On Love, Eros, and the Perverse

Introduction:

Recently with my students, I began a discussion about transference and counter-transference in psychotherapy, including erotic transferences and counter-transferences. The class seemed to cleave into two: those who regarded the idea of any sort of erotic feelings arising, in either direction, as "gross"; and those who didn't see what the big deal was. I'm not sure by whose response I am more disconcerted. 

Part of the difficulty turns on the wide variety of meanings attached to the term "erotic." I tried, following the ancients, to expand upon it as something much wider and more vital than the merely sexual or, narrower still, the genital. I brought in Freud's notion of the libidinal and its close links in to the notion of both "life" and "love." This gained traction with the students and also frank relief among them. At last they seemed to find a notion they could relate to: the erotic as something that excites deep and wide interest, even "passion," as people often say today, without necessarily implicating them in some sordid desire for sexual intercourse with whatever/whomever this objet is. 

In talking with them, I was of course drawing on what I've written previously about what I have learned, and am still learning, from Andrea Celenza, especially in her vitally important book Erotic Revelations: Clinical Applications and Perverse Scenarios (Routledge, 2014). I drew on her work with my students in attempting to illustrate the polymorphous ways in which erotic desire can arise in treatment. As Celenza shows, such desire, far from being avoided as it almost universally seems to be today, can in fact be helpful--but it can also lead to disastrous outcomes if not handled well. 

On the strength of how much I had learned from that book, I recently bought another of hers: Transference, Love, Being: Essential Essays from the Field (Routledge, 2022). There are riches scattered throughout this collection, one of whose chief virtues is that almost every chapter is 3 or at most 4 pages in length. 

The collection begins by reflecting on the disappearance of the notion of love in psychotherapeutic practice. And that reflection itself begins by referring to Philip Bromberg's work, who really deserves (and will one day achieve) an essay of his own on here. When someone introduced me, last fall, to his essay "Standing in the Spaces," it effected a sea-change in how I conceive of my own mind and the notion of selfhood and psychic change. It also changed for the good how therapy was progressing with one particular long-term case that seemed to be bogged down. 

Since then, I have used excerpts from his essay in a number of classes, and in every case it has stirred up lengthy and fascinating discussion. 

Celenza says that the splits in the self, which Bromberg focuses on, can be helped by reconsidering and reintroducing the notion and practice of love, properly understood, in the therapeutic relationship. 

Disappearing Love and Hidden Sexuality:

Along with the disappearance of any notion of love in contemporary practice, Celenza, in this book and her other one, has pressed the case more relentlessly and compellingly than anyone else I have read about the disappearance of sexuality and the erotic, citing a word-count Fonagy did some years back showing that terms like 'relational' are all over the literature today, but 'sexual' and cognate terms have taken a nose-dive. This leads Celenza to claim that "there is an unmistakable desexualization that pervades psychoanalytic theorizing...., an erasure of the natural erotic and sensual aspects of intersubjectivity" (p.75).

Celenza, later in this chapter, speculates that perhaps this disappearance has someting to do with the fact that, understood classically, "Eros is described as the son of Chaos, the original primeval emptiness of the universe" (p.76). She does not elaborate the point but the suggestion seems to be that therapy is often difficult enough without (one imagines some bedraggled, overworked, underpaid clinician moaning) introducing further potentially destabilizing and presumably difficult elements such as the erotic.

But at what cost do we exclude such things? In later chapters, she returns indirectly to the theme saying that "we must have the full range of affectivity at our disposal" in order for us to "help our patients...experience the excitements and mysteries within themselves" (113). These excitements, she notes a page later, "include allowing sexual desire to be present in our countertransference." The point of doing so, she repeatedly notes throughout the book, is to serve the patient: "the more we can acknowledge what we feel at work with our patients, the better we do." (Her earlier book, Erotic Revelations, has helped me greatly in seeing that such feelings can be stirred up within us in ways that unconsciously and blithely ignore our cultured notions of "gender" and "sexual orientation.") 

The Perverse and Sadomasochistic:

The essays in the final section are the ones I gravitated towards the most for I have for some time been engaged in trying to understand manifestations of what she calls "the perverse," including sadomasochistic fantasies and actions of some patients.

