Running head: A CURE THROUGH LOVE

A Cure Through Love, or: How I Learned to Stop Worrying and Love My Clients by Mark Lackey

Masters Paper Presented to the Contemplative Psychotherapy Faculty of Naropa University in partial fulfillment of the requirements for the degree of Master of Arts: Psychology Contemplative Psychotherapy Naropa University Boulder, Colorado July 2011

A CURE THROUGH LOVE Abstract This paper addresses the clinical issue of the therapists feelings of love for his or her clients. Feelings of love for clients are often left unexamined by therapists, which can result in missed opportunities to help clients, or worse, harm to clients. Some historical context of love within

the field is provided, as well as a broader context for love within human society. The benefits of inviting and examining loving feelings for clients are addressed, as are some of the ways in which a so-called countertransference love can be mistaken for other phenomena in therapy. Two clinical vignettes illustrate relevant clinical topics.

A CURE THROUGH LOVE Table of Contents

Abstract ........................................................................................................................................... 2 Introduction ..................................................................................................................................... 4 A Challenging Topic ........................................................................................................... 4 What is Love? ..................................................................................................................... 5 Love, Absent ................................................................................................................................... 6 Love, Banished ................................................................................................................... 9 Loves Return.................................................................................................................... 10 Making Sense of Love .................................................................................................................. 12 Unconditional Love .......................................................................................................... 13 Vignette 1: Emily .............................................................................................................. 14 Therapeutic Love .......................................................................................................................... 17 Vignette 2: Claire .............................................................................................................. 19 Re-Parenting With Love? ................................................................................................. 20 Oedipal Love..................................................................................................................... 21 Real Love ...................................................................................................................................... 23 References ..................................................................................................................................... 28

A CURE THROUGH LOVE A Cure Through Love, or: How I Learned to Stop Worrying and Love My Clients Introduction In this paper I will investigate various views on therapists feelings of love for their clients. From this discussion, I will attempt to formulate a basis for further research on how clients and therapists might benefit from integrating love into the context and content of psychotherapeutic treatment. I will draw primarily from two bodies of knowledge in my

treatment of the topic of love in therapy. The first set of sources is largely derived from the evergrowing pool of writings available at the intersection of psychotherapy and Buddhism. These sources will serve mainly to provide applications of Buddhist Psychology to the health and happiness of therapists and clients in relationship. A second body of knowledge will be comprised of a set of articles representing recent, mostly British, psychoanalytical views on the analysts feelings of love for his or her clients. These articles speak to the benefits of allowing for feelings of love towards clients, but also outline possible risks for clients and therapists. A Challenging Topic Writing about love in clinical contexts immediately presents several daunting challenges. The first and most obvious issue is definition of termsa problem that would be present in any discussion of a topic as personal, subjective, and fundamental to the emotional lives of human beings and life in general. Can I define love? The short answer is: No. The slightly longer answer is that I have attempted here to categorize love into several distinct types and sub-types that I have found useful in discussing the presence of love in therapeutic settings. The second major issue in writing about love in clinical contexts is that it is generally a taboo subject in academic journals. Part of what helps to keep the taboo against love in place is

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the nearness, for most people (and most therapists), of love to sex. This paper will address the issue of sexual desire for clients, but I will not take up a great deal of space examining erotic feelings or transgressive sexual acts. After a few words establishing love within a cultural context, I will briefly trace the presence of love in the first 100 years of modern psychotherapy. Then, beginning with a discussion of what I will call unconditional love (see below), I will attempt to build a case for the inclusion and acknowledgement of love as a component of existing therapeutic techniques and as a modality unto itself. In the process of building the case for love, I will also identify several different types of conditional love (see below). Conditional (personal) love for clients, including the desire for sexual contact, can be problematic if it remains outside of awareness, or if it is kept from colleagues and supervisors. However, I argue that a better understanding of differing forms of love, which will come from a more open and widespread discussion of its presence in clinical settings, can allow for love to be a more powerful healing agent in many (if not all) therapeutic settings. I will also highlight several practices that can increase the ability of therapists to feel love for their clients in a safe and professional way. What is Love? Definitions are often difficult to produce, especially when trying to differentiate components or types of something as subjective and often non-verbal as love; I will attempt such differentiations below. I would ask the reader to hold these ideas lightly, however, in recognition of the impossibility of adequately classifying and categorizing every feeling of love that might occur for a therapist. More broadly, I would suggest that all definitions be considered limited and as means rather than as ends. For the purposes of introduction, I offer a somewhat simplified

