resist the conceptualization of an "independent mind" and see all interaction in therapy as transference-counter-transference interaction or "enactment" (Maroda, 1998, p. 517) and between two subjectivities (Benjamin, 1995; Stolorow, Brandchaft, & Atwood, 1987). Thus the question of transference is coupled with counter-transference and the psychoanalysis is viewed as mutual, and reciprocal (although asymmetrical), of two individuals trying to primarily help one--the patient (Aron, 2001).

Other theorists have also reconceptualized counter-transference. Donna Orange (1995) goes so far to suggest that perhaps the term counter-transference should be dropped all together, and we should rather refer to the therapist's emotional reaction to the patient as co-transference. Gabbard (1996) has stated, "it is generally more clinically useful to consider transference and counter-transference as a unit ... a joint creation involving contributions from both patient and analyst" (p. 260). We contend that transference --counter-transference theory be repositioned from its either/or and replaced with concepts such as "transferential experience," (Fosshage, 2000) "intersubjectivity," (Atwood, Brandchaft, & Stolorow, 1987) or the "interpersonal" (Mitchell, 1988). Transference-counter-transference is then essentially perceived as an organism, as something that is transactional, interactive, and perspectival, a relationship in which there is a "mutual, bi-directional, interactive influence" (Fosshage, 2000, p. 25). In this connection past, present and future collide and require the analytic couple to make meaning of all aspects of a person's life as it now presents itself between the two. This complex human encounter gets at the matter of the self-in-relation to the world, in an experiential visceral way, and moves the patient beyond an isolated, analyzed review of their past. The relational stance challenges a treatment where patients historically were

shadow companions, ostensibly invited on a mutually intimate journey, but traveling a course piloted by the analyst ... [resulting] in an experience in aloneness, a tutorial in free association, replete with intellectual understanding of genetics and dynamics.sprinkled with interpretations that locate pathology within the patient. (Geist, 2009, p. 66)

The outcome of such an analysis is that the patient ends up with better explanations, but not a better life. What occurs in a relational analysis, however, is not just a good interpretation of the past, but a working through of the conflict, as it is now staged and co-produced, between both actors--therapist and patient. In this kind of analysis, we no longer hold to a benign neutrality or hold to the belief that we, as the therapist, are the authority, rather we are engaged in an intense intimate act of human relations.

It is important to note that this relativistic stance that privileges the co-created interaction between therapist and patient does not negate the individual and his/her early object relations. The power of early attachment is not disputed. We live a good deal of our lives, hindered by the experiences of our past. This history needs revision. It needs someone to re-do it with a new object experience. However, we would argue remembering and gaining insight through interpretation is only one aspect of the work. The unconscious is made conscious not solely through interpretation of the past, but is most likely able to be given voice, through direct encounter of an authentic relational response. Inquiry of the repressed is lived in the intricate, subtle, intersubjective, inevitable conflictual interplay of the therapeutic relationship.

This effort on the patient to enlist us as co-designers of their past and present relational world is most vulnerable to distortion and avoidance around issues of aggression and sexuality. It is perhaps these two primitive, socially constricted affective states that move us to sanitize and revert to external controls within the therapy. We want to find a way to make it--these strong sexy angry feelings, go away. And yet, it is within these early felt emotions that much of the work takes place. It is our view that in the privatization of the therapist's thoughts and feelings, often distilled into precise interpretations, ignoring material or forbidding the patient to talk about areas of their lives that may make us uncomfortable, we forfeit authenticity. "Unable to maintain our usual emotional responsiveness in the face of losing control; we [will] tend to act defensively to the patient's 'provocativeness'" (Geist, 2009, p. 176). However, as Geist has noted it is "through heightened affective moments that the patient's self comes alive and feels real and more organized" (p. 175).

Conflict Regarding Erotic Disclosure in Contemporary Psychoanalysis

Even as the Relational Model has moved disclosure front and center, it is curious that the literature gives only marginal support to any disclosure to the patient of erotic feelings. Perhaps it is this double standard around sexual arousal that caused one of Bollas' (1994) patients to comment on psychoanalysis as a "set-up, a seduction that refuses to assume responsibility for itself" (p. 576). His patient is correct, for the emphasis in relational psychoanalysis of lived intersubjective experiences, dyadic attachments and affective attunement, the literature as discussed below is replete with the dangers of disclosing erotic.

