Love in the Afternoon: a relational Reconsideration of Desire and Dread in the Countertransference

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A Case Example

Let me conclude with a brief clinical vignette, which I hope will illustrate the importance of (1) the analyst's not defensively denigrating the centrality of physiological and sensational correlates to erotic fantasy and (2) the analyst's need to acknowledge her own participation in the erotic fantasies of the patient and at times to reveal her view of that participation within the treatment.

Mr. M was a 27-year-old graduate student in mathematics who lived most of his life from within his world of numbers theories and abstractions. He had a history of developing intensely eroticized, fantasied relationships with female colleagues and fellow students, though he never acted on these feelings in reality. Whenever he attempted to approach a woman, he would become anxious, sweaty, and overwhelmed by what he described as “a rather urgent and threatening nausea,” thus ending any romantic initiatives on his part. If a woman approached him in anything resembling a seductive manner, the patient would become cold and rejecting. He somatized a great deal and in fact had a long history of physical illnesses and complaints, which merely reinforced his sense of himself as weak, sickly, and decidedly unattractive to the opposite sex.

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It was somewhat surprising, therefore, that the patient quickly developed an intense and highly eroticized transference, complete with compelling, almost poetic descriptions of his sexual fantasies involving the two of us. I was for him, he claimed, “the perfect woman, warm, sensual, perhaps the only person who could lead him out of his life of sexual inhibition and loneliness.” The fantasies themselves were vivid and compelling, somewhat at odds with the patient's experience of extreme sexual awkwardness, and I found that I was beginning to warn myself of the dangers of taking them too seriously, that is, enjoying them too much. Yet there was more than a small thrill, that under this deadened mathematically abstract persona, I had somehow stimulated the heart of a most truly poetic lover. How shocked I was one day, to find myself thinking, rather jealously, of the real lover who would someday be the beneficiary of the patient's sensuality. I began to regret never having had a son. That felt like a betrayal of my own daughters. The guilt of betrayal brought my own mother into focus, along with the uncomfortable recognition in memory of some of my own more grandiose oedipal desires and experiences. Clearly, I had left the real world behind and had entered with my patient a shared illusion of oedipal passion, victory, triumph, and remorse, as much a subject of my own resurrected struggles as I had become the object of his. I felt confused, not exactly sure what kind of state I was in, but all the while painfully clear that whatever state it was, it was a long way from the comfortable states of abstinence and neutrality.

In the meantime an interesting pattern was emerging in the rhythm of each session. The patient would enter somewhat shyly, and despite the always varied content, a mood of some intimacy and intensity would soon be established. Sometimes this experience could be verbalized by the patient; at other times I would be alerted by my own sense of inner tension and arousal, physiological states that became necessary clues to hearing the erotic subtext of the sessions. I would struggle for a way of responding to both the manifest and latent content of the process in a way that would be perceived as neither anxious and rejecting nor eager and overstimulating. Regardless of how long it took to formulate such an impossibly measured response, it became apparent, over time, that the patient's attitude and persona would change dramatically at the precise moment that I was about to intervene. Clearly, I was being permitted to observe, take in, and reflect the process of the session, but the patient seemed to have an uncanny sense of the exact moment at which I was prepared to step inside and become a more active participant in the process between us.

At that exact moment he would appear to implode upon himself,

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slumping down in his chair, his voice whining and somewhat grating; he had no right to these feelings about me. Of course, it was impossible that I shared any of his sentiments, and therefore I must be secretly laughing at him, describing to my friends how paltry and pitiful he was. I could only assume that the experience of such symbolic, yet eroticized, mutuality was being experienced by the patient as a consummation of sorts, a traumatic boundary transgression that would instantly precipitate a realignment of the self and object constellation at work in the therapeutic reenactment of the moment. It was clear that he no longer felt like the same person to me. My sense of warmth and growing arousal would dissipate instantly, and in its place I felt enraged, seduced, misled. I was aware of feeling sick to my stomach, and there was an experience of dread that became physically palpable and frightening. Where I had initially made it safe for the patient to experiment with a more active, seductive, and sexual side of himself, it was apparent that within a certain aspect of our clinical reenactment he made that experience feel safe for me too. As I attempted to follow my own states of arousal, desire, jealousy, counterarousal, and inhibition, followed by fear and dread, it became obvious that these experiences in the countertransference had the potential to serve as a road map of sorts through the shifting matrices of self and object representation as they played themselves out with rapid shifts and transitions in the specific transference-countertransference matrices at work in the clinical endeavor.

There also came a time in the analysis when the patient needed to confront me as a sexual being, and to deal with the very intense reaction that he had to this realization. As we followed the signposts of our emotional and physical reactions to each other, as they gave way to the reenactment and interpretation of particular aspects of his internal object world, it became increasingly clear that the patient's mother had been extremely seductive, romantic, and erotically stimulating, although never in an actually physical way. He remembered long, languid afternoons in which he would lie curled up next to her while she read to him; always epic poems or stories of romance, passion, and adventure, the stories of Odysseus, the legends of King Arthur and the Knights of the Round Table. He recalled the recurrent fantasy of mother and him as Guinevere and Lancelot, with a benign, yet asexual father, Arthur, looking on from the background.