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distinction between two types of love (allowing that this distinction is guaranteed to break down under scrutiny): unconditional love, and conditional love. Unconditional love is an impersonal and universal caring, and does not depend on circumstances, nor can it be possessed. Rogers (1957/2007) concept of unconditional positive regard (p. 829) captures much of the meaning of unconditional love as it applies in therapy. However, as I will discuss below, unconditional love is a much broader concept than unconditional positive regard, and can be accessed by the therapist even when unconditional positive regard is absent. Conditional love is a personal and specific form of love. Its presence is dependent to some degree on the qualities and characteristics of its sources and recipients. In clinical settings and in the outside world, conditional love appears and disappears dependent upon circumstances. As a therapist, I might concurrently feel multiple types of love for a client, some of which are of an unconditional variety, some of which are more conditional. With some attempt at definition out of the way, I will now proceed to describe a contextualized view of the concept of love in therapy since the time of Freud. There is undoubtedly more to discover in tracing such a history, but for the purposes of this paper, a sketch will have to suffice. Love, Absent Love, conditional and unconditional, is undoubtedly central to human life. Sociologists, biologists, and evolutionary psychologists might label the phenomenon of love reciprocal altruism, parental nurturing, or some other similarly objective term. One can certainly attempt to remove the observer (scientist) from the equation, and in the process discover myriad ways of

A CURE THROUGH LOVE describing the human capacity for propagation of the species and the maintenance of

civilizations. However, if experiences are described subjectively, the concept or feeling of love will figure prominently. Parents will say that they love their children unconditionally, and couples will describe passionate love for one another. As evidence of the importance of love to human interest, a quick survey will reveal that love is a concept central to most major religions (religion being among the most important and time consuming activities of virtually all human societies prior to the 18th century). Within Christianity, the Bible states God is love (1 John. 4:8 New International Version). In Judaism, there is ahava, which means giving in the Hebrew languagein this case love is equated to giving of oneself. In Buddhism, there is the concept of maitri, translated as loving-kindness or unconditional friendliness (discussed below). In fact, from a cursory examination of religion in general, it might be said that one of the basic tenets of most religion is to love each other (and/or a god or multiple gods) unconditionally. However, in contrast to the ancient world, where gods and semi-divine rulers (pharaohs, kings, etc.) wielded power, religion is not the foundation of a modern, increasingly global society. The worlds largest and most powerful institutions, governments and corporations, rarely if ever promote love as a core valuea natural development given that since the time of Epicurus, philosophy and science have slowly replaced religion as the foundations of global society. Contemporary Western society is structured to permit maximal individual freedom, leaving the practice of love an optional activity most often practiced at the discretion of individuals within two contexts: the family unit (including childless romantic relationships) and the religious community.

A CURE THROUGH LOVE In particular, emerging from within the increasingly secular societies of Europe, the Enlightenment of the 18th century brought with it the clear differentiation of religion, art, and science in the public sphere (Wilber, 2000b). As a result, love was now completely removed from the increasingly important realm of scientific inquiry. By the time Sigmund Freud, an Austrian medical doctor, began to develop his psychological theories in the last decade of the 19th century, the practice of medicine was well on its way to becoming an almost exclusively scientific enterprise, based on a reductionistic view of the human body as made up of various biologically understood parts. From the beginning, Freud considered himself a scientist, having begun his medical career in neurology. How curious, then, is Freuds statement in a 1906 letter to Carl Jung that

Psychoanalysis is in essence a cure through love (as cited in Bettelheim, 1983, p. vi). Here is a scientist declaring that his meticulous method, based in scientifically derived theory, is powered by lovea phenomenon generally considered quite personal and subjective, and within the domain of religion. Of course, there is ample documentation of Freud the man that renders the above quote less surprising. It is said that Dr. Freud was often quite loving and affectionate towards his patients, in seeming violation of the written principles of psychoanalysis (much of which Freud himself had codified or had been written at Freuds request) (Bonasia, 2001). Despite Freuds statement and behaviors, love-as-cure never became an established part of the psychoanalytical literature. There were exceptionsauthors who wrote about loving their clients. Sndor Ferenczi (1926) stands out as an early proponent of providing maternal love to his patients. Harold Searles (1959) was bold enough to declare that he fantasized about marrying and making love to most of his long-term patients, including an unattractive male client suffering

A CURE THROUGH LOVE from Schizophrenia (someone Searles would be unlikely to find himself attracted to outside of

the clinical setting). Still, the relative absence of a discussion of love as a therapeutic tool in the psychoanalytic literature (Bernstein, 1992) raises the question: should therapists love their clients? Love, Banished The answer to this question within the field of psychoanalysis became a clear no (with the exceptions listed above). The reasoning behind this answer can be traced back to the beginnings of psychoanalysis and the development of the concept of countertransference. Early on, the analyst was instructed to remain in the familiar role of doctoran objective healer who was not personally affected by the analysis or emotionally involved with the patient. However, in 1909, Freud requested that the concept of countertransference be written about (Bonasia, 2001). Countertransference, most broadly, refers to the emotional response of the therapist to the client. Initially, the idea was to eliminate or control the countertransference; over time, countertransference came to be seen as a useful tool for the analyst. Bonasia (2001) suggests, however, that the perceived need to elucidate the nature of countertransference was most likely due to Freuds concern that the new professional position of psychoanalyst would be harmed by too many male analysts engaging in sexual relationships with their patients (p. 250). Today, in all 50 states, a registered psychotherapist, psychologist, or psychiatrist, beyond sanctions within the profession, will be vulnerable to legal prosecution if he or she has sex with a client (Pope, 2001). The prohibition of sexual contact between client and therapist is supported by numerous studies demonstrating the harm done to clients by such transgressions (Gabbard,

