Psychoanalysis and Homosexuality

This short new book, Psychoanalysis and Homosexuality: A Contemporary Introduction (Routledge, 2023, vii+164pp.) by two British clinicians, Leezah Hertzmann and Juliet Newbigin, is something of a useful handbook of (select) sources. It would be helpful to have on hand to refute those who still wish to criticize Freud and associate to him what are demonstrably later and far less felicitous attitudes towards homosexuality, which he never held. Such (often tendentious) criticism is rather tiresome and has long been known to be baseless by those of us who have actually read, and still regularly re-read, Freud (as I have done since 1990), either in German or in the authorized translation, or both. 

Hertzmann and Newbigin's book reads, in part, rather like a graduate student's lit review as part of a thesis requirement. The authors have provided decent lashings of (select) primary source material (always in translation, of course) farced not with scholarly analysis but rather with commentary of their own, which has its place. The style is admirably and immediately accessible and clear.

My hesitation with this book is threefold: first, it is never clear how they chose to pay attention to some figures and not others. It is never good to leave your readers guessing about your selection criteria. To my amazement, the radical views of Sandor Ferenczi (so much so that Freud himself, very "liberal" in his day on this question, was made uncomfortable by them) on homosexuality show up nowhere in this book.  It would have been good, at the very least, to have a look into Sandor Ferenczi: Reconsidering Active Intervention by Martin Stanton. Other important figures from that first generation--which, as a whole, was far more "liberationist" than their reactionary heirs in postwar America--are also overlooked. Why?

Second, the book attends in no significant way to significant historiographical issues in the composition and context of the texts they choose to include, and in those they exclude. I teach my history of psychology class every fall, and attending to how and why that history is written, and by whom--who is in, who is out, who does the choosing, and what are the subterranean currents to this choosing and composing we need to listen for with our third ear--is at least as important as any question of what was written. 

From this follows my third concern: the book pays insufficient attention to sociopolitical factors, especially in the United States in the postwar (=Cold War) period, where many of the developments we can now rightly deplore in psychoanalysis took root with a vengeance. Though these authors indicate a nodding familiarity with Dagmar Herzog's book Cold War Freud, they have not sufficiently integrated her arguments into this little book (or those of other scholars who are relevant here, including Todd McGowan and Paul Roazen). 

The problem--as Freud foresaw as far back as 1909--was that on questions of sexuality in general, America was a puritannical and hostile nation that could not handle his ideas. And this was confirmed after his death in 1939 and the end of the war in 1945 when American attitudes (many of them politically driven) towards many things argued by Freud were disastrously distorted or abandoned, including such things as the restriction of analysis to physicians (which he strongly denounced in The Question of Lay Analysis) and the rise of psychoanalysis as an ideology (the best recent book here is Adam Phillips, The Cure for Psychoanalysis) with orthodox beliefs and practices rigorously policed and enforced by training institutes that often existed in a state of excommunication from each other) rather than a method of treatment. Those institutes, of course, came to exclude homosexual candidates from training. 

Now, it is rightly objected--as I have objected in the past as both editor and reviewer--that one must not unfairly criticize authors for not having written the book the reviewer thinks they should have while overlooking the book they did in fact write. That would be a valid objection here if--again--we were given any sort of rationale for how this book was written, or what the purposes of composing this highly selective, almost idiosyncratic text were. It is certainly not a systematic or comprehensive history, but that does not deny its value and virtues, and the place it does fill as a very brief introduction to the topic. Scholars wanting a more thorough, searching, critical, historiographically sophisticated text will have to produce one themselves or wait for others to do so. 

Having offered such concerns, let me now end with some examples of the book's virtues. 

The third chapter does, in some ways, attend to postwar figures sometimes overlooked, including Sandor Rado who, with some of the Kleinians and others like Edmund Bergler, seem to have played significant roles in shaping views on homosexuality and trying to obtain a role in its "treatment." This chapter--drawing on Herzog--also notes (as more recent authors such as Andrea Celenza and Galit Atlas have done) that psychoanalysis as a whole became far less willing to consider the role of the erotic, in all its forms, and far more suspicious of it and intolerant of its ambivalences and ambiguities. 

The final chapter of the book is the richest, and here the authors turn again to the problem of the exclusion and suspicion of sexuality across the board in clinical work, noting--as others such as Celenza, Atlas, Maroda, and Gabbard have done--that most training programs deal insufficiently or not at all with questions of erotic transference and counter-transference, but that such questions are even more defended against when "the patient's sexual or gender orientation is different from that of the therapist" (p.133). Thus, they argue, one of the challenges going forward is to more fully recognize non-heterosexual forms of desire and how they show up in, and have an impact upon, treatment. 

Desire: An Enigma Wrapped In Riddles Inside Mystery

Introduction:

I learn such things on Twitter. 

I forget to whom exactly to give credit for introducing me to Galit Atlas and her book, The Enigma of Desire: Sex, Longing, and Belonging in Psychoanalysis (Routledge, 2016). It may well have first been Adam Rodriguez, but I know it was even more forcefully Taylor Zimmerman, whom I met with great delight in Indianapolis in April at the celebrated day with Jonathan Shedler. Over the coffee hour and in subsequent correspondence, Taylor strongly encouraged me to read Atlas, so I am grateful to him as to Adam. 

Atlas is the third person in an ongoing series of clinicians in whom I am finding much wisdom with regard to erotic dynamics in psychotherapy, especially in the transference and countertransference. The first of these was, and is, Andrea Celenza, about whom I first wrote here, and more recently here. 