Although Bollas (1994) allows for a generative erotic transference that "implicitly recognizes the passion of a love relationship," (p. 589), he refers more commonly to the negative sexualized transference as the "blackness of hate" (p. 589), and implores the therapist to adhere to rigorous neutrality. Bollas' concern in breaking the analytic barrier of neutrality is that "something [is] now revealed of [the analysts] true feelings or true self, from behind the screen of analytical neutrality...[and] the analysand [gains] what she wished" (p. 583), namely, the desire to control her object. But we ask the question, "is change not made most possible when the screen of analytical neutrality is broken?" It seems that when the therapist's emotional veil is penetrated and an authentic response is offered, the patient is able to gain a greater sense of what their action means. Bollas contends however, that by responding outside of neutrality, we arouse within the patient, their conviction that infantile sexuality will arouse the mother's "ire." Indeed something is being aroused! But is it only ire? Is infantile sexuality only about aggression? Or does that "baby" also long for contact, touch, holding, affirmation of its body, and play? Rather than neutrality, it would seem important to enter into the quest of this infantile sexuality, to discover together what is hateful and what is love, and not defend against the arousal through denial for awakening longing in the patient.

Kumin (1985) also argues that erotic transference is also a form of negative transference and contends that both patient and therapist suffer from being objects of frustrated desire, and are therefore, expected to behave themselves--the patient by free-associating and the therapist by maintaining a professional attitude. The rule of abstinence, which he states, "serves a protective purpose in the analytic situation, similar to that of the incest taboo in the family" (p. 16). Yes, the taboo of not having sex is a given, but unlike the taboo in the family, where not only having sex is taboo, so is talking about it. Talking is not taboo within the analytic situation. In fact, this is what we do. We talk about it! Conversations that have been taboo can finally be released, uncensored, free associated and spoken about without constraint. Kumin's solution to this matter, however, is to abstain and to "produce the correct interpretation to reduce desire and resistance" (p. 16). It is not clear what he means by the "correct" interpretation, but states you know it is correct when "the analyst returns to the essential neutrality of feeling concerning the patient and the patient returns to productive free association" (p. 16). As to the correct interpretation, the best interpretation we have found is the one that is verified by both patient and therapist and that we play with our resistances until they no longer need to exist.

Kahn (1979), who ironically upset his own career through sexual scandal, views the reenactment of sexual arousal as a perverse collusion. He contends that the pervert wishes to "make known to himself and announce and press into another. his inmost nature as well as to discharge its instinctual tension" (Khan as cited in Kumin 1985, p. 15). Rather than placing the patient in this locked position, we must ask, what is the "pervert," if you will, pressing for? The erotic is filled with aggressive action and provokes vulnerability, rejection, retaliation, and shame, but we also believe that which is being pushed away is also the most desired.

Gabbard (1998) contends that direct, "disclosure of the analyst's sexual feelings toward the patient is an enterprise fraught with peril and must be carefully considered in terms of a risk-benefit equation" (p. 782). He goes on to say,
   disclosure of sexual feelings by the
   analyst is fundamentally different
   from disclosure of other counter-transference
   affects. Acknowledgement of
   anger, for example, does not imply,
   either inside the consulting room or
   outside of it, in social situations, that
   violence will ensue. (p. 783)


This argument baffles and we must wonder if it is indeed true that we can talk about anger without violence, but we cannot talk about sex without consummation? It appears as though for Gabbard, acknowledgement of sex means that sex between the participants will ensue. Although we understand Gabbard's (1998) reluctance to disclose because "our capacity for rationalization and self-deception in analytic work is remarkable" (p. 784), it is for this very reason that we must be careful not to hold too much on our own. Rather, it seems incumbent upon therapists to bring to the patient what we experience, so that in some awkward way we are able to discover the veracity of what the arousal is seeking to consummate.

In contrast to these views of the erotic as aggressive, perverted, and infantile, Ulanov (2009) reminds us that even for Freud, "the nucleus of love found in sexual love, includes our drive to make unities--within ourselves, in the world, and in our relation to the cosmos" (p. 92). Ulanov who notes that Fairbairn "saw libido as something that sought relation to another, not gratification" (p. 92) agrees and continues,
   ... Eros is the function of psychic
   relatedness that urges us to connect,
   get involved with, poke into, be in
   the midst of, reach out to, get inside
   of, value, not to abstract or theorize
   but get in touch with, invest energy,
   endow libido. Relatedness does not
   mean relationship. [rather] Eros is
   like a huge spark that ignites our passion,
   and then confronts us with how
   we will live this fire in ordinary space
   and time. Eros brings us into the
   mysteries of desire to bond and
   believe in the other and ourselves as
   a unit, as a union that enhances both
   of us, and even gives something to
   the world, benefiting others, as if our
   living adds more to the sum of light
   available to everyone. (p. 93)


Ulanov's (2009) statement suggests that the erotic energy within a relationship exists as a spark towards unity arousing us towards a "sense of purpose, of going somewhere important, something that enlists body, soul, and spirit" (p. 90). Russ (1999) states, "if Eros is a real vehicle for the profound effects of life, death, and the need for protection, merger, surrender, trust and bliss, the analyst should expect to be a full participant" (p. 613). What these authors are telling us is that Eros has purpose. Its drive is towards life and not death. It cries for our involvement. Therefore, "we must allow erotic responses, including attendant emotions, to become available for discourse with the patient" (Russ, 1999, p. 613).

