My Blameless Physician

The Ethical Limits of Erotic Transference

repair: clinical conflict ii

H.D.’s admiration for Freud gave her an appetite to speak, not to submit; an appetite to write, but not in Freud’s language. H.D. never became a Freudian, or even a follower; she simply went on being the writer she was becoming. Read closely it is clear that despite, or because of, her being so impressed by Freud—and Freud explicitly encourages this—H.D. goes her own way and gets what she seems to want from the analysis (when she refers to Freud’s “infallibility” she knows what she is doing, and she knows the irony of what she is saying).

— Adam Phillips, Introduction to Tribute to Freud by H. D.

1

She haunts me, C. I think about her for some measure of every day, and go through weeks where she materializes all around me: in a back-turned figure walking away down the street, in the bent posture of a partially obscured body on the rush-hour train. When I encounter her apparition, it’s different than the way my mind conjures a new crush or a recent ex out of anyone—dynamics wherein time apart grows in tandem with a gnawing desire for resolution or actualization. C.’s appearance feels truly shocking, as if it’s beyond my control, imagination, or any conscious desire for repair or resolve. This is how I most comfortably contend with my memory of her, as a fleeting, enclosed stranger.

C. was my analyst for almost two years, from December 2017 through the fall of 2019. Though her ghostliness feels like it belongs to the time that’s elapsed since the termination of my treatment, in truth, her present absence was a dilemma throughout my analysis itself. Of course, my attraction to the presently absent maternal figure was inscribed far before I met C., and I told her as much early on in my treatment. In one of my first sessions, I explained how, for the last few years, I’d agonizingly and routinely become obsessed with older, unavailable women (often caregivers from whom I sought treatment), and that I wanted to understand why. I’m sure it was clear that I was both naively and smugly proud of this tragic romantic narrative, and also that I found it unbearably painful and lonely. I felt held by C.’s compassionate assurance, her devoted concern, her sturdy warmth. I didn’t consciously realize at the time that she would naturally become my newest erotic fixation, that I was telling her about these desires as both a warning to her, lest she submit to them, and a plea for her to help me interrupt the pattern.

As I, like clockwork, developed an all-consuming obsession with C. over the following weeks and months, she seemed to reply with a steady, oftentimes tawdry cascade of mirrored seductions. My confessions of love, which I would come to recognize as erotic transference (or, my confessions of erotic transference, which I would come to recognize as love), were at first met with subtle, countertransferential gestures that felt titillating and confusing. Over time, these gestures became much more straightforward enactments of her own feelings. She suggested we read books together as a way of staying connected when we wouldn’t have sessions for a while, shared a dream she’d had about me, lost her cool and flooded me with her own overwhelm about what was unfolding between us.

The more C. let me know in bits and pieces that I was successfully seducing her, the more my obsession grew, and the more terrified and out of control I felt in the analysis. Whatever reparative potential existed for the erotic transference that erupted in my analysis with C. was impeded as she wavered between responding to my desires and needs with her own, and then trying to transcend the reenactment that I unconsciously solicited. I desperately needed her to retain her solidity even as I tried to destroy it, to maintain her capacity to care for me rather than frighten me by coming undone in the face of my raw emotionality, as my parents often had. What I understand now is that I had a far more powerful, corrective fantasy for an adult to contain their own needs enough to remain present rather than overpowered and obliterated in the face of my and their emotions. My experience in analysis with C. is, on the one hand, a rich case study and, on the other, simply a fucked-up derailment of the healing that relational analysis can provide. C.’s ability to accept her own limitations flickered, and so she redundantly and devastatingly became my latest unavailable mother whose entire attention and affection I could never quite secure.

2

In 1906, Freud wrote in a letter to Carl Jung that “psychoanalysis in essence is a cure through love.” The love Freud talks about is not an erotic love or even the love an analyst has for their analysand, but the love a patient did and did not receive from their original caregivers. The analyst, in the place of those original caregivers, ideally can hold the very raw type of feelings we all have toward those first figures who were supposed to protect us. The potential for healing exists in how an analyst can help a patient come to terms with and accept the imperfection of the love they received in early childhood and understand how it shaped them.