She and Glen Gabbard are arguably the two leading scholar-clinicians writing on sexualized boundary violations in professional contexts, including clinical and clerical contexts. Given the power of their writings, and the fact these topics are almost universally ignored in all training programs, and even by licensed professionals, I am at the point now where I just flatly tell anyone who asks, and even more who don't, that they should buy all of Gabbard's books and all of Celenza's and read them. Were I in charge of training programs in this country for future clinicians of all sorts, I would absolutely make these two authors mandatory reading. 

Into this group I now can bring Galit Atlas, who writes in a different style and with a different focus than Gabbard and Celenza, but with them is still broadly in the field--hitherto often terribly overlooked or denied--of erotic dynamics in treatment. Her book, The Enigma of Desire, puts me in mind of another recent treatment by another psychoanalyst, Carlos Dominguez-Morano (whose utterly irreplaceable Belief After Freud should also be required reading, not least by Christians still talking bollocks about Freud), The Myth of Desire: Sexuality, Love, and the Self, which I have to go back and re-read. 

Right, down to business. 

Atlas on Maternal Erotics:

Atlas begins punchily enough in her introduction by arguing that "In treatment, adopting the role of a nurturing mother can function as the therapist's way to avoid the erotic material that emerges between her and the patient." This I take to be just another version of the important warning (echoed by Shedler, Maroda, McWilliams, and many others) that being too much of a "container" (Bion) or providing little more than a "holding environment" (Winnicott) will mean you ultimately fail your patient who is there because something is wrong and something needs to be changed, not merely contained. 

A second related warning follows from this later in the book (p.80): "our patients' traumatized self-states may collude with our own in order to protect the tender parts of the self, the other, and the treatment from damage by the aggressive parts." (This, of course, is reason #23689 for the psychotherapist to have had his or her own in-depth and intensive long-term psychotherapy, and to engage in regular supervision and consultation.)

Also early in her book Atlas makes plain her own debts to what she calls Kleinian mothers, who have led her to be able "to trust the mind to lead us to the most unknown truths and to believe that the ability to tolerate those tensions allows us to live and to love." She also mentions her debts to Laplanche and Kristeva, and Jessica Benjamin, especially this: "I do not believe we can definitely know what belongs to us and what belongs to our patients." 

This point, of course, puts one in mind of Thomas Ogden's celebrated notion of the analytic third, and of the inability, as he has also recognized, to know where the patient's experience ends and the clinician's begins. 

The Erotics of Writing:

There is a sensuous quality to Atlas's writing itself, not least in her case studies, which are presented here in ways that are less stilted and bloodless than one so often finds. That is to say, there is still a warm pulse in the people she writes about. 

Moreover, and more interesting for me who has long loved to write and cared deeply about the felicities and rewards of style, and who has often felt a flush of excitement in the exchange of ideas, she openly acknowledges that "While writing, I found myself...swinging from feeling overaroused and exposed to using ideas as a way to distance, process, and regulate" (p.30). Lest we miss the point, a bit later she quotes a famous 1989 paper of Ronald Britton in which he recounts a patient demanding: "'Stop that fucking thinking'!" From this Atlas deduces that "thinking is a form of the therapist's internal intercourse" (p.32). Just so! 

I can relate to that outside the consulting room, but also in, which she captures with equal candor: "I notice the movement between moments of sexual stimulation and arousal to use of theory....I believe we often experience the same movement as analysts trying to regulate ourselves and our patients when the erotic pervades the analytic space" (p.30). Guilty as charged! (If I find myself becoming very theoretical, or subjecting the patient to a lecture, than I know my intellectualized defenses have led to such an enactment, and, following Fonagy's counsel, I need to rewind the session back to the point where I was able to mentalize before the defenses were, uh, aroused.)

The Enigmatic and the Pragmatic:

The unique contribution that Atlas make, so far as I can see at this point, is her stress on what she calls Enigmatic and Pragmatic knowing. Much more could be said about this, but I don't want to give all of the book away, so suffice it for me to say that the enigmatic and pragmatic are tied to her dual understanding of the origins of, changes in, and different desires manifested in sexuality: "the erotic comes into existence when the sexuality that at the start was based exclusively on nourishment and satisfaction of hunger moves away from the functional and toward play" (p.41). 

Do not, she warns later, be too enchanted (as some of us who love Winnicott are inclined to be) by notions of play, for these, too, can be used to displace certain important things: "playfullness can be a seductive way to express erotic and aggressive contents...but it's important to note that it can also serve to obstruct erotic transference and countertransference" (p.81). Yes it can, as I've noticed in some sessions after the fact, and not without some chagrin! 

Sexual Longing and Erotic Manifestations and Their Dangers:

Her mention of the erotic obstructing transference material takes us back onto more familiar ground, also covered by Gabbard and Celenza, and then by David Mann, whose two books on the topic I began last weekend, and about which I will have a very great deal to say later (O lucky reader!). 

Rightly does Atlas note early in the book that "sometimes we underestimate how dangerous it feels to be part of a dyad." I try to remind myself of that at least a few times a week, and (for some reason) it always happens at the last turn of the corridor immediately before bringing a patient into my consulting room. In those seconds as I usher them in, I cast my mind back to the first time I ever met with a psychotherapist (a pastoral counselor as I recall) in my teen years (to discuss sexual matters, too!), and how anxious I felt: I try to get a feel for whether this person with me is also a bit anxious, which is an entirely understandable feeling for, as Atlas continues a bit later, "being a patient is a dangerous position" for the patient may feel "he is forced back into the powerless position of being a child to a seductive mother who penetrates and excites him, feeds him but also controls his food and will certainly abandon him, leaving him overexcited, humiliated, and alone" (p.37). 