Davies (1994), in her much talked about article, Love in the Afternoon, contends that the erotic urge drives us towards some purpose and that the therapist's "unwillingness to regard her sexual responses, as a significant aspect of the countertransferential process, [creates] a perverse scenario, rather than an increasingly intimate one" (p. 7). Her fear is "that which masquerades as analytic neutrality may in many cases represent the reenactment in the transference of a countertransferentially induced gratification of the patient's eroticized masochism, [italics ours] rather than an enhanced capacity for intimacy and erotic mutuality" (p. 7). It is Davies contention that within a two-person analytic discourse, it is incumbent upon both patient and therapist to enter the risk. Believing if "aspects of the analyst's unconscious participation in the therapeutic drama remained unexpressed and therefore, unexplored, whole areas of the patient's unconscious experience may be kept out of full participation in the interpersonal arena of reconfigured meanings" (p. 11). We must confront this anxiety according to Dimen (2003) who states, "anxiety prevents analysts from addressing sex where it is and makes them see it where it isn't. The solution, [she has] found is to talk about sex.seriously with humor and with pleasure" (p.158).

Erotic Transference-Countertransference and Christians

The topic of erotic transference-counter-transference, while difficult for all therapists, may be particularly problematic for the Christian therapist. In many Christian circles, sexuality has unfortunately been dangerously linked with sin. To think or talk about sex, let alone to become sexually aroused, has for many Christians, been equivalent to engaging in sex. It is as if to feel sexual, or to even talk about sex, inevitably leads to consummation. This may be due in part to a very limited understanding of Christ's teaching on adultery (Matt 5: 27-30) but this perspective often leads to denial, causing Christian therapists to ignore arousal in their patients and within themselves, closing their eyes to hints of erotic transference-counter-transference issues that emerge in the treatment. By way of example, a Christian female therapist experiencing discomfort and anxiety due to a male patient who frequently complimented on her clothing informed him that his comments made her uncomfortable and asked him to stop. She stated that he seemed somewhat confused but was apologetic and he did indeed stop. She reported this event as progression within the treatment. We, however, are left wondering how her intervention may have negatively impacted the therapy, and circumscribed other areas of exploration for her patient, which subsequently became inaccessible. We would argue that as therapists influenced by a Christian ethic of abstinence, we may tend to invoke the concept of abstinence in both thought and deed running the risk of avoiding this topic and leaving whole realms of the patient's experience off limits to exploration, restoration and transformation. Because sexual feelings are anxiety provoking, often producing guilt and shame in both parties, we may feel safer in this maneuvering, but no therapeutic work will be possible in this important area of human flourishing. We believe, in fact, that it is the acknowledgement of what is occurring between therapist and the patient that mitigates against shameful feelings of fantasy, chastity and fidelity and guards against exploitation. Too often, our Christian teachings have encouraged us to keep our sexuality hidden. But sex and aggression are where most of our dissociated and unformulated thoughts and affects lie. It is where we are the most hidden, where we experience the most tension within the self and interpersonally, and where we often need the most help.

From our experience, as will be demonstrated in the following vignette, interacting defensively with our patients diminishes our capacity to understand what is unfolding, circumscribes the complexity of a delicate interplay, and ultimately damages the relationship. We posit a reconsideration of the transference--counter-transference relationship that affective states (sex and aggression) must be considered from a variety of vantage points; the patient's perspective, the perspective of the therapist, and the interaction of the two. Within a relational model and from a shared theological perspective of embodiment (Anderson, 1982; Brown & Strawn, 2012) the therapeutic relationship is viewed as co-constructed and therapists are not only objects of a patient's projection but must "recognize that the analysand and analyst variably co-create the transferential experience [and the] analyst [must be] alert to address, and acknowledge his contribution" (Fosshage, 2000, p. 34).