A CURE THROUGH LOVE 1994). I am not aware, however, of any studies suggesting that having love for a client is

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harmful. Yet, love for clients, especially of the conditional variety, is relatively rarely discussed in the psychoanalytic literature. Thankfully, love has been present in the therapeutic literature for some time, if not always by name. Loves Return Since the 1940s and 1950s, the notion of love as curative has increasingly become more prominent and accepted. The return of love came as a result of the work of two psychological pioneers, Carl Rogers and John Bowlby, both of whom worked with children early in their careers. Rogers, based on studies of his own work with patients and that of his colleagues, determined that love communicated by the therapist to the client as genuineness, empathy, and unconditional positive regard allowed the client to heal (Kahn, 1997). Bowlbys work (1951), known as attachment theory, highlights the importance of early childhood relationships in adult psychological functioning. Later developments in attachment theory posit that healing can occur when a client restructures the self through relationship with a therapist (Wallin, 2007, p. 85)or put another way, when a client learns (or re-learns) to love another person (and himself or herself). Of course, neither Bowlby nor Rogers themselves typically referred to what they were doing as loving their clients. Michael Kahn (1997) provides a clear though possibly over-simplified explanation of the shift away from Freud that Rogers work signified: Freud was a physician, and he saw neurosis as an illness to be cured. Rogers was not a physician, and he did not view emotional difficulties as an indication of an illness to be cured. He called the people with whom he worked clients not patients. He had at

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one time planned on being a minister, and though he abandoned that career, his religious predilection can be seen in his view of psychology. He believed that human beings need to be loved, and that when their need is inadequately met, the result is confusion and pain. If someone could give the suffering person a significant experience of the love so sorely missing, the confusion and pain would go away by itself (p. 38). The work of Rogers and Bowlby influenced what Maslow (1971) referred to as the Third Force or third psychology (p. 4), coming after behaviorism and psychologies based in Freuds work. This third psychology, or humanistic psychology, is characterized by a value orientation that holds a hopeful, constructive view of human beings and of their substantial capacity to be self-determining (Association for Humanistic Psychology, n.d., para. 16). Humanistic psychology acknowledges such essentially human phenomena as love, selfconsciousness, self-determination, personal freedom, greed, lust for power, cruelty, morality, art, philosophy, religion, literature, and science (Association for Humanistic Psychology, n.d., para. 17). Love, along with many other forms of human flourishing, seems to be allowed within the humanistic view of therapy. And, by the influence of Attachment Theory and Rogers PersonCentered Therapy, relationship is seen as an important component of healing. Many therapists have been influenced by this more open, more human way of viewing the process of therapy. Unfortunately, many of these same therapists eschew a rational or intellectual approach in favor of allowing for therapy to be solely about the experience that happens in therapy (Maslow, 1971, p.4). Though there is value in letting go and just being with another person, I have found the

A CURE THROUGH LOVE concepts in the next section useful in harnessing the healing power of love in therapeutic settings. Making Sense of Love

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What is love, anyway? The ancient Greeks had several words for love, two of which in particular, eros and agape, might help clarify role of love in psychotherapy. Referring again to Kahn (1997): Eros is characterized by the desire for something that will fulfill the lover. It includes the wish to possess the beloved object or person. Agape, by contrast, is characterized by the desire to fulfill the beloved. It demands nothing in return and wants only the growth and fulfillment of the loved one. Agape is a strengthening love, a love that, by definition, does not burden or obligate the loved one (p. 39). Kahn (1997) mentions agape to explain Rogers concept of unconditional positive regard. Agape is also the Greek word translated as love in the earlier cited reference to 1 John 4:8, God is love. Agape is motherly, nurturing, selfless and accepting. Eros on the other hand, is desirous, creative, penetrating and demanding. Every person has some capacity for both eros and agape. However, in Kahns description and in my limited reading of Rogers, I find myself wondering What place is there in therapy for the eros within the therapist? At first, one might postulate that the eros of the therapist ought not see the light of day while with a client. Yet the idea of banning desire or wanting from clients seems to go against Rogers notion of genuineness (and against the notion of the usefulness of countertransference). In the psychoanalytical literature, and especially since Winnicotts (1949) seminal Hate

