Discussion of "The Erotic Transference"

I have elected to take as my starting point Franco de Masi's concluding comment about the necessity for the analyst to find and retain his bearings when working with, and in the erotic transference. He makes clear the reasons for this statement. Firstly, there is the importance of identifying the erotic transference and differentiating or attempting to differentiate the various manifestations of its presentation. Secondly, understanding and meaning derived from this identification and differentiation then become the basis for making informed interpretive comments in the quest for psychic integration.

In our psychoanalytic work generally, the challenge and task of finding our bearings and keeping our course is of great importance. In our work generally we become living witness to a panoramic world of desires, fears, hopes, dreams, beliefs and personal history as we participate in the process and work of understanding. Our patients seek to be understood by us as well as to gain understanding with us.

It is in working with the erotic transference that this challenge assumes far greater importance for there are both clinical and ethical considerations if the analyst fails in his task to identify, work with, and work through the erotic transference especially in the more malign forms.

Freud's analogy is worth reiterating. "The psychoanalyst knows that he is working with highly explosive forces and that he needs to proceed with as much caution and conscientiousness as a chemist but when have chemists ever been forbidden because of the danger from handling explosive substances which are indispensable, on account of their effects?" This metaphorical reference and rhetorical question underscores what Franco de Masi has presented today - that the nature, intensity and interactive qualities of the erotic transference may be harnessed for good, constructive and creative purposes or be potentially damaging and destructive if not handled carefully and thoughtfully.

I liked Franco's comments about the erotic transference as a frontier region with many kinds of clinical experience, not only with diagnostically diverse entities, but also between past and present, between love and hate and between internal psychic reality and the external world.

Before presenting his own clinical material, Franco reminds us of Freud's 1915 paper "Observations on Transference Love " and what we would nowadays term boundary transgressions being one of the prime factors in the genesis of this seminal work. In addition to the concern about male analysts falling in love with female patients, one of the central messages in this paper is Freud's recommendation for the analyst to view and treat the patient's love as "unreal".

At the time, this was a major conceptual advance positing as it did, the patient's "love" for the analyst as the new edition of an old and infantile trait - and, most importantly, a situation contributed to, and evoked by, the analytic situation. Although not as yet formally termed 'repetition compulsion', this was clearly enough implied. It was also evident that Freud considered the erotic transference as the cornerstone for potential transformation and cure as well as a potential hazard.

In detailing the Jung-Spielrein affair, Franco comments on the development of mutual idealisation between the patient (later to become analyst) and her doctor. For me, one of the prominent features here is the power of the force of this mutuality for both protagonists. The tenacity of the erotic transference is notable as are the attempts, especially by Spielrein, to come to terms with the sequelae of what Franco points out as the unanalysed, unmitigated and inextinguishable erotic experience. The grandiose and unrealisable aspirations are as striking to us as they were painful for Sabina Spielrein.

Franco reminds us of some of the important contributions to the psychoanalytic literature. It is interesting that the various contributors conceptualise erotic transference as being a kind of umbrella term for various and diverse manifestations of love, sexuality and intense ambivalent attachments – some of these being flexible and analysable and others being entrenched and immutable with varying clinical outcomes.

This brings us to Franco's clinical examples in which he presents two broad categories of erotic transference- dream or delusion.

Out of her emotionally isolated, impoverished and constricted life, Anna declares her love for her analyst. Franco tells us that he failed to respond to this unanticipated manifestation of the erotic transference "on the right level". However, he subsequently addressed her reaction (withdrawal into silence) and Anna's feelings of hurt, rejection and disappointment could then be articulated and worked with. In turn this opens up for both participants the opportunity for working through. Anna's wish is for a kind of primal union with a maternal object – interestingly not to fuse with, but rather to develop from.

Essentially this is not a regressive wish but rather a developmentally appropriate need for a reliable, secure, stable and attuned maternal object. From this perspective, the expressed desire to travel to Morocco represents Anna's wish and need for an enlivened and enlivening sensory life, as Franco notes, with the mother/ analyst travelling companion.