Case Vignette Mary

Mary came from a highly abusive home where over the course of several years, her father had sexually abused her, ending in a menage trois in her eighteenth year between her father, herself, and her father's girlfriend. During the course of Mary's childhood and adolescence, her mother had married the same two men, Mary's father, and stepfather, five different times. The patient was an attractive, articulate woman who held to a belief that her only means of getting attention was through sex. A highly charged erotic transference/counter-transference reaction ensued. The tension between desire and aggression began to dominate our work. As the sparks of eroticism grew, rather than addressing the tension, the therapy languished under the protection of the coolness of technique. The therapist becoming neutral and emotionally unavailable, the banter and the play that had characterized the earlier work, was replaced with indifference and cold, calculating interpretations.

Davies (2006) speaks to this tension of desire and aggression and stresses the importance of the "creation of a psychic bridge" (p. 673) between these two opposing feelings. She states,
   Sensual pleasures, erotic tenderness,
   intimate murmurings ... into whose
   arms we fall and melt and merge. is
   the object with whom we experience
   pleasure, cohesion, satiation and a
   sense of fullness and completeness ... and
   yet its survival is precarious
   [for] it must be protected from
   the aggression also spilling in our
   relationship ... the object who arouses ... the
   object who teases, tortures
   and holds us captive, awaiting ultimate
   release ... these are the fantasies
   that involve aggression, shame, domination
   and submission, the power
   dimensions of who loves more, who
   needs more ... the fantasies that unite
   the self with a taunting, teasing, ever alluring,
   bad exciting object. (p. 674)


This dissociation, the unbearable of the wanting and the not getting was the drama that was being played in our work together. Part of what was driving our enactment was "the patient's deep conviction that [I, akin to her father].. .didn't want to know her dissociated self-state crashing against the urgent need to let [me] know" (Benjamin, 2009, p. 444). My patient learned early that her father's affections towards her were sexualized and her only means for connection with him were through her body. Consequently, in her attempt to get my attention, she vowed that if I did not sleep with her, she would kill herself. Overwhelmed, I shut down. Overwhelmed she pursued. I was scared sexless! Finally, in exasperation she declared, "I swear to God you are asexual." Awakened, I responded, "in this room, in this moment, with you, I am. For your threat to kill yourself if I do not go to bed with you scares me and I have shut down." When I was finally able, under much pressure, to "fess" up to the tension between us and the reprise of the abusive nature with her father replaying itself with me, the work opened up encouraging the patient that her deepest longings could be expressed but not exploited. The result of acknowledging what was happening with me and within our relationship brought us back to life. A good thing happened. Our work was able to thrive. Mary's pursuit was a desire for contact, for someone to love her. Filled with very primitive fears that her hopes would be dashed; exploited, demeaned, rejected she sought to destroy. But she was more than her aggression, and in talking about what had been taboo, a deep and profound love was also present. Love and hate were never separate entities. Both were present all of the time. The result of the disclosure allowed us to return to imaginative play and to more effectively regulate fantasies within reality and live within the tension of desire and aggression. Davies (2006), continues,
   The capacity to experience pleasurable
   anticipation must not be overwhelmed
   by frustration and rage, nor
   can its fantasized elaboration be
   inhibited and potentially shut down
   by an overly restrictive and primitively
   bifurcated notion of 'goodness." A
   sense of playful adventure, mischievousness,
   naughtiness, the capacity
   to tease and not torture, to allure
   and not torment, to attract without
   holding captive.[to] no longer live
   entirely within either to the exclusion
   of the other. (p .676)


Davies is correct and our work did take a new direction when we were able to remain in a state of playful adventure, instead of an overly restrictive and primitively bifurcated notion of goodness. We did better when we talked, playing our cards face up, acknowledging that her seductions evoked both feelings of love and of hate within me, as well as how her despair, her threat of killing herself, rendered me afraid and impotent. As we were able to explore the sexual arousal actively in pursuit of us, while holding to the tension that neither of us wanted it to end in a tryst, we learned that the sexiness of our relationship though about sex, and arousal, was about so much more. Had I not been so preoccupied by my own sexual guilt and fear that consummation followed arousal, we could have held that "bodily arousal, excitement and tension [does not hold any] guarantee of immediate satisfaction or release" (Davies, 2006, p. 272) and we would have been able to move toward a place of satisfaction and release that would be life altering and may not have lead to her suicidal dramas. I now believe that, had I the courage to have stayed in the game earlier than I did, my patient would not have needed to get to the point of such despair. The enactment--that inevitable place where the therapist's and patients' past collide, and where failure and breakdown occur would not have grown so intense. Though much was gained in working through the enactment, the concern that I hold several years past this treatment is: did the enactment last too long, and become more of an acting out, because of my long refusal to acknowledge the tension that existed between us? I believe so, and believe that over the years as my work has matured, I have been more at the ready, less defensive and more willing to acknowledge the truths that exist between me and my patient, and the inevitable enactments have been less contaminated by my fears, and thus more fertile for the analysis.