As we struggled to understand my repetitive experience of sudden danger and dread, followed by a deadening of erotic experience in the countertransference, other aspects of the patient's experience with mother began to emerge. He recalled that all would be well between

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them as long as he was careful not to respond too overtly to her intimate cuddlings. If he rubbed or cuddled too eagerly, or as he put it one day:

Even if I sighed too deeply or longingly, she would change, virtually transform before my very eyes. She would look at me in horror and disgust, as if I was the most hideous person in the world. It was like she knew how I felt about her, and she was revolted by me … revolted by the thought that I could have those feelings about her. I know that must be why I can't stand it when women respond to me sexually. I'm afraid that they will change suddenly and find me disgusting. And I can't take that risk. It's too humiliating.

Though this represented a partial working through, the patient was never able to accept the interpretation from me that perhaps his mother had been revolted by her own sexual urges toward her young son, during these most intimate times, that perhaps when he responded in particular ways, it was she who became more highly aroused, surpassing even her own threshold of denial. Mr. M would become enraged at these suggestions, claiming, with controlled anger, that I knew that to be impossible; mothers weren't allowed to have sexual feelings for their children anymore than analysts were allowed to have such feelings for their patients. His admonition worked well and indeed kept my sexual responses well in check for some time, much as his mother's had controlled his. When I did experience such feelings for the patient, they were accompanied by a sense of some kind of professional misconduct or shame. Here, I believe we remained more or less embedded in a rather perverse scenario, which, in fact, made it impossible for the treatment to move into the experience of real erotic desire and understanding. Between the patient and me I placed allegiance to an impersonal theory, which taught that such countertransference was to be understood and worked through on my own, that it could be used to enhance my understanding of the patient, but, particularly in this area of sexual arousal, it could not be shared without committing an act of symbolic incest. The patient placed between us the stereotyped fantasy, rigidly adhered to, that parents felt no sexual arousal for their children, and likewise that an analyst had no such feelings for a patient. By relying on these stereotypes and maintaining what would have appeared to be a position of neutrality, I believe that I was, in fact, sadistically gratifying the patient's fundamentally masochistic assumptions about the nature of our relationship and his relationships with women in general.

Moving beyond this treatment impasse involved a commitment to working through a host of formidable countertransferential resistances of

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my own: the dreaded fear of becoming for the patient an overwhelming, preoedipal, chasmic mother; my fear of reencountering my own over-whelming and intrusive memories of being so physiologically and erotically enmeshed; the dangers of resuscitating the struggles to transcend idealized oedipal romance and find mature love. In part the struggle was pushed along by this young man's adamant need to deny the reality that he could be the object of a woman's sexual desire. He saw himself only as the victim of unrequited love after unrequited love, and such stuckness in the treatment defied all other interpretive avenues that felt “safer” to me. Feeling that there was no other honest alternative, I said to the patient one day, “But you know I have had sexual fantasies about you, many times, sometimes when we're together and sometimes when I'm alone.” The patient began to look anxious and physically agitated. I added, “We certainly will not act on those feelings, but you seem so intent on denying that a woman could feel that way, that your mother might have felt that way, I couldn't think of a more direct way of letting you know that this simply isn't true.” The patient became enraged beyond a point that I had ever seen him. I was perverse, not only an unethical therapist, but probably a sick and perverted mother as well. He thought he needed to press charges, professional charges, maybe even child abuse charges; how could I help him when my own sexuality was so entirely out of control. He was literally beside himself. Unaware of what he was saying, he could only mutter, “You make me sick, I'm going to be sick. God, I'm going to throw up.”

Though set off course by my own visions of professional ethics reviews and child welfare investigations, I was refocused more by the patient's physical reaction of intense nausea, one of his presenting symptoms, in reestablishing the operative transference-countertransference than by anything else. I was able to say to him, “I don't think that there's anything sick and disgusting about the sexual feelings that either of us have had in here…. In seeing your revulsion and disgust with me, I think I'm understanding how your own sexuality made you feel sick whenever your mother withdrew from it with such horror. You felt perverse and criminal and fearful of retaliation. King Arthur was a powerful guy.” The patient added, “And Guinevere was very beautiful.” “But,” I added, “Guinevere knew that her sexual feelings began inside of herself; she didn't hold anyone else responsible.” The patient began to weep, he punched his fist into his palm repeatedly. I said, “I think you're just enraged, that you were forced to carry these feelings for your mother for so many years, her revulsion, disgust, and shame about her own erotic sensations, that she made you believe the shame rested with you.” At a later time: “You felt sickened by my sexuality, just like you want to throw

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up whenever a woman begins to respond to you in this way. You must have felt sickened by your mother's arousal and enraged by her rejection … so you become sickened and then reject the woman who is seducing you.” At a still later time, perhaps with the greatest difficulty: “Perhaps you are also angry with me for allowing you to carry the responsibility for all of the sexual feelings in here.”

This vignette is, of course, collapsed, covering many sessions. But I hope that it does illustrate first, how the therapist's use of her own bodily states of awareness served as a map through a veritable minefield of potentially explosive and disorienting transference-countertransference reenactments, and second, how recognition of the therapist's sexual subjectivity in the clinical setting enabled at least this patient to break through into an area of inquiry that had remained up to that point debilitatingly dissociated.

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