With this understanding I found myself thinking about Anna's dream in which the analyst's wife appears, inviting Anna to explore the world. I thought this imagery may have expressed the maternal transference in which Anna experienced herself to be emotionally held with trust and confidence by the mother / analyst so that movement out of her inner world of marshes and enclosed spaces could begin or indeed was already beginning to occur. Thus, exploration becomes possible in the context of the analytic work and developmental evolution becomes a reality in life and living more generally for Anna.

Franco's analytic work with Aldo is described as difficult but not impossible. From the outset, the presence of mistrust, suspiciousness and intense persecutory anxiety in the transference alert the analyst to the presence of brittle narcissistic defences, a fragile self image, and schizoid delusional-like ideation including distorted projective thinking.

As an aside, variations on the myth and re-workings of the myth of Narcissus portray him both as a victim of cruel fate and as the perpetrator of his own inevitable demise through vanity, pride and most importantly, the active rejection of love and loving overtures from others.

And so it is with Aldo. Hence, the analyst becomes witness to the grandiose omnipotent self-idealisation (at times projected onto the analyst), the ruthless and unremitting super-ego and the masochistic elements – all of them powerful destructive influences.

Aldo's reported dreams feature images of luxuriant abundant growth, animal and plant vitality, only to mysteriously and precipitously disappear. Franco's understanding of Aldo's pre-history is one in which trauma interfered with the infantile dependent state. To take this further, one might postulate the presence of catastrophic irreversible loss of the idealised mother / infant union – forever after yearned.

Whether developmental trauma actually occurred in material historical fact, in unconscious phantasy, or with elements of both, this precarious, highly feared and fearful state of mind expresses itself in the transference as persistent, overwhelming separation anxiety. And I think too, intense psychic pain about Aldo's own state of separateness both in the analytic relationship and in the world more generally.

To my mind, rage, fury, hatred, chronic resentment and embitterment are implied rather than explicated in this clinical picture. Intimacy and direct emotional contact with another, including with the analyst of course, is therefore a terrifying and feared experience for Aldo.

In contrast to Anna and Aldo with whom working through could be undertaken, Franco's work with his other clinical examples is relatively more difficult and problematic for both patient and analyst for a variety of reasons. The term "parallel reality" is used to denote patients who emotionally withdraw into a fantasy world in preference to living with the vicissitudes of lived psychic and shared reality. The relative inaccessibility of this fantasy world speaks to dissociation, splitting and a well developed defensive organisation operating to prevent the vagaries of emotional contact, growth and development. This is reminiscent of John Steiner's concept of the psychic retreat.

In the supervised case of Fausta , her private and sequestered erotised world is made overt and explicit after several years of analysis. I think this is an important consideration. Only after relative trust, security and stability of the analytic relationship has been established and maintained, is it possible that Fausta is either willing or able for her analyst to gain accessibility into this secret fantasy world.

As I understand it, Fausta not only recruits her analyst's ordinary relating to her in the service of seductive erotisation but in doing so, is actually perverting the authentic analytic relationship through enactment. Her sustained attempts to draw the analyst into this highly erotised world are termed "malignant".

In addition, there is an element in this supervised case of erotomania - the projection onto the analyst of her own sexual wishes and desires with the belief that he too shares in a delusional pact of mutual sexual idealisation.

The lack of insight together with repetition compulsion are a highlight of this case and illustrate indeed, as Franco points out, the attempt to short-circuit external and internal reality with particular reference to the experience of loss or losses - presumably past as well as present ones. Such realities are not only powerfully defended against but are also replaced by the manufactured falsified world so vividly communicated in Fausta's dream in which the unconscious wish appears to be to preserve and actively feed the Oedipal phantasy of being father's sexual consort by replacing the mother.

Between the lines, grievance, resentment, envy and jealousy are present with particular reference to the hated reality of the differences between analyst and patient. At the same time, Fausta is strenuously attempting to actively falsify these realities of the analytic relationship.

This is not easy psychoanalytic work! For his part the analyst is working towards enhanced psychic integration and the patient, for her part, is powerfully resisting such synthesis by energetically maintaining the split-off parallel secretive world of sexual and emotional gratification.

The analyst's need to keep his bearings is nowhere conveyed more powerfully than in Franco's work with Aurelia . Blatantly overt compulsive sexual acting-in has an unambiguous addictive and destructive quality. Projective identification is employed not so much to communicate but to control the analyst's reality testing, his sense of worth and his psychic equilibrium generally.