Twenty-one years following the termination of our work, this patient and I had the opportunity to meet once again. Midway in our conversation, she brought up those two long years of our six-year analyses of the highly eroticized, sexually charged relationship between us. She stated, "it must have been awful for you." I responded, "it was most likely awful for both of us and that in fact, I felt responsible for a good deal of what was occurring at that time." I acknowledged that because of my inability to hold the tension of her desire and aggression, our work was placed in serious peril. She went on to say, she was not so sure that I was the cause of her wish to act out, but was grateful that I had never acted upon her sexually during that time. She said, "I wanted you so much." I responded, "and yet in many ways, you didn't want me at all." She became thoughtful for a time, and then quietly said, "I have never thought of that before, but you are right, I didn't want you that way, but it was the only way I knew how to make contact with you."

I believe this early experience in my work confirmed the danger of not working with all of the tensions--the aggressive and the erotic and every emotion in between, that emerges between the therapeutic couple. As the work with my patient became more terrifying, and the more split off I became from my own sexuality and feelings of arousal, the work regressed into very early self-states of both patient and therapist. I do believe our enactment was inevitable, but I also believe that my refusal to attend earlier on to the urges and desires stirring within me placed undue stress upon the patient that was unnecessary. Benjamin (2009) is helpful here in that she says, "our failure to link is inevitable, and to be unable to link feelings and parts is a natural part of our procedure, a liability intrinsic to our work, and not the failure that it feels like. Self-correction is our way of life" (p. 443). Yes, and as noted in this case, emphasize that self-correction is most often achieved through the act of acknowledgement.

The next vignette illustrates the use of erotic tension earlier--before it becomes expressed in troublesome enactments causes damage or retraumatization as evidenced in the earlier case presentation. It is also an example of flying blind in which the therapist didn't premeditate an answer to the patient's question. He couldn't have planned a response, in part, because the question was asked in an oblique manner. Rather by fully entering into the collaborative transference/counter-transference dialogue and trusting the process, the therapist responded in a nondefensive, authentic and immediate manner. In either case, erotic tension acknowledged after the fact or in the moment, it is noted that when the erotic tension is revealed, the work is either salvaged and/or advanced.

Case of Julia

Julia was a 20-something Christian woman who had been socialized to fear her sexuality and to dissociate it as bad/sinful. Her highly religious family, especially her father, never talked about sex, and if they did, it was in hushed and shameful tones. Not surprisingly, Julia came to therapy in part because of difficulty relating to men. With Christian men, she felt as though she had no clue how to act. It appeared that these post-college Christian young people were stymied as to how to be sexual beings while holding on to sexual values that advocated abstinence. They either fled from sexual feelings or damned the torpedoes of their values and engaged in all manner of sexual behavior. With non-Christian men (who didn't have the same religious conflicts), Julia could engage in sexual behavior but only for the man's pleasure and never her own.

Over time, Julia and I developed a sexual transference-counter-transference. She began to flirt with me, to dream about us sexually and to entertain sexual fantasies about what our life would be like if we had met under different circumstances. I found Julia attractive and at times became uncomfortable, as she would ask questions that indicated that she desired more information about my feelings towards her. I believed that she needed to experience her impact on me and to revisit her early attachments with men especially her father. I hypothesized that she needed to know that I did in some sense experience her as sexually attractive and capable of impacting me in this way. And she needed to experience this as pleasurable for herself and not just for me. But while she needed the acknowledgment of her impact on me, and a place to repeat the past in the present, I believed she also needed the protection of the analytic frame.

There appeared to be two primary issues. First, as a Christian, Julia needed to know that her sexual feelings didn't have to be dissociated; she could be playful with sexuality without fear. I determined that there was a high degree of affective safety between us in that the manner in which Julia spoke of her fantasies led me to believe that she was aware that we wouldn't engage in any form of sexual behavior. However, this did not answer her possible question of how I felt toward her. Did I enjoy her flirting with me? Did I experience her as an attractive young woman and could she experience pleasure knowing I did? I must admit that I felt anxious when I became convinced that Julia was pressing me for this information/new experience. I was certain that this new experience was happening between us in unspoken ways and was unclear if I needed to verbalize it or at the moment consider what I would say if she eventually asked me. I also worried what might happen, or be communicated to her, if I never helped move this interaction into the realm of language. Honestly, I hoped that we could keep it in the area of the unspoken!