Strong stuff! No wonder people on Twitter lose their bloody minds when you speak such thoughts aloud; no wonder my undergrads had a collective meltdown at the mention of any hint of anything remotely "erotic" in the therapeutic relationship; no wonder even licensed professionals shy away from these discussions at best, and at worst become amusingly and revealingly hyper-defended. 

Why would anyone submit to this humiliating penetration and abandonment? Later she notes some of its rewards: "Allowing yourself to be penetrated means embracing a more fluid structure that is based on unsolidified boundaries....This is not exclusively a feminine process" (p.69). Indeed not. 

Precisely my attraction to psychoanalytic thinking, starting with Freud, more than three decades ago now was because it seemed to be quite at home with the idea of the fluidity, the complexity, the ambiguity and ambivalence--the sheer messiness--of human sexuality. I have always been highly suspicious of anyone who wants to put it into neat boxes, or map it out on a linear continuum or Kinsey scale. None of us is ever "straight." 

Before going further, she reminds us that for many of us, we had (referring to Kohut) no "mirroring" of the erotic and sexual growing up: "sexual feelings are unique in that caregivers systematically ignore them and they are therefore unmirrored" (p.115). This will and will not show up in a variety of ways in life, and in therapy. 

For some this lack of mirroring can leave the terror of such feelings in place, and that is where you must begin in therapy: "are there ways to listen for, and to, the unique accents of the language of sex." And if those accents are ones of fear, then, nodding towards Bion, Atlas says that an early task of the second mind in the room is to help the first mind bear to think about those fearful desires and terrifying thoughts.

As you think about them, some of the difficulty of such feelings comes from the fact that "sexual longing presupposes a sense of loss and a hope of refinding." 

That refinding is not a straightforward path from infantile attachment to adult sexual longings. It is often much more complicated than that, and thus the clinician needs to proceed with due caution: "the secret psychoanalytic touch is always about tolerating the erotic in the room while not adding to the stimulus." 

Earlier, she notes that we can and probably should do more than that: "we try to hold the unknown darkness with them, tolerate the 'too muchness' of excitement, joy, horror, and shame." Later she will speak of the "suffering of pleasure, of the excess that the body and the mind cannot contain," to which some might give the name "lust" while others (here Melanie Klein) prefer to speak of "human yearning for an 'unattainable perfect internal state'." 

Enactments Made and Redeemed:

Atlas is making what seems to me a very significant advance on how we think about therapeutic enactments. That word is almost universally taken as a sign of danger and enactments seem almost always to be treated sternly. This mirrors, it seems to me, the early Freud and his unidimensional warnings about the dangers of transference and countertransference especially. Only after 1950 did we start to get some limited reflection on what positive things countertransference might contain, and only much later--that is, within the relational movement of which Atlas is a significant part--do we start to see people recognize that countertransference can often be a positive good and contain much valuable information.

Similarly, Atlas is, in the last section of the last chapter of her book, opening up new territory by arguing that enactments are not just "a return of past dissociated memories but rather as the threshold for the introduction of emergent ways of being, of an opening toward new relational possibilities" (p.150). Enactments thus "work toward the future."

They do more than that, as becomes clear in her attempted definition: "enactments may well be a central means by which patients and analysts enter into each other's inner world and discover themselves as participants within each other's psychic life" (p.150). This does not guarantee, of course, that all enactments will always have a positive outcome, but it does begin to help them lose some of their fear, just as we have overcome fear from a century ago of countertransference as a sign of an insufficiently analyzed analyst. 

A concluding word that reminds us of how demanding our vocation as psychotherapists is, for we "must straddle a paradox, always skeptical, questioning, seeking hidden meanings, searching for unconscious dynamics at play, the trailing edge, a hermeneutics of suspicion--while also, paradoxically, trusting unconscious process and surrendering to the continuous flow of the enactive dimension of analysis, relying on a hermeneutics of faith" (here referencing Ricoeur).

Gabbard and Bejnamin on Love and Hate

Freud won the Goethe prize for his magnificent German prose. We do not seem to have comparable prizes (so far as I know) in English to award to psychoanalysts like the venerable Glen Gabbard, whose prose is cogent and crisp, and written in an accessible and admirably humble way. In a future world when justice is finally and permanently established, that is, when I am at last emperor of all I survey, I shall bestow a prize on him. Perhaps we might call it the BST Prize. 

Having, as you will see here and here, recently written of how profoundly helpful I have found Andrea Celenza on the challenges of erotic and loving transferences and counter-transferences, and the associated problems of boundaries, it is no surprise to find Gabbard, in Love and Hate in the Analytic Setting, to be equally valuable on precisely the same points. Indeed, Gabbard and Celenza have collaborated on these issues in previous publications.

What follows is less a systematic reflection on Gabbard (and, toward the end, Jessica Benjamin, whose The Bonds of Love: Psychoanalysis, Feminism, and the Problem of Domination I finished on the same weekend as Gabbard) and more a kind of "aphoristic plundering," as it were. I used to feel vaguely guilty about this method of reading (which I do not use all the time), but having been fortified by stiff doses of Winnicott, quoted lavishly by both Gabbard and Benjamin, I justify such a method to myself by saying I am "using up" both authors, consuming them as good objects, and they are manifestly able to survive this "destructive" consumption of mine. 