A CURE THROUGH LOVE in the Countertransference, there seems to be no shortage of writing about negative feelings

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towards clients. Still, within the growing literature about feelings of love for clients, the subject is still treated delicately and with some degree of trepidationeros is still regarded as dangerous, and agape-like feelings are regarded as possible traps. I believe that with the proper understanding (both academic and experiential) of unconditional love, therapists can begin to drop the fear of erotic (in the broad sense) feelings for clients and start to make use of this often suppressed category of feeling. Unconditional Love I am a student in the Contemplative Psychotherapy (MACP) clinical training program at Naropa University, a Buddhist-inspired university. Our program was founded on the view that health is intrinsic and unconditional (MA Psychology: Contemplative Psychotherapy, n.d., para. 1). Perhaps the most often mentioned subject throughout the program is the Buddhist concept of maitri. Additionally, throughout the three-year program nine weeks are spent on meditation retreats where the practice of maitri is the focus. Suffice it to say, MACP students spend a great deal of time and energy on the concept and practice of maitri. Buddhist Meditation master Chgyam Trungpa Rinpoche, the founder of Naropa University, often defined maitri as: unconditional friendliness (Wegela, 2009, p. 72). In other Buddhist traditions, maitri (or metta in the Pali language) is defined as loving kindness. Carl Rogers wrote of an unconditional positive regard as a necessary ingredient for client growth: To the extent that the therapist finds himself experiencing a warm acceptance of each aspect of the client's experience as being a part of that client, he is experiencing unconditional positive regard It means that there are no conditions of acceptance

A CURE THROUGH LOVE (Rogers, 1957/2007, p. 242) I imagine a large percentage of practicing psychotherapists, and probably a large percentage of practitioners in other healing arts, would aspire to a similar stance with clients. John Welwood (1985) writes about unconditional love: The expression of unconditional love follows the movements of the heart, which is its

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source. We could define "heart" as that "part" of us where we are most tender and open to the world around us, where we can let others in and feel moved by them; as well as reach outside ourselves to contact them more fully. (p. 34) Cultivating unconditional love for oneself and for others is a profound practice, to which anyone who has spent a significant amount of time doing so will attest. It also has tremendous clinical utility for the beginning therapist. Though students in the MACP program are exposed to considerable amounts of Western theory, they have, like most interning therapists, relatively little experience in putting clinical theory in to practice. Having ample experience with the unconditional love as described above by Welwood (1985) can be profoundly helpful, as I hope to illustrate with the following example. (I will have more to say regarding unconditional love in the last section, so as to round out the concept and highlight its unique importance. In particular, I will point out how unconditional love is not only about warmth, and therefore not merely a synonym for unconditional positive regard.) Vignette 1: Emily I met with Emily only once, during so-called Drop-In Hours at my internship site, a university counseling center. (From 11:30am to 2pm each weekday, the center is staffed by a therapist who is available for sessions with students who drop in without appointments.)

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Emily, who looked to be in her mid-twenties, 53 tall, and 140 lbs., had her tightly curled hair in bushy ponytail. She looked like there was something on her mind, but her behavior and appearance were within normal ranges. I invited her to join me in the counseling room. Shortly after allowing me to say a few (probably unnecessary) words about the context of our time together, Emily began, Theres just so much going on for me right now. She had only a month previously started a graduate program in Art Therapy, where she was being encouraged to explore inwardly. She made several references to what sounded like an extremely challenging childhood without good-enough parents, and began to cry as she spoke. According to her, in addition to a history of psychological wounding and her introspective schoolwork, current circumstances involving her mother were creating conditions that were simply too much for Emily to handle. On top of all that, there had been a scheduling mistake with a local therapist she had recently started seeing: She called me at 10:30 this morning and left a voicemail saying that I had missed the session and that we could try to reschedule. If she had only called me closer to the beginning of the session, I could have made it in for a good portion of itI only live five minutes away. As Emily began to cry a little harder, I continued to check in with myself as I had been since she first came in. Generally, I was feeling quite well--clear-headed and open-minded, receptive and warm towards others. I had been paying close attention to Emily since she began to speak. In a soft tone, I had offered only the most basic minimal encouragers and reflections of content and feelingsimple active listening. I felt very open, warm and accepting towards Emilys experience. I dont think I can explain it all to you probably not to anyone right now, she said. I