While all this was occurring, I had a second experience; sex, attraction, and even affection were clearly in the air, but I also had a distinct feeling that I was not just being aroused, but that I was also feeling protective and proud of her in a paternal manner. Because of her father's inability to mirror her as a developing sexual young woman, I conceptualized, at least in part, her sexual transference needs as paternal--that is she needed a father figure who could acknowledge/admire her sexual maturing self without taking advantage of it.

In one session after she had been especially forthcoming about a sexual dream and subsequent daydream about me she said, "You are probably tired of me sharing all my sexual fantasies about you." Understanding this comment as a question, and an opportunity for a new experience, I wondered what to say. I felt that I could hide behind my understanding of her developmental need and make some kind of interpretation--suggesting she was needing an admiring father figure (which I think she did in fact need)--or I could take a risk to share my subjectivity, which might allow her to know her impact on me, and provide a new kind of experience of herself as a sexual woman, who was capable of impacting a man without shame and allowing her that pleasure. What came to me very quickly, and what I said, was framed as a rhetorical question, "You don't think I enjoy being admired by an attractive young woman?" She laughed, smiled, and responded sincerely saying, "Thank you for saying that." She then paused and said, "thank you for what you are helping me with."

I believe that acknowledging what we both knew, but was yet to be spoken, accomplished two things simultaneously. First, it did provide a new developmental experience for Julia. In me, she had an older paternal figure admire and welcome her emerging sexuality without exploitation. Secondly, our acknowledgment (rather than an interpretation) allowed her to own dissociated aspects of herself. We "knew" things about her (through our intersubjectivity), and it was my acknowledgment of what we knew that allowed her to come to own them. She was sexy, she could arouse a man, and she could experience pleasure in that.

It is important to note that my acknowledging the obvious did not increase Julia's sexual fantasies (i.e., seduce her or over stimulate her) nor did it decrease our ability to explore the multiple meanings of her sexual feelings (i.e., contaminate the transference). We went on to explore her sexual longings, and her conflicted feelings about giving and receiving pleasure. We processed defenses against sexual longings and how she used me as a "test case," to figure out what she wanted in a man. But I also believe that together Julia and I practiced real love together. We both experienced how to give and to receive love.

It would be nice to report that I had all these issues figured out before Julia pressed me into service, but I didn't. I was in fact "flying blind" and believing that my patient would teach me what she needed. For this reason, I "chose"--if one can really say that--to play my cards "face up" with her when the moment arrived.

A New Relational Ethic

Is there danger in acknowledging the erotic? Yes, but there may be more danger in not doing so. Bridges (1994) in her research with trainees discovered that trainees revealed much fear and discomfort concerning erotic feelings, and responded to therapists who revealed any type of sexual arousal with their patients with harsh assessments, concentrated efforts to clarifying rules of conduct and limit setting and attempts to control the therapeutic process. Furthermore,
   Efforts to think about the material
   symbolically were interspersed with
   distancing maneuvers like labeling a
   patient seductive, viewing the therapist
   as needy, or by instructing
   patients about ethical codes of conduct ... clinical
   curiosity evaporated
   when trainees were frightened or
   startled by sexual and loving feelings
   in clinical material. (p. 333)


The study continues, however, that when trainees sense of danger was diminished through (a) course material that informed them of the ubiquity of anxiety inherent in arousal within the therapeutic relationship for any practitioner, (b) offering them a psychodynamic formulation to consider transference and counter-transference reactions, and (c) encouragement to examine compassionately their inner experience and appreciation for clinical complexity, they moved towards a less defensive stance replacing their fears with a spirit of inquiry and curiosity. The results of this study stated, "it is inadequate simply to emphasize boundary maintenance and the taboo against therapist-patient sexual contact. Focusing exclusively on boundaries and ethical conduct leaves the clinician vulnerable, unprepared and often confused about techniques for handling these matters" (p. 338).

It appears as though the rule against disclosing carries its own danger. Although rules define parameters, they also invoke law and punishment, exclusion when the rules are not followed and ultimately, exploitation. Exploitation occurs because someone holds the power. Someone has the rulebook. Someone decides the interpretation of the rules. And quite commonly, the one with the power interprets the rules for their own protection. If we appreciate the relational model as one that endorses dynamic non-linear boundaries, and that the power differential is negotiated by the therapist and the patient, perhaps we need to reconsider our ethics beyond boundary.