A feature of this patient is her repeated effort to invade and colonise her analyst's mind. In turn, to have him believe that bad is good and good is bad. This is an attempt at inverting as well as perverting reality including the realm of moral judgment and insight. This is the essence of Meltzer's anal masturbatory world.

Franco tells us about Aurelia's dream (featuring the white painted casket) and states that this dream marked a shift in her moving away from sexualised madness. I found myself also thinking about mad sexuality and my further association was to childhood sexual abuse with perhaps the loss of Aurelia's innocence represented in the dream as a morbid fear of losing her own daughter.

If this construction has any validity, then Aurelia's inverting the real into illusion and illusory / delusional thinking into reality might be understood as a virtual wholesale dissociation - a psychic survival mechanism, at a great cost to be sure, but perhaps also a necessary one.

Franco comments on his technique of 'releasing' Aurelia. This tallies with her being both the victim of, as well as being in a perpetual state of identification with, a powerful malign seductive object- both transferences having their countertransference correlative experiences for the analyst.

Franco's final clinical example, Maria , illustrates the development of a frankly psychotic transference of an erotic kind. As Franco points out, this patient was characterised by an incapacity to think, reflect upon and communicate on a symbolic level with her analyst.

I was reminded here of Winnicott's comment in working with the psychotic part of the personality and the total absence of an "as if" quality. For this patient the reality of the analytic couch was not a space and an opportunity for understanding and development but a space and an opportunity for a delusional attachment.

Delusional falsifications as Franco calls them, did indeed protect or at least were meant to protect Maria and her analyst from the pain and trauma of separations and separateness itself.

The elevated manic state communicated in her dream seemed to me to also have a schizoid quality – cut off, isolated and over-valued in her own private enchanted mind / garden. When the analyst fails to collude with his patient's wish to draw him into this encapsulated time and space of an idealised permanent retreat, she breaks off contact and seeks another analyst.

Subsequently three manifestly psychotic episodes is a very sad and poignant postscript.

We always hope and presume we can help our analysands to understand or try to understand what they bring to us via the transference. This presupposes an internal object world that has the capacity to engage, reflect upon and think symbolically as well as communicate in the language of words rather than action. It presumes that the capacity for growth and connectedness outweighs psychic injury, damage and destructiveness.

Maria's background of maternal deprivation and abuse together with the conspicuously absent father seems to have prevented an attachment to her analyst in which growth and development could potentially occur. The erotisation of the transference here appears to be one in which Maria is identified with the entrapping and seductive grandmother. The analyst's inability to help Maria provides insight, I think, into the omnipotent and monopolising quality of this malignant transference. Sometimes this can only be known with hindsight.

Franco has provided us with a wealth of clinical material which richly illustrates the spectrum of manifestations of erotic transference. The use of graphic dream material in conjunction with an understanding of both enacted and non-enacted transference enables the analyst to identify and interpret the conflicts, defences and anxieties associated with polymorphous Eros.

At one end, the relatively healthy object related transferences enabling emotional contact such that growth, development, understanding and insight can proceed. This is the dimension of "the dream"- the benign loving transferences which do not excessively disturb the analyst or disrupt the work of analysis.

At the other end of the spectrum, the essentially anti -object related transferences hell- bent on a course of compulsive destructiveness variously manifest clinically as addiction, perversion and psychosis. This is the "delusion" dimension- the disturbing malignant sexualized transferences which mitigate or even prevent analytic work.

Franco makes clear also that oscillations occur within this conceptual framework requiring the analyst to be empathic, alert, mindful, tactful and considerate of the motives and intentions associated with such shifts.

He illustrates how the analyst is both observer and participant as he engages in the holding and interpretive aspects of analytic work with his patients. By allowing himself to retain open-mindedness and experience through projective identification the role(s) to which he is assigned in the transference, the nature and function of the unconscious phantasy life becomes clearer.

Many thanks Franco for a rich and illuminating presentation on the vicissitudes and challenges of working with, and working through, the many faces of erotic transference and corresponding counter-transferences. I anticipate a lively audience discussion!

Peter Smith

APAS Conference

Melbourne

October 2013