Gabbard on Love and its Limits:

Gabbard begins on a note that might seem commonplace to many but which, within the hidebound context of psychoanalytic schools-cum-ideologies, is startlingly rare to read: "No one theory had all the answers to the challenges we confront in clinical practice" (xi). With this one simple manumission, as it were, Gabbard frees himself to range widely and unapologetically over Freudian, object relational, intersubjective, Kohutian, and other analytic traditions, finding what is useful and leaving the rest behind--the very model of "plundering the Egyptians" (cf. Exodus 12:36) one expects, but infrequently finds, in scholars and clinicians alike. 

Chapters 1 and 2 went over well-trod territory (for me) in quoting Freud's famous line to Jung that "essentially, one might say, the cure is effected by love." Gabbard admires this but is also troubled by it, leading him, in the second chapter, to note that one common motive in choosing to follow a vocation to be a psychotherapist is that you wish to be loved and admired. This is fine, he seems to say, provided you come (as he will spend the bulk of the book doing) to grapple with how much "sadism and aggression are ubiquitous forces in love relationships" (p.43). 

You must, to be an effective clinician, not fall into the trap of assuming that love is all you need, for love never goes anywhere by itself: tagging along are always aggression and hatred, and your failure to recognize and deal with these can, at best, lead to stalemate in the treatment, and at worse destructive enactments of various sorts (up to and including sexual boundary violations, about which he has written definitively in several places, including here). 

Gabbard on Hate and its Purposes:

Hatred, Gabbard shows, has multiple functions. Inter alia, it can:

• organize the ego
• master rage and destructiveness to prevent them from getting out of hand
• "conceal longings for love and acceptance" (especially in the transference; p.47)

Why, we often ask, do we hate for so long? Why can we not adhere to the simple counsel, "let it go!"? Gabbard says that "to hate is to hold on to an internal object" which may have had some purpose, including maintaining some contact with that object which was and is better than no contact. Such contact cannot just be dropped by the patient alone: the ties that bind to the object, he argues, can only be undone via the transference. Once again, following Franz Alexander, we see that what we learn to hate in one relationship we can relearn to hate (less) in another, and perhaps even to love it (more). 

Gabbard sees"hatred as residing on a continuum." My crude attempt to illustrate his several points would look like this: on the mild end of the continuum we'd see attempts at control or "domination" (as Benjamin calls it); in the middle there would be preservation of the hated object, but with some sadistically inflicted suffering; and on the extreme end, we would find complete destruction of the object. 

Regardless of type, Gabbard repeatedly cautions the clinician against rushing in to change focus, or try to control the hatred, or urge the patient on to replace it quickly with "positive" thoughts or "happy" memories (or worksheets and breathing exercises one might add somewhat snippily). I have often felt the pressure to do so, but every time I have resisted such pressure it has turned out for the best. As he rightly reminds us, "with many patients the necessary depth of understanding is not reached until one has sat for a sustained period with searing hatred or painful longings" (p.65).

Gabbard reminds us throughout the book that we all have our own hatreds and propensity for aggression. We cannot, even as well analyzed clinicians, fool ourselves into thinking we are utterly incapable of such things. Thus, he seems to suggest, it should not be that hard for us to have empathy for the patient's hatred and aggression if they are relatively accessible within us. (He quotes Searles and often Winnicott on this point of having your own hatred and aggression close by.) If we do find those things hard to understand, then we have forgotten what Christopher Bollas said decades ago: "In order to find the patient we must look for him within ourselves."

No Collusion!

Gabbard reinforces an important lesson, especially relevant to work with teens or disaffected spouses, but in some ways to all of our patients and their diverse hatreds: do not collude in creating an extra-transferential object to hate together. A therapeutic alliance cannot be built upon having a shared person or movement or experience to hate. Remember: hatred and love always co-exist, and to indulge in one-sided and totalized hatred (of, say, your patient's spouse, boss, or parent) is to risk collapsing the analytic space, to destroy the therapeutic stage on which you need to be able to "play" with these things for the patient to move forward. 

How Special Am I?

At one point Gabbard says we must confront the tension inherent in this work: we can only be special to the patient by renouncing all other special relationships, including lover, mother/father, friend, etc.

I admit to finding this very helpful with certain cases from time to time which seem to evoke a very strong protective-paternal counter-transference (discussed weekly in supervision, I hasten to say!). Part of me wants to fill multiple roles for such patients, being special in a good 4 or 5 different roles they lack--but which I know I cannot play because doing so would actually be harmful. 

What I can do, instead, is make sure that this one role--that of psychotherapist--is done according to the best of my ability. Allen Frances, on one of his very valuable videos with Marvin Goldfried (some of which I have my students watch), says that at every session the therapist should ensure it is a memorable experience for the patient. Do not treat it as just an ordinary event because, he says, for some their appointment with you is the highlight of their week. Thus it is special for the patient even as I am not that special. 

Such tension is hard to maintain for some. Gabbard recognizes that the forbidden nature of the relationship can make it highly erotically charged. We might not even experience conscious erotic or sexual attraction to the person; but the fact that we operate inside the frame, with its restrictions on what and how we meet and work together, increases the desire some have for a deeper intimacy than is possible (or healthful). 

At the same time, however, erotic and sexual desires may not be the hardest to deal with. I admit I was rather stopped cold by Gabbard's claim that "Sexualization may also defend against feelings of love...,which are relatively more difficult for many analysts to acknowledge than lustful feelings" (p.91). I have never thought of that before, but in reflecting on it, especially in light of my own analytic therapy, I think I see the logic of this now.  

Gender Fluid Transferences:

Perhaps the most valuable thing I have learned, first in Celenza, and now in Gabbard, is that--as it were--the unconscious mind and its desires are not gendered in the ways we might consciously expect. Some of the transferences toward me have been baffling until reading these two authors who argue, as Gabbard does here, that "there is considerable gender fluidity in the roles played by both analyst and patient in the analytic drama, and if these are allowed to emerge without premature foreclosure, a variety of transferences may appear that involve both homosexual & heterosexual longings" (120). 