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sensed that she was overwhelmed with pain and confusion. You dont have to explain anything at all, I said in a near whisper. She began to sob uncontrollably as she bent over, bobbing up and down a little with each painful wave of tears. I felt tears begin to well up inside me. Noticing my reaction (tearing up), I wondered how to best to handle the situation with Emily. New to the field, I have not had much experience with others in extreme emotional pain, and I held the concern that revisiting the pain of trauma can be harmful to the client. Surely, allowing myself to cry with her would not be helpful, as this would likely increase her sense of chaos and helplessness. Despite the risk of re-traumatization, I had a sense that crying was serving as a release for Emily in this situation, and was of benefit to her. However, her stating that she could not explain her tears to me (implying in her tone that she felt the need to do so) clued me in to the probability that if I were to speak to her she would attempt to abruptly stop crying and join me verbally in a non-emotional or rational state. I let her continue to cry for what seemed like a long time, but was probably only one or two minutes. At this point, perhaps sensing that she had gotten what she needed to for the time being, I found myself deepening and slowing my own breath and emphasizing the out breath enough so that it was audible to Emily. In what seemed like an organic (i.e. unintended) process, she slowly began to stop crying. Though I only met with Emily once, I believe that unconditional love was the only therapeutic technique that was needed to support her. Though while with her I did have other ideas based on knowing something about trauma, I do not believe that those thoughts were particularly necessary to help Emily. By cultivating unconditional love within myself, a practice taught in the MACP program, I was able to assist Emily in two ways: I adopted a non-neutral,

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but natural stance of warmth and affection towards Emily; and I adopted the same stance towards my own feelings. In essence, I implemented unconditional positive regard for Emily, and importantly, for myself. Allowing my own feelings to arise, I believe, helped to provide a sense of attunement and safety to Emily, in which natural healing processes could proceed. Therapeutic Love Other clients may need more than unconditional love, however. My search for information on how to deal with feelings of love for my clients revealed only a handful of articles between up until 1990. However, an ongoing dialogue in the psychoanalytic journals regarding feelings of love in the therapist (especially sexual feelings, but also romantic feelings and falling in love) seems to have started in the mid-1990s in response to the issue of therapists who begin sexual relationships with clients (to nearly universally, devastatingly harmful results for the clients involved). Still, articles regarding the therapists love for his or her clients are found in far fewer number than articles regarding hatred for clients, or the love of clients for their therapists. Though I contend something is lost in doing so, it is customary in clinical psychology to label the feelings of the therapist for the client as countertransference (and as I have done in the first section). I feel similarly regarding use of the term transference, which I also use below. The definition of countertransference has been endlessly modified and debated within the field. Notable is the idea of dividing countertransference into objective or diagnostic countertransference, which provides information about the clients unconscious material, and personal, neurotic, or subjective countertransference, which points to the unconscious material of the therapist.

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In this discussion, countertransference love is a type of conditional love, and consists of loving feelings felt by a therapist for a client that are due at least in part to unconscious material in the therapist. (In other words, for convenience Im assuming objective countertransference love is adequately described as unconditional positive regard or unconditional love.) Whereas unconditional love, by definition impersonal, might often result in warm feelings of love for a client that can safely remain unexplained, if not unexamined, love in the countertransference ought to be brought into awareness and analyzed by the therapist. Some reasons therapists might avoid differentiating between unconditional love and countertransference love in themselves: the desire to maintain all positive countertransference towards a client due to a general clinging to positive feelings, or on the theory that all positive feelings for a client are helpful to the client; fear of discovering that they actually do not have unconditional love for their clients; fear of discovering difficult or painful unconscious material; or fear of discovering unprofessional feelings towards clients. I have experienced all of these fears. Celenza (1995) worked with therapists who had entered romantic and/or sexual relationships with clients. Though similar in some respects to the points listed above, she identified the following points of concern in addressing countertransference love: 1) Confusing countertransference love for something like unconditional positive regard (in Celenzas words, the therapeutic alliance) (p. 303); 2) Leaving countertransference love unexamined because, perhaps in response to transference love, it feeds the therapists positive self-image (p. 305); and 3) Confusing loving feelings for the client for empathy (p. 306). I offer the following account of my experience with a client who I saw briefly in my second month of internship. The client ended up taking a leave of absence from school at the

A CURE THROUGH LOVE end of the semester during which I saw her due to the added difficulty of dealing her mothers

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early-onset dementia. In addition to factors within her therapy with me, I believe her impending departure contributed to her decision to terminate therapy with me. Vignette 2: Claire Claire was a 27 year-old, heterosexual woman. She was approximately 5 7 tall, with a slender build, dark brown hair, and blue eyes. By her description, Claires father exhibited traits of a narcissistic defense. More than once Claire mentioned that her father told her that he sees Claires mother purely as a sex object. Claire is incredulous about her father telling her this, saying What is that?!? Claire frequently suffered from debilitating anxiety and depression, the symptoms of which rendered her unable to get out of bed for days at a time. She reported that several years before I saw her she spent the better part of four months in bed. In session, she seemed to second-guess her every thought and feeling, and often wondered aloud how things will ever change. She declared that she only feels comfortable with certain people, such as therapists and attuned professors who can understand how to be with her, considering how, in her words, overly-sensitive she was. Claire first showed up during my Drop-In hours, and ended up talking with me for 90 minutes (drop-in sessions are usually short, but have no standard duration). We made an appointment for one week later, but two days later she contacted me wondering if I could see her that afternoon. Though I did have the time, I decided that I should not see her, primarily to protect her relationship with another therapist that she was seeing at that time. I brought Claire up with my supervisor because I wanted to discuss my decision to not