To begin with, boundaries within a relational model are considered to be fluid, dynamic, and co-constructed. This non-linear view opens up the frozen frame of set boundaries and the isolation of the counter-transference feelings, as it attends to the ever-emergent emotional landscape developing between the analytic pair. Shane (2006) states:
   There is no baseline, no analytic
   frame ... from which the analyst can
   be seen to deviate. Boundary exists
   only as a function of the particular
   pair; it emerges from within the particular
   dyad and is shaped by it,
   often changing over time in keeping
   with the changing developmental
   needs of either of the persons who
   constitute the system. we must
   [she contends], consider boundaries
   contextually. (p. 38)


This positioning of the therapist and patient contextually requires a different kind of discipline. The disciplines of traditional analytic methods of objectivity, interpretation, explanation, and reason as its primary discipline, are augmented by skepticism, wonder, and curiosity. Truth, ethics, morality, meaning, and relationship emerge within the dialectic as opposed to an objective interpretation from the supposed unbiased therapist. This requires a discipline of attending to that which is occurring in the in-between as we sort out motivation and meaning and the impact of a person's life within their relational world. Unable to call forth scripted boundaries, the therapist is required to attend to the patient from within their perspective, and within the experience of how that perspective is being co-created between the two. This no man's land establishes a deeper bond and connectedness between the patient and the therapist, as they increasingly trust one another to reveal authentic responses between the two. Geist (2009) is helpful in this regard when he says we "often confuse boundaries with safety. The feeling of safety, which every patient requires, emerges from the evolution of connectedness (which includes a mutually evolving frame) between patient and analyst, not from imposing boundaries externally" (p. 73).

Perhaps it is this concept of connectedness that can better serve our work. With boundary, we think arbitrary and often defined externally. While the APA code of ethics may be the gold standard for our profession, its limitation is in its capacity to only speak to general ethics. Clearly it is in the mind of APA that in the absence of skill, maturity, and overwhelming pressure, boundaries often serve to prevent catastrophic outcome. However, it cannot speak to the uniqueness of each therapeutic dyad. When connectedness is considered however, our thoughts begin to move towards mutuality, consideration of the other, care, honor and protection from harm or exploitation. It also moves us to consider authority, fairness, access, and difference in ways that benefit both parties. In considering connectedness, we remove arbitrariness and consequently, though on less stable ground, we are more authentically engaged. In this engagement, our "rule" or boundary is to care for, value and to play in such a manner that does not exploit the other.

Connectedness over boundaries requires a place of openness of subjectivity over object usage, a place of reflection and of wonder. In our work, we are invited, seduced, called forth to enter historical places with our patients, not to look around as tourists, but to embody, feel with them, react, interact, and to participate. What this requires of us is (a) a non-defensive stance, (b) mutuality and a holding to non-linear boundaries, (c) offering our presence mindfully and without authority, (d) candor and surrender to the process, (e) risk taking with concern of safety and honor at its core, and (f) a relationship defined by being interdependent and dyadically determined. These guidelines differ from holding to an ethic of boundary that though intended to protect the patient, often does not regard the patient's input in establishing the parameters of their work. Rather they have been used to protect the therapist rather than the patient from uncomfortable affective states generated in the therapist's counter-transference experience. However, change is primarily effected by profound interactional moments and from early on psychoanalysis has believed that, "what turns the scale is not intellectual insight, but the relationship to the doctor" (Freud, 1921, p. 90). What the relational analytic model affords us are proper conditions for a genuine encounter to occur, that requires an awareness that leaves room to consider how two people affect one another, to speak candidly about this experience and a willingness to get lost for awhile as together, patient and therapist, sort out primitive messages seeking voice and resolve.

Without connectedness, we are limited in what we can speak to our patients, particularly about deeply held affective states. With connectedness we all surprise ourselves at times, as we fly blind the candidness in which we hear ourselves speaking to our patients as we play our cards face up. Upon reflection, we know we would never have dared to say such things, if we did not have a strong sense of trust and safety between us. We know at some profound level we exist in this therapeutic relationship for the betterment of each other and as advocate for our patient's well-being, and with this confidence are willing to risk much for their benefit.

In considering an ethic of Connectedness vs. Boundary, Nancy McWilliams (2004) states that the guidelines that she has developed for herself in this vexed area,
   ... are to admit to feelings that are
   obvious to the client anyway, to try
   to respond honestly to direct questions
   about my feelings whether or
   not I explicitly disclose, to bring up
   my emotional state when I am pretty
   certain it will further rather than complicate
   the client's work, and, when I
   do reveal my feelings, to do so in
   ways that run the least risk of making
   the patient feel either blamed for my
   reactions or impelled to take care of
   me. (p. 185)


In addition to the guidelines that McWilliams offers, we would like to add the importance of developing a discipline of self-censoring that causes us to pause before we speak. A rule of thumb for ourselves is that if we feel a strong urge to produce a disclosure, it is most likely not yet to be disclosed. As an example, one of us recently found ourselves overly eager to blurt out what we believed to be a very well crafted interpretation, that we felt for certain would blow the socks off the patient. I had a hunch that my eagerness to speak was motivated by a need to impress my patient, also a psychologist, and was more about showing prowess and in the service of my own ego then it was in helping the patient expand their awareness of themselves.