Thus, whether with male or female patients, and prescinding from their manifest gender and sexual identities, I can at times be mother, father, brother, lover, and many other objects in the transference. And my counter-transferences are not just what might be called "paternal" (this one seems the most obvious) but also (much less obviously) "maternal": on this latter point I am constantly reminded of how much the experience inside the consulting room is indeed a "holding environment" as Winnicott put it, a "container" as Bion called it, and how those contemporary-clinical experiences are not far removed from the primitive experience of being held and cradled as a child as one's upsets and unknown desires are contained by the soothing mother. 

Let me turn now from Gabbard to Jessica Benjamin. Her book The Bonds of Love is one I have found helpful in dealing with overly sadistic material in some patients. 

I will not go into the wonderful (I almost said masterful!) ways she spends the first part of the book going beyond the understanding of domination in Freud to bring in Winnicott and others. She very helpfully gets us past the rather narrow range within which Freud understood these concepts into a wider terrain from which we gain a broader perspective. 

Much of this is possible by returning to Winnicott on "The Use of an Object." There he famously outlined how objects can be used and are destroyed--but survive. Indeed, use and destruction are linked: they must be destroyed inside our minds in order to see that they can survive outside and beyond us. This is a necessary first testing of reality, and (unlike Winnicott) Benjamin says such a discovery of reality is not merely grim awareness, but can be joyful: the destroyed object has--I discover to my delight--survived after all. 

Benjamin says the utility of this experience lies in the fact it reminds us how interconnected we forever are to each other: "if we assume complete control over him and destroy his identity, then we will have negated ourselves as well. For then there is no one there to recognize us, no one there for us to desire" (39). In saying this, of course, what echoes loudly in the background is Winnicott's famous declaration "there's no such thing as a baby!" By that he meant that a baby is always and only an object-in-relation: to the mother, father, and others around it on whom it depends. 

This dynamic helps us understand relations between sadists and masochists. Both need each other to undergo but survive the experience. Both may arrive at love via the experience. 

For the sadist (and I must say Benjamin gives rather more attention to masochists: her attempt to understand sadists is much less developed), the "thrill of transgression and the sense of complete freedom" are tinged with "fear (guilt) that his aggression will annihilate her." Her survival, however, "creates for him the first condition of freedom." The survival of the masochist creates in and for the sadist a real feeling of "love." 

In turn, the masochist's "submission is ambiguous," Benjamin suggests. It is a "false self," that is a "compliant, adaptive self that has staved off chaos by accepting the other's direction and control, that has maintained connection to the object by renouncing exploration, aggression, separateness" (p.72). But in giving over to an experience of pain "in the presence of a trusted other who comprehends the suffering he inflicts," the masochist can find not just relief but also a form of love. 

There is something a bit too neat here, I must admit. But I have already inflicted my own form of suffering on the reader with this over-long reflection, so I shall rein in my sadism for now, recommending both Gabbard and Benjamin and their excellent books to those who are not familiar with them.

On Sexualized Defenses, Transferences, and Counter-Transferences

Though I can remember almost none of my undergraduate professors at the University of Ottawa from the early 1990s, I have never forgotten Dr Arthur Blank, for both salutary and unsavory reasons. The salutary: I got to write a research paper in his Family Psychology class on what happens to families (such as mine) with a child who is chronically ill and then dies, and it was a profoundly revealing and helpful experience which earned me an A (not a grade I was anywhere near in my psychometrics or neurobiology classes that semester!), and gave me new and more sympathetic insights into what my parents faced and the choices they made to concentrate on my sister in the last six years of her life to the inevitable and unavoidable neglect of me and my younger sisters for most of our late childhood and nearly entire adolescence. 

The unsavory: a few months after class ended, he was in the papers on a regular basis being sued by former patients whom he had sexually abused in his private practice, including a woman who went into therapy with him to deal with having been sexually abused while growing up. He would be struck off the register of psychologists in Ontario and have to pay hundreds of thousands in damages to his ex-patients. I read the newspaper accounts with horror that a man could do such a thing to vulnerable patients. 

This coincided with living with a roommate, whom I knew slightly from my church (which very much encouraged his moving in), who had all kinds of issues with boundaries; we ended up having to ask him to leave. And it also coincided a few months later with my starting analysis and the great pains my analyst took to coax me onto the couch, which I was more than a little frightened of for the vulnerable position it places one in. ("What's she thinking back there watching me? What if she reaches around and touches me before I can see what she's up to and leap out of the way?")

Boundaries, then, have long been prominent in my mind. A few weeks back, I had occasion to read Glen Gabbard, "Lessons to be Learned from the Study of Sexual Boundary Violations" last week (American Journal of Psychotherapy 50, Summer 1996: pp.311-322). I posted insights from that on Twitter. He offers clear and concrete guidelines for avoiding boundary violations based on his work with more than 100 such cases. 

As important as his work in this essay is, he does not reflect on what might be useful in erotic transferences and counter-transferences and how to handle them in a profitable way that does not lead to disastrous outcomes. That crucial task falls to Andrea Celenza, Erotic Revelations: Clinical Applications and Perverse Scenarios (Routledge, 2014), who breaks the ice on these discussions (for me at least). As she notes, much of the clinical literature and likely almost all supervisory contexts avoid the topic because of the understandable fear and even shame such things evoke. 