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see Claire outside our agreed upon time. Early on in my description of my session with Claire, my supervisor picked up on something, saying You like her, dont you? In that moment, I realized it was true: I liked her. At first, thinking back to my session with Claire, I remembered feelings of unconditional love for a person in distress. I also remembered enjoying the success I was having in guiding Claire towards greater mindfulness and acceptance of her thoughts and feelings in the moment. Encouraged by a very supportive and knowledgeable supervisor who, like me, was also trained in Contemplative Psychotherapy, I sat with my thoughts and feelings about Claire. Rather than leave my positive regard for her unexamined, I explored further and discovered that my feelings for Claire were not contained within my notions of acceptable therapeutic regard for clients. I had feelings I could not control and with which I was certainly not comfortable. In light of this disconcerting situation, I turned to self-analysis. What I discovered became the genesis of this paper. Re-Parenting With Love? The particular way Claire managed the task of emotional suppression, and her struggles with depression and anxiety, reminded me of myself, even if my difficulties have resulted in less severe functional deficits. Seeing myself in her made it easier to understand and empathize with her. I also sensed in her what I might call a tender heart of sadness, something I can also find in myself. I might have even seen in her the unconditional love she had for most people by default (possibly even me), but that she could not find for herself. Relating easily to Claire triggered in me feelings of care, or we might say, love. These feelings alone did not seem problematic; though having such feelings led me to watch to make

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sure I was not merging with the client, or losing my therapeutic stance. With Claire, however, there was more. I was drawn to her, and as I write these words, the image of a priest comes up for me. In particular, there is a scene in my mind, probably from a movie Ive seen, of one priest telling another that every 10 years he falls in love with a woman, and must choose to suppress or let go of his desires. Another powerful image that comes to mind is that of the damsel in distress. In my life, physical danger has not often been present. Rescuing a beautiful woman from an oncoming train, or even from an attacker would not arise for me as a rescue fantasy. Instead, I might have a subconscious desire to save a woman who is in psychological distress, that is, to help her feel better and find happiness (or love, even!). With all these feelings present, it is not hard to explain why I spent 90 minutes with Claire at our first meeting. Oedipal Love Deriving therapeutic benefit from the feelings of the therapist hinges on the critical task of determining what is helpful to the client, how the therapist might be attempting to get his or her needs met, and how these two competing interests coexist in the therapeutic relationship. My need in this case is to have a sexual relationship with an appropriate partner, in my case, likely a woman between 25 and 35 years of age. In addition to the loving feelings for Claire I described above, I also mentioned being drawn to her. To be more explicit, I found myself physically attracted to her. I found myself attracted to her physically, emotionally and mentally. Fortunately, attempting to engage in a sexual relationship with Claire was an idea that I found repulsive. I explain this repulsion by highlighting the power differential involved, and the sometimes-regressed state of the client.

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Generally, for me to have a sexual relationship with a client would be, depending on the client, akin to a 32 year-old engaging in sex with a high school student, or an adult committing sexual abuse against a child. Yet, my attraction remained, and I had to remain aware of how I might have attempted to gain Claires affection to satisfy my needs, rather than worked for her benefit. I was attracted to Claire and yet repulsed by the idea of making our relationship physical. What seems like a paradox is resolved in remembering two things: 1) that many human relationships, but especially adult relationships with children, often have a sensual component; and 2) that the therapeutic relationship is designed to accommodate and make use of fantasy. As Schamess (1999) discusses, modern clinical theory tends to minimize the sensual and sexual aspects of the therapeutic relationship. In so doing, perhaps something is lost. My desire for Claire could be thought of as the reciprocal desire a father might have to his daughters erotic desire for him. My feeling that desire without acting upon it might have been helpful to Claire. So long as I am able to maintain my therapeutic stance, or, hold my seat, as I would put it, I believe the range of my feelings of love for Claire can be of benefit. It is my sense that most human beings can differentiate personal (countertransference) love and unconditional love. Sensing that my love for her might be unique to her and not something I feel for everyone else could have been meaningful for Claire, especially if there was a father transference. I do not imagine it would have been useful for me to verbalize my feelings for Claire, but allowing myself to feel more of them, including erotic components, I can see as having been helpful in the healing of wounds occurring during the oedipal phase of Claires development. Searles (1959) is an excellent resource supporting the potential healing effect of allowing oedipal love to be a part of therapy.