Some interesting work has been attempted here over the years, but there seems to have been gaps in the literature. Robert Stoller's book Perversion: the Erotic Form of Hatred, from the mid 1970s, seems to have been one of the first major works in the area. The topic comes and goes across the decades. There was renewed interest in the late 90s on the "perverse," and I have to say that it was a great surprise to see my first analyst's work in this area cited in Celenza's chapters and notes. (See also this essay by Dr. Louise Carignan, whose winsome necrology is here.) 

Celenza brings much (not all) of this literature together in chapters 30 and 31, which I found the richest in the book. She begins, rightly, by trying to define terms, offering "a contemporary definition of perversion that reveals a form of psychic functioning as a quality of being toward others, toward one's body, or toward internal objects" (p.139). This differs, she says, from past definitions which were almost always entirely behavioral in nature. She continues: "I propose that a perverse internal psychic mode is one where affective embodied and pre-reflective self-experience is split off or dissociated." 

Chapter 31 is perhaps the longest and most helpfully detailed in the book, and continues on these themes. She explicitly reviews the past literature to see what she finds still useful, discarding the rest. She says that any new attempt at defining the perverse must abandon "phallocentric and heteronormative assumptions." 

What does perversion look like in action? She begins by arguing that "persons engaging in perverse scenarios are attempting to imagine a one-person universe" (142). The tracks closely with cases I have seen clinically.

From here she lays out seven "characteristics that define a perverse quality of being." These are:

• Constriction and Constraint
• Repetition
• Objectification
• Sexualization
• Desire to Harm
• Means/End Reversal
• Absence of Symbolization. 

Taken together, these are usually brought to bear in constructing scenarios and fantasies to manage anxiety, ward off danger, and maintain control. As Stoller put it, sadomasochistic fantasies are usually ones of triumph that at some level are thereby trying to reverse the traumas of the past. They have a dead and deadening, self-reinforcing nature to them; their objects are sexualized to turn threats into pleasure; and there is very little ability to play with them in a symbolic register. She very helpfully elaborates on all these points in some detail, and with clinical material--as she does in nearly every chapter. 

Overall, then, Transference, Love, Being is a rewarding collection and I continue to be grateful for having been led to Celenza's work.

On Bare Attention: Notes on Ascetical Practice in Psychotherapy

I'm trying to teach my students this semester what it is required of clinicians if you are to open yourself to a patient in psychotherapy and listen to them at depth and in a way nobody else does. Such listening has, of course, gone under a number of phrases, starting with Freud's "evenly hovering attention." He posits this as the equally demanding practice expected of the analyst to correspond with the "fundamental rule" of free association. Both are deceptively simple on paper, but fiendishly difficult to practice regularly. 

I've never forgotten the first time that phrase came back to mind as a life-preserver as it were. It was during my internship and I was listening to my first-ever patient to report childhood sexual abuse in the Catholic church. It was a horrifying tale of systematic gang rape in essence lasting many years. As detail after detail poured forth, I found myself fixating on each fresh revelation, trying to sustain an equal level of horror and compassion for every new item. But after about 15 minutes of this, I felt my mind (in what I now regard as a protective-defensive manoeuver to protect me from this demonic horror) starting to disbelieve the patient and think she must be joking. Horrified at this, I realized I had to pull back, as it were, and allow my attention evenly to hover over the entire story rather than immersing myself in the bloody and dark gore of each detail. This allowed me to listen with less inner perturbance and with a greater distance on the scene, which, of course, is what the patient needed for she already knew how horrifying it was, and my constatnly saying so added nothing useful. 

I felt twinges of guilt as I pulled back, as though not being constantly horrified at each detail was somewhow to fail at being compassionate. But I've learned over the years that you cannot be over-identified with your patients. That does not, in the end, help them. They need you to be more objective, to have greater distance, and to offer a perspective that differs from all others in their life. 

How do I know this? They tell me, very explicitly! People will note how their friends will rush to offer them heaps of support and unquestioned sympathy, but they themselves know they need more and other than that, which is why they present for therapy in the first place. 

From this one can derive a technical rule: Don't try to outdo their friends, thinking this is what "empathy" is! As my first supervisor pounded into my head, "The fact you get paid means you will never be friends with your patients!" Thus, I tell my students, you need to listen in ways that go well beyond what friends and family do. Listen for the gaps, the pauses, the inconsistencies, the contradictions; listen for the darker emotions their friends and family did not hear and could not handle. 

From this a second technical rule can be derived: do not collude, especially unconsciously, in hating the people your patient hates. You need to be free to see what might be good in the person (typically parents or spouses) they claim to hate, and how that hate is invariably closely bound up with more tender emotions, including those of love. Your colluding in hate will preemptively destroy any space for ambivalence to emerge and breathe. 