I was not familiar with her work until Adam Rodriguez on Twitter mentioned how important her work is, and how she should be required reading in training programs. Having taken at least one lesson from her already, and used it in my own supervision, I would agree: she offers insights that begin a long overdue discussion, and we should be introducing that discussion to our students and supervisees. 

What do I mean by that? My take-away from her many insights is that there is a necessary difference between erotic attraction and sexual enactment, and that to feel and discuss the former without shame is not to necessarily risk the latter. Indeed, to put the point more strongly: perhaps the extent to which we feel more free to discuss erotic elements in the transference and counter-transference we may deprive them of the power of secrecy which so often masks and precedes boundary violations. Reading her book has in fact moved me along into feeling more comfortable discussing these things with my own supervisor, who has himself published on problems of sexual boundaries with certain populations, and discusses these with grace and good humour (not unlike Celenza's own supervisor as recounted in an hilarious anecdote on p. 69). 

The other crucial insight she offers is that sexual desire between patient and psychotherapist is always complex and complicated. Though Celenza is not so blunt on this point, I take her to be reminding therapists that if you think your patient really wants to just have sex with you in some straightforward manner, then you are deluded and have indulged in a self-serving and grossly reductionistic attempt to focus on only one thing: your desire. In this monomaniacal pursuit, you not only take your eye off the patient and his or her welfare, but you also fail to recognize that the patient's putative desire for you is highly ambivalent and complicated by many factors, and most certainly does not mean what you want it to. 

She puts it more elegantly and less compactly throughout the book, noting, first, that "being multiple selves is the human condition, and being multiple others to our patients is the analytic condition" (p.62). This multiplicity of self-states comes up several times in the book, and puts me in mind of a wonderful essay by Phillip Bromberg, "Standing in the Spaces," that I read recently and profitably. 

She continues in this vein, arguing, second, that "the gender that the analyst is...is not necessarily the only gender the analyst can be in the erotic transference" (ibid). I found this very revealing, opening up a new way of trying to understand same-sex erotic transference which baffled me in one particular case.

So the patient--whether male or female--could be responding erotically to us in a more maternal or masculine, or paternal or feminine role, or mixtures thereof; they could be responding from a younger and more childish part of the self, or (in our counter-transference) we to them from such multiple and entangled and ambiguous self-states of our own. Thus we see that the erotic response of patient to analyst, and therapist to patient, is not at all clear or straightforward, and responding as though it is will always invite disaster. (Celenza notes in an offhand passage something that Gabbard goes into in more detail: sexualized boundary crossings often happen when the therapist is engaged in "defensive efforts to manage our self-neglect" [p.67, with a reference to her 2007 book on the topic].)

Third, she states a little later that "the wish to know the analyst sexually is invariably complicated and usually highly conflicted. And if it is not, it should be, given the inherent power imbalances" in the therapeutic relationship (p.79). This theme of power imbalance is one she threads throughout much of the book, noting that it is inevitable no matter how much some misguided efforts might be made to flatten things and to insist patient and clinician meet on equal terms. We do not, and never will. 

I remember almost nothing else from one of my first supervisors, but he made damn sure to pound into my head one crucial point: We are not and never will be friends with our patients. A fortiori, we are never going to be lovers, either. As Adam Phillips says in one of his many wonderful books, psychoanalysis welcomes exploration of any and all topics no matter how emotionally and erotically laden and we can do this only because we agree never to have sex with each other.

On the question of sexual desires and their conflicts, I think the crucial passage in the entire book is this:

What do our patients want? They say they want our love, or more pointedly, to have sex--but do they really want that? We are many things to our patients simultaneously and equally important: analyst, woman, person, mother, father, sibling, and child....At any one time a plea for love or sex is a plea from within only one of those dimensions....The man may want a kiss, but the child does not. 

From this she follows up even more directly, insisting that "our patients do not really want us to gratify their erotic wishes, despite their vociferous protests to the contrary. But they do not want us to simply maintain our professional role either" (p.68-69). 

How, then, ought we to handle such things if it seems we are caught on the horns of a most serious dilemma? I confess I was gratified to read of her approach, which I stumbled upon myself before I had heard of this book. Celenza notes that if we cannot indulge patient desires, nor shut them down in a brutally "professional" way (for both responses harm patients in different ways), what is needed of us? Patients need us to respond to them as human beings, and so she said that sometimes a response like "I would if I could!" or "In another time or place" are just the sorts of responses "we need to convey to our patients" (p.69). (Quoted in this way, it may sound like Celenza is a bit flippant about such matters, but the force of her cogent book is quite to the contrary: she has clearly thought about such matters in depth and has hard-won wisdom abundantly displayed throughout the book.) 

I do not want to suggest this book is only devoted to these issues. Its other riches include good discussions in ch.1 especially on overly restrictive ideas of gender and on the uses of sexuality as a defense mechanism. Ironically, sexualized defenses and behaviors can often be used to stave off intimacy--a theme she devotes the entire second part of the book to in her focus on sadomasochistic and perverse habits and enactments. 

That final section, on sadomasochism, explicitly draws on a book I have half-finished right now: Robert Stoller's Perversion: The Erotic Form of Hatred. Celenza picks up where Stoller (whose work was published in 1975 but still has valuable insights for me at least in clinical work with sex offenders) leaves off and gives us a nuanced and balanced assessment before concluding that in her view sadomasochistic enactments are problematic insofar as they may be attempts to destroy any "tolerance of dependency, vulnerability, and self-revelation" (p.114) and may participate in "dehumanization of the other" (p.109). She notes that too often sadomasochistic habits may exist as a "closed feedback loop in which repetition and sameness is substituted for creativity and growth" (p.100). She gives an encouraging case study of one such patient who was finally able, after intensive analysis, to move into a much freer and more loving relationship with a woman who became his wife.