It’s important to articulate that there were definitely many crucial, lifesaving realizations I came to about my first experiences of care while in treatment with C. I wouldn’t have developed the capacity to receive my parents’ love and generosity (which they show me in many ways); to sustain and interrogate the devastation I feel when they invalidate the life I have chosen; or to have my current body without her care. I started seeing C. when I was twenty-four. At the time, I tentatively identified as a cisgender woman and had realized I was queer a few years earlier, in college. I’d been genuinely, perhaps naively, surprised when my liberal parents—who’d sent me to progressive private schools in the Bay Area, whose gay best friends were my godparents, whose whiteness and coastal elitism had never hindered their ability to connect with white, coastal elite gays—refused to accept my sexuality as anything other than a misguided phase. I hadn’t anticipated the ways my father’s own repressed queerness (which he’d spoken to me about in private since I was a child) and my mother’s denial of his sexuality (which she’d spoken to me about in private since I was a child) would play into my own coming out. C. helped me unravel this story, and understand how it played into the dread, shame, and self-loathing that accompanied my burgeoning secret knowledge that I was also trans.

Under C.’s care, I drew necessary boundaries my parents that allowed me to begin my physical and medical transition. She was instrumental in helping me differentiate from my parents both financially and emotionally, and to begin an ongoing process of prioritizing my own visions and desires for my life over theirs. C. also guided me toward an understanding of how my mother’s experience being raised by two bereft, orphaned Holocaust survivors had informed her strengths and limitations as a mother. I was profoundly angry with her for how emotionally unreachable she’d been during my childhood and harbored an even more unplumbed sense of guilt and responsibility for her unhappiness. Mom’s fragmented moods and lack of emotional availability, I began to understand, were not my fault but rather a result of the psychic contortions she’d devised to protect herself from pain and suffering. She was unable to give me the kind of care I so desperately needed because her parents, robbed suddenly and forever of their own parents when they were teenagers, had not known how to give her what they never received in full.

My parents’ respective inability to transcend their own needs, C. insisted, was fundamentally related to the dubiousness and revulsion I felt when “appropriate” romantic prospects pursued me. Whatever these people felt for me, it was obviously more for them than it was for me (which of course it always is to some extent). These people, I believed, would never be able to see past themselves enough to properly care for me, and so, by never giving them a chance, I made sure they wouldn’t fail me, and I wouldn’t get hurt. When I initially confessed my feelings for C. about three months into my analysis, she wisely pointed out that it wasn’t actually as vulnerable as I thought to throw myself at unavailable love objects. I had control in such a scenario because the disappointment was secured from the beginning, the letdown familiar and inevitable. I was insolent—how dare she suggest that my overwhelming love for her was about anything other than her. I dreamt about her every night, smelled her perfume on every breeze, felt sick with envy and grief when I envisioned her returning to the domestic bliss I was convinced must be life with her partner. She assured me that though it felt unimaginable, I would eventually feel differently. Though C.’s knowing response felt patronizing and cruelly unempathetic at the time, I realize now that this was exactly the kind of care I was after. An unrealistically selfless care that can, perhaps, be given consistently only by a therapist to their patient in the space of a session, but which resounds far beyond it.

It’s precisely because C. was helping me in such meaningfully fundamental ways that made moments where she broke boundaries around the very themes she was helping me process so much more disconcerting and painful. Her lapses in judgment allowed her to give into and return my relentless flirtation; and her fluctuation between denying and admitting the dynamic confirmed my belief that the adults were never really home—that it was always up to me to manage the mess.

The power I felt was thrilling and terrifyingly lonely. I remember at one point, deep into the messy web my treatment had become, C. accurately surmised that I was in a double bind—wholly reliant on her support as my therapist, yet tortured by how deeply I loved her and how rapidly I was losing trust in her ability to properly care for me. She acknowledged that I was overwhelmed by having seen too much of the tangle of her own needs. For many months, this double bind was functional—I was still able to access her as my therapist when I was frequently awash in the ceaseless friend, job, housing, family, and romantic dramas that characterized my mid-twenties. There were a few key