A CURE THROUGH LOVE In addition to occupying a father transference, I might be utilized by Claire in an

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identification whereby, much as I see myself in her, she might see herself in me. In one session, when I suggested that Claire say to herself the comforting things she might say to a friend in her situation, she not only was unable to do so, but became quiet, curled up and held herself. Perhaps my love for Claire could be translated into a love for herself. Real Love One might imagine psychotherapy as an activity, the goal of which is to promote the ability of the client to express love in the world. Hopefully, the therapist has already learned how to love well, but he or she may also discover something about how to love from his or her experiences with clients. The question remains, however, how does this process actually work how do clients learn to love or to love more fully? From my limited experience as a therapist, I would like to suggest that there are three important elements in using the therapists loving feelings for the client to the clients benefit. First, the therapist must remember that it is not his or her feelings that help the client, but the process of therapy itself that is helpful. In writing this paper, focusing intently on my own thoughts and feelings and making a case for the value and importance of feelings of love for clients, I slipped into this trap of thinking that a cure through love meant that my love cured the client. I momentarily forgot that as the therapist, it is not my feelings that are paramount. Luckily, I happened upon an article that reminded me that it is the process of therapy itself (Bernstein, 1992, p. 253) that helps the client achieve greater health. Furthermore, what matters most in terms of what the therapist does, is what he or she communicates to (or how he or she behaves with) the client (p. 254). It is in his or her thoughts, feelings, and actions in relationship

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with the client and in creating a safe environment for healing that the therapist does his or her job well. The second element of helpfully loving a client is a recognition that the feelings present in the counseling room are real and are not merely transference and countertransference (Slavin, Rahmani, & Pollock, 1998). This is not to say that feelings between therapists and clients are not outside the influence of previous relationships, but rather that transference and countertransference involve real feelingsthe therapist, in order to be effective, cannot escape some degree of vulnerability to his or her own feelings. The key to effectively treating a client with love is to allow feelings of attraction or other loving feelings to arise but to always act for the benefit of the client, even if the therapist must endure emotional pain in order to do so (Slavin et al., 1998). The third and final element that has allowed me to therapeutically love my clients is training in unconditional love. I have discussed unconditional love above. One additional aspect of unconditional love that is particularly important in facilitating the helpful presence of other forms of (conditional) love is an idea from Buddhist Psychology sometimes translated as awakened patience. Wegela (2009) writes ... awakened patience is about being open to whatever we experience in the present moment. It is the practice of nonagression (p. 134). Awakened patience itself can be broken down into components. However, the most salient point here is the necessity of tolerating discomfort. Especially when the therapist finds himself or herself physically attracted to a client or has somehow otherwise become subject to intense feelings for the client (in this case, loving feelings), it is vital to allow these feelings to be present so that the therapist can remain genuine and authentic while in relationship with the client. I

A CURE THROUGH LOVE believe that remaining open to any and all thoughts and feelings, even intensely painful ones, while remaining dedicated to the health of the client, is crucial to helping the client achieve greater health. In other words, the therapist helps the client by demonstrating how to love in a good enough fashion. In my experience, unconditional love is something that everyone can cultivate, and

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something that every practitioner of a healing art ought to consider contemplating. This can be done via spiritual (or religious) practices, or in a strictly secular context. Whereas the truly unconditional love of a therapist for his or her client unto itself holds little danger for clients, other forms of therapists love for clients are inherently more risky. Love can be accompanied by erotic desire, which can lead to gross boundary violations and significant harm to the client if acted on. Countertransference love, or what could be thought of as a personal rather than impersonal love, can also lead to harm if the therapists feelings are an indication of an unmet need in his or her life that he or she is attempting to satisfy with the client. And yet, whereas I am advocating that therapists attempt to allow for such feelings and contain them, it might be that distraction or even suppression might be necessary to truly work in the best interest of the client. For the therapist who seeks to explore the therapeutic benefit of his or her countertransference love for clients, the work of Sleeth (2010) may be useful. Sleeth, a student of Ken Wilbers Integral Psychology (Wilber, 2000a), proposes that an integration of autistic love (selfish) and empathetic love (care) is necessary for achieving what Sleeth calls integral love (Sleeth, 2010). Integral love develops as a balance between I and thou, and has the qualities of tolerance and acceptance. Integral love also corresponds to Kohlbergs fifth and