Sadomasochism in Everyday Life

During the fall of 2018 I was on sabbatical and set aside plans to finish my book on Freud, and instead wrote what became Everything Hidden Shall Be Revealed: Ridding the Church of Abuses of Sex and Power, published the following year. 

Freud still featured in that unexpected book in important ways. I made the case for why Freud's theory of moral masochism was very helpful in explaining some of the continued cringe-making deference, indeed submission and subservience, to the "Holy Father" and pope of Rome and to all others bearing the title "Father" in the Catholic Church. Such submission is not a small factor in seeking to understand how and why this crisis of sexual abuse has gone on for so long and been so widespread across every continent on earth. 

Freud's 1924 essay "The Economic Problem of Masochism" was very helpful here, along with his other, better known works. That essay is available in this very rich collection: Essential Papers on Masochism. 

Since reading that book, and writing my own, I have had on my list of things to return to and investigate in more depth the topic of sadomasochism. Part of this is driven by clinical work with sexual offenders. 

But part of this is also driven by trying to understand certain dynamics within contemporary America, including contemporary American Christianity in its reactionary and "conservative" guises where the levels of cruelty have been revealed in the past few years in ways I still find astonishing both in number and degree. I am far from finished thinking through all these issues so I will say no more about them here.

Instead the purpose of this note is to draw your attention to a book I just finished this week which is very much worth your time if you are interested in these issues whether to understand your own life, or the life of your patients, or of parts of our culture, or perhaps all three. 

Before doing so, however, let me draw your attention very briefly to two other works I have found useful, and then a longer note about a third book in particular. 

The first book is one that R.A. Glick and D.I Meyers edited: Masochism: Current Psychoanalytic Perspectives, which was first published in 1988 and has a number of useful and insightful chapters by such well-known figures as Otto Kernberg and Roy Schafer. 

The second book is also an edited collection: The Clinical Problem of Masochism, eds. D. Holtzman and N. Kulish (Jason Aronson/Rowman & Littlefield, 2012). This work contains chapters again by Kernberg, alongside others such as Glen Gabbard, Stanley Coen, Harold Blum, and others. 

The book I want to focus on now has been published for nearly a quarter-century now, so some of its cultural references are a bit dated, but the overall discussion and analysis stands up very well indeed to the passage of time. The book is by a clinical psychologist and psychoanalyst in New York, John Munder Ross, and was published in 1997 by Simon & Schuster as The Sadomasochism of Everyday Life: Why We Hurt Ourselves--and Others--and How to Stop.

The sub-title and the fact of being brought out by a commercial publisher both suggest a certain "self-helpish" nature to the book, but the author, to his credit, largely steers clear of that. As author he's more a sober clinician than a gushing guru bidding for a spot on Oprah, and we can be thankful for that. At the same time, however, he manages to write as a clinician in a way that makes abundant use of examples from modern culture and describes them in ways those with little clinical or psychoanalytic background could easily grasp. 

Before diving into Ross, I went back to Freud's Three Essays on the Theory of Sexuality, and he does not equivocate in there when he argues that "the tendency to cause pain to the sexual object and its opposite, [is] the most frequent and most significant of all the perversions." And a little further on in this section he notes reassuringly that "sadism can be readily demonstrable in the normal individual" not least by looking at the forms of its "displacement" through aggression. And masochism, too, is equally widely to be found: "Masochism is nothing but a continuation of sadism directed against one's own person." (These views, of course, would be modified by some of Freud's later works, including the essay mentioned above, but the general point still stands in my view.) 

This is clearly where Ross picks up, too, as when, on the first page, he claims that "Scratch the most normal surface and you will find a little fundamental erotic sadomasochism in just about everybody" (p.11). Before we all run furiously to issue disavowals of this, note that Ross uses terms in the same way as Freud: "erotic," like "libidinal," is not the same thing as "sexual" and does not necessarily entail "genital activity." The former terms are used much more diffusely, and Ross gives examples that reassure us of this: the scab we were fascinated with picking as a child, or the neck-craning we do as adults at the scene of a motor wreck on the highway. Pain and suffering, both our own and that of others, often elicits a certain frisson in us, a soupçon of Schadenfreude if you will, however much admitting so is uncomfortable to us. But admitting so does not thereby entail copping to all of us having bondage dungeons in our basements! Ross's title here is important: everyday life. Dungeons are still a little outré for most of us!

Ross then brings to our attention people who, knowing what they are doing, and knowing the need to change, still engage in self-sabotage. In dramatic and large terms we know such people as, e.g., alcoholics who have lost jobs, children, marriages, even housing. But in smaller and more everyday terms, whom does he not describe? Which of us has not done this a little bit ourselves, and probably as recently as, oh, this week? Self-sabotage seems very much to be an everyday and a universal phenomenon. (It could have been something as banal as skipping on your workout this morning even though you know you need it after scarfing that entire bag of chips last night watching that old horror flick that always gives you nightmares and leaves you feeling anxious and fatigued the next day.)

Work with a patient once brought me back to Freud's little-known 1916 essay "Those Wrecked by Success" as a means of helping to understand how and why it is a person in the prime of life, who has achieved very widespread success and recognition, would descend into a fit of self-destruction. Ross also avers to this essay, which deserves more attention than it seems to have gotten.

Since the pandemic started, and more recently as it appeared to be winding down, how many stories have we been bombarded with about workers not returning? Restaurants are notoriously desperate for staff, truck-haulage companies as well, daycare institutions across the country, and just this morning a local story about 70 unfilled positions in the Indiana State Police after a rash of retirements and resignations. Everyone rightly focuses on the low wages in many of these occupations but in these and many (most?) other occupations, how much attention have we given to the power structures and their abuses? If, writing in 1997, Ross could claim this, it is surely a fortiori applicable today: "Nowhere in daily life is sadomasochism more constantly in evidence than in the institutions that constitute the workplace" (p.44). He expands on this a little later, noting that "surreptitious sadomasochism is to be found everywhere in the life of ordinary individuals and the institutions that organize their social lives" (p.47). 

Overt sadists are rare; so too masochists. Ross draws our attention to how often such phenomena are masked and only manifest clinically in compromise formations, therapeutic enactments, and of course the transference. For some particularly recondite sadomasochistic dynamics, I would follow Nina Coltart's lead and pay attention to whatever images, nicknames, or reveries thrown up in the counter-transference.

Much of sadomasochism, he says later in the book, must be seen as "obeying two basic principles of mental functioning: 'overdetermination' and 'multiple function.' In other words, it has many causes and, once it is in place, serves many ends" (p.160). Some of these manifestations and causes--and here Ross avers to the famous "third ear" of Reik--have to be listened and watched for in particular ways. 

Sadism and masochism may once have played a useful role in the child's development (Ross is familiar with the work of Klein and Winnicott in particular, and cites them later in the book), but he recognizes how "maladaptive" (96) such things usually become later in life. One manifestation in adulthood may be the lack of self-love: "Sadomasochists...lack the basic self-self with which to withstand the fact of their own repugnant but naturally ordained desires" (102). 

The reference here to self-love indicates that Ross is also familiar with, and occasionally quotes from, Heinz Kohut. I have not read as much Kohut as I feel I should, but Charles Strozier's biography is lovely and a worthy introduction to Kohut's life. (I suppose I should confess a bias here in that Strozier has been kind and helpful to me on a number of occasions in sending me drafts of stuff he was working on, and reviewing an article I was working on. It was through Strozier, moreover, that I was introduced to the enormously valuable work of Vamik Volkan.)

When I was on my fellowship at the Chicago Psychoanalytic Institute in 2018-2019, we did devote a day to Kohut and our teacher was very helpful in breaking down some of the recondite terminology and opaque jargon that Kohut seems to have unhelpfully delighted in. 

In addition to Kohut and the others, Ross also rightly draws on the work of Robert Stoller, to whom I was first introduced a few years back by the great Adam Phillips, from whom I have learned so much. Stoller's book Perversion: the Erotic Form of Hatred is one of the most insightful things I have read in this whole area. For Stoller many manifestations of masochism and sadism are "reparative" attempts by the adult self to turn childhood traumas into triumphs. 

Later in the book, Ross returns to Freud's views on moral masochism, and claims that "since neurosis is inevitable and universal, so, too, is moral masochism" (p.152). Here Ross links this back to one of Freud's last works, Civilization and its Discontents, suggesting that in some ways the price of civilized order is that we all must tolerate a certain degree of moral masochism. 

Moral masochism preoccupies the last two chapters of Ross' book. Chapter 9 ("Sadomasochism in the Treatment Setting: the Cure") argues that "the universality of moral masochism makes almost every course of treatment harder and longer than might otherwise be the case" (p. 185). Here, of course, our attention is drawn to negative therapeutic reactions, retrenchment, and so-called resistance. Here we are confronted, in some patients, with a high enough level of masochistic guilt that they keep themselves from betting better. (As Winnicott famously observed, "health is ever so much more difficult to deal with than disease.")

The therapeutic challenges are many, and Ross does not shy away from discussing them. He notes that people who punish themselves and are unable to allow themselves to get better do so because such reactions have many "internal and external masters" whose job is always to seek to maintain "the social status quo" (187). Thus for some, they really do prefer to remain in "an oppressive but contained and secure" environment of their own making--however painful it is to them and others. 

For the therapist inclined here, when faced with such patients, to resort to moral exhortation to grow past their masochistic masters, Ross rightly cautions us in no uncertain terms that 

The very act of offering advice runs counter to the ingenuity of psychoanalytic method [that]...is devised to draw out & then call into question the omniscience & omnipotence attributed to the practitioner by the patient & to analyze the sources of these illusions (191).

In saying this, Ross is echoing and in fact anticipating Adam Phillips, not least in the latter's recent book The Cure for Psychoanalysis (but see also his Terrors and Experts). 

What then, can the clinician, tempted to despair, actually do? Ross offers two things worth considering. The first has very strong echoes of Winnicott: "What is most significant for the resolution of masochistic conflicts...is the psychoanalyst's growing emphasis on the patient's capacity to be alone and to tolerate tension and uncertainty" (192). In increasing such an emphasis, the therapist has to find ways of gently but firmly thwarting the patient's desire for a panacea, for a clear-cut "fix" to all their problems. 

An additional way forward is here suggested by Ross: "in order to be free or independent, one must mourn one's past, refrain from taking the path of least resistance, and constantly act to impose one's will on oneself" (193). In saying this, Ross is rightly pointing out that the work rests on the patient. Here he reminds me of that constant refrain supervisors have given down through the ages: do not work harder than your patient. Ross makes this explicit thus when addressing the reader directly at the very end of his book The Sadomasochism of Everyday Life: Why We Hurt Ourselves -- and Others -- and How to Stop: "the responsibility for making changes is your own, and in a sense nobody changes anybody else's mind or heart" (220).