On the other hand, when we find ourselves reluctant to disclose or acknowledge, we discipline ourselves in a different way: (a) we proceed by speaking what is on our mind offering it tentatively, inviting the patient to explore the disclosure with us, asking that we collaborate together to locate the "truth" of what it is on our mind that we might be hesitant to disclose, and (b) if we remain uncertain and not ready to offer what is on our minds, we enlist the patient to consider our dilemma with us, first exploring with them why it is we might be reluctant to bring forth what it is we are thinking or experiencing. Usually in this cooperative effort, we set up a place of safety and timing for the disclosure to take place.

This new hermeneutic of boundaries--of collaboration, safety and connectedness--is essentially a new ethic for psychotherapy. We concur with literature that suggests that embedded within every school of psychotherapy are religio-ethical systems which contain metaphors signifying what is normal, how one ought to live life, and even a vision of the good life (Browning & Cooper, 2004). Schools of psychotherapy are therefore ethical systems and psychotherapy is fundamentally an ethical discourse between patient and therapist (Cushman, 1995). Yet usually these schools are not explicit about their ethics and are de-traditioned from any particular cultural system. This de-traditioning leaves them to fall back onto a vague emotivism advancing the idea that it is the feelings of the individual that is the sole arbitrator for truth and ethical decision-making (MacIntyre, 2007; Wright & Strawn, 2010). For this reason, we explicitly tradition our new ethic deeply within Christianity.

It is our contention that this ethic we are espousing finds affinity with the Christian concept of kenosis. Kenosis means "self-emptying" and it appears in the "Christ hymn" found in Philippians 2: 5-6. Here the author writes,

Let the same mind be in you that was in Christ Jesus, who, though he was in the form of God, did not regard equality with God as something to be exploited, but emptied himself, taking the form of a slave, being born in human likeness. (NRSV)

We believe that the ethic we are advancing, embedded in our new epistemology for boundaries, is best summed up by the concept of kenotic love. Therapists empty themselves of authority, self-gratification, exploitation, defensiveness, universalizing, and individualism, for the sake of the patient. This self-emptying enables the therapist to see the patient as a distinct other, a "thou" subjectivity in their own right.

Emptying or "losing one's self" has frequently had a bad reputation in therapeutic circles. But self-emptying does not mean that therapists lose themselves or become less than what they are, no more than Jesus became less Jesus by emptying himself. Therapists cannot do away with their subjectivity, for this is impossible. What we have been essentially arguing in this paper is that self-emptying kenotic love actually means that therapists must give up whatever it is that has been causing them to withhold their subjectivity. We believe that being truly present for the sake of the patient--often via acknowledgement--is a kind of kenotic activity that brings newness and life.

The erotic is a powerful form of communication within the therapeutic relationship. A phenomenon full of peril, but we cannot deny this profound form of communication. Understanding sexual arousal from the Relational Psychoanalytic perspective, within the context of an ethic of connectedness, we have advanced that acknowledgement of the erotic, though difficult, is essential, facilitates a deeper understanding of the intrapsychic/interpersonal dynamics, and assists the patient in reconciling dissociated aspects of themselves. We find this therapeutic stance consistent with our Christian beliefs that invite us to be open and vulnerable with one another, not for the purpose of pursuing our own ends, but to live with and for the sake of the other.

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Roy Barsness

The Seattle School of Theology and Psychology

Brad D. Strawn

Fuller Theological Seminary

Correspondence regarding this article should be sent to Roy Barsness Ph.D. The Seattle School of Theology and Psychology 2501 Elliott Avenue, Seattle, WA 98121, rbarsness@theseattleschool.edu; Brad Strawn Ph.D. Fuller Theological Seminary, 135 N. Oakland, Pasadena, CA 91182, bradstrawn@fuller.edu

Dr. Roy Barsness is Professor of Counseling Psychology at The Seattle School of Theology and Psychology, Seattle, WA.

Dr. Brad D. Strawn is the Evelyn and Frank Freed Professor of Integration of Psychology and Theology at Fuller Theological Seminary in Pasadena CA.

Dr. Barsness and Dr. Strawn's research is in the intersection of psychoanalytic thought and theology. Both are members of the Society for the Exploration of Psychoanalytic Psychotherapies and Theology and are on the faculty of the Brookhaven Institute for Psychoanalysis and Theology.
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Date:Sep 22, 2014
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