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sixth levels of moral development (Sleeth, 2010). I would like to suggest that a clinician aspiring to integral love can balance his or her own needs (autistic love) and the general task of therapy (empathic love) so that there is less of a need to suppress ones own needs while still acting for the benefit of the client. Buddhist teacher Thich Nhat Hanh (2006) would like us to let go of terms like loving kindness, unconditional positive regard, even unconditional friendliness: I prefer the word love. Words sometimes get sick and we have to heal them. We have been using the word love to mean appetite or desire, as in I love hamburgers. We have to use language more carefully (p. 4). I would like to take part in Hanhs vision of healing the word love. In spiritual teachings and in the public discourse, it might make sense to begin to simply use the word love in a way closer to what Hanh (2006) suggests. Within the mental health field, I would suggest re-introducing the word love, but retaining distinctions such as those I have used throughout this paper. Generally, I advocate a shift away from technical language within the field of psychotherapy. I see the tendency to use words like transference and countertransference as the result of a wish to create distance or separation between the therapist and his or her thoughts and feelings, and between the therapist and the clients thoughts and feelings about the therapist. This seems ill advised. Even in the MACP program (mentioned above), a unique training program that teaches about love, a technical term for unconditional love is introduced and other forms of love are rarely if ever addressed. Here, there may be a wish to create distance not between the therapist

A CURE THROUGH LOVE and his or her emotions or his or her clients, but between Contemplative Psychotherapists and allegations of unprofessional conduct. Love is an important subjective experience in the lives of humans and is probably essential to human survival on an individual level and to human society in general. Love has

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been a part of what is now broadly referred to as psychotherapy from the earliest beginnings, but is often an underground phenomenon relegated to discussions of sexual transgressions by therapists. It seems clear to me that there is great benefit in addressing the presence of love in psychotherapy in an open manner. There are some dangers in doing so, but the risks seem to be outweighed by the rewards.

A CURE THROUGH LOVE References

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Bernstein, A. (1992) Beyond countertransference: The love that cures. Modern Psychoanalysis, 17(1), 15-21. Bettelheim, B. (1983). Freud and mans soul. New York, NY: A.A. Knopf. Bonasia, E. (2001). The countertransference: Erotic, erotised, and perverse International Journal of Psychoanalysis, 82, 249 Bowlby, J. (1951). Maternal care and mental health [Monograph]. World Health Organization. Celenza, A. (1995). Love and hate in the countertransference. Psychotherapy: Theory, Research, Practice, Training, 32(2), 301-307. Ferenczi, S. (Suttie, J., Trans.) (1926). Further Contributions to the Theory and Technique of Psycho- Analysis. London, England: Hogarth. Gabbard, G. O. (1994). Sexual excitement and countertransference love in the analyst. Journal of the American Psychoanalytic Association, 42, 1083-1106. Hanh, T.N. (2006). Teachings on love. Berkeley, CA: Parallax Press. Humanistic Psychology Overview (n.d.). In Association for Humanistic Psychology. Retrieved 6/25/2011, from http://www.ahpweb.org/aboutahp/whatis.html Kahn, M. (1997). Between therapist and client: The new relationship. New York, NY: Macmillan MA Psychology: Contemplative Psychotherapy (n.d.). In Naropa University. Retrieved 12/1/2010, from http://www.naropa.edu/academics/graduate/psychology/macp/index.cfm Maslow, A.H. (1971). The farther reaches of human nature, New York, NY: Viking.

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Pope, K. (2001). Sex between therapists and clients. In J. Worell (Ed.), Encyclopedia of women and gender: Similarities and differences and the impact of society on gender (pp. 955962). San Diego, CA: Academic Press. Rogers, C. R. (2007). The necessary and sufficient conditions of therapeutic personality change. Psychotherapy: Theory, Research, Practice, Training, 44(3), 240-248. doi:10.1037/00333204.44.3.240 (Original work published 1957) Schamess, G. (1999). Therapeutic love and its permutations. Clinical Social Work Journal, 27(1) 9-26. Searles, H. (1959). Oedipal love in the countertransference. International Journal of Psychoanalysis, 40 18090. Slavin, J., Rahmani, M. and Pollock, L. (1998). Reality and danger in psychoanalytic treatment. Psychoanalytic Quarterly, 67 191-217. Sleeth, D. (2010). Integral love: The role of love in clinical practice as a rite of passage. Journal of Humanistic Psychology, 50(4), 471-494. doi:10.1177/0022167810361970 Wallin, D. J. (2007). Attachment in psychotherapy. New York, NY: Guilford. Wegela, K. K. (2009). The courage to be present: Buddhism, psychotherapy, and the awakening of natural wisdom. Boston, MA: Shambhala. Welwood, J. (1985). On love: conditional and unconditional The Journal of Transpersonal Psychology,1985, Vol. 17, No.1 Wilber, K. (2000a). Integral Psychology: Consciousness, spirit, psychology, therapy. Boston, MA: Shambhala

A CURE THROUGH LOVE Wilber, K. (2000b). Sex, ecology, spirituality: The spirit of evolution (2nd. Ed.). Bosotn, MA: Shambhala. Winnicott, D.W. (1949). Hate in the countertransference. International Journal of Psychoanalysis, 30, 69-74.

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