How can you do such things, avoiding such entanglements as over-identifying and hating? At this point I introduce to my students the concept of "bare attention," which is a Buddhist-inflected concept found in the works of Nina Coltart. What does that mean?

Fittingly, Coltart offers only a very minimal definition, saying that to practice bare attention requires that we "teach ourselves so continuously to observe, and watch, and listen, and feel, in silence that this kind of attention becomes--in the end--second nature to us." But what does that look like? She does offer two highly complex paragraphs (quoted here) trying to explain this, which I have my students "meditate" upon as it were. But for the time being I want to advance the thesis that "bare attention" and "evenly hovering attention" are both practices I can only describe using explicitly theological language: they are ascetical practices.

Now "ascetical," for those who remember their Greek, is not in fact theological in origin, but simply pertains to that form of "training" or, as the OED has it, "ἀσκεῖν to exercise." Thus listening with "bare attention" requires the same sort of exercise, training, or practice as you would expect Olympiads to put in to train for a marathon or comparable exercise. 

The sheer physicality of this training should not escape us. It means--as I have learned by trying to ignore some of these things--that you have to take seriously the following as inescapable components of your training:

Food: don't skip meals or hydration in order to see more patients. Your practice of "bare attention" will be severely weakened as you pay more attention to your growling stomach or fantasies of how large a steak you will grill for dinner. (I've learned to keep "good" snacks in my desk--fruit and nuts usually, but also dark chocolate, along with a large pot of tea.)

Exercise: Coltart learned to her great cost that years of sitting without exercise can bring on severe back pain. Do not stint on getting up and walking around between sessions, and working in as much physical movement as you can outside of your clinical schedule. (For me running 15 miles a week is the bare minimum I need to sustain my attention as well as clear my head of the "vicariously traumatic" details of my patients' lives.) 

Timing and Scheduling: Figure out what works for you. If late afternoon or early evening appointments mean you are very tired, but are wide awake for an 8am appointment, then adjust your schedule if you can. There's no attention--bare or otherwise--paid to your patients if you are nodding off! 

Furniture in your consulting room: Again, Coltart was a cautionary tale for me: crappy chairs for you to sit in (including a lack of the fabled ottoman!) will induce discomfort that make your practice of "bare attention" much more difficult. Don't stint here! 

Sleep: You can't pay attention to anything or anyone if you are exhausted all the time. Get good sleep and don't stint on this to work in a few extra appointments.  

Your own Psychotherapy: I think for me likely the single-biggest factor on this list is my own first full psychoanalysis and then ongoing analytic psychotherapy which has allowed me to feel sufficient "ego strength" as it were that I can open myself up to my patient in a self-denying way without feeling threatened or deprived. To put it in "oral" terms, their slaking their needs through me does not leave me starving and resentful. 

These practices require a commitment to training or physical exercise, a form of discipline, a type of "rule of life" known to monastics of antiquity. Observing these things requires a form of self-discipline, indeed of self-denial and self-emptying. 

Such language may make some uncomfortable. Perhaps they will be reassured by learning that no less a figure than Thomas Ogden, in his book Reclaiming Unlived Life, on which I reflected a bit here, calls for such self-denial: 

the analyst must engage in an act of self-renunciation. By self-renunciation I mean the act of allowing oneself to become less definitively oneself in order to create a psychological space in which analyst and patient may enter into a shared state of intuiting and being-at-one-with a disturbing psychic reality that the patient, on his own, is unable to bear.

Ogden does not make the point explicit, but I have to think he would be adamant here that none of this self-renunciation is to be done masochistically.

Here I think Ogden would gladly join hands with Karen Maroda who, echoing Emmanuel Ghent, has rightly called for  "distinguishing between emotional surrender and masochistic submission" (p.39) in the therapeutic dyad. If you are masochistically foregoing food or sleep or other basic needs in order to spend more time with your patients, perhaps you need to ask whether this is really helping you practice the "bare attention" they need and want from you? 

In the end, then, the paradox of self-renunciation is that it helps not just the patient but you as the psychotherapist. After all, which of us does not want to be well-fed, well-rested, decently mobile and fit, and reasonably comfortable in our consulting rooms? Perhaps in the end "self-renunciation" is a disguised synonym for that sometimes infelicitous phrase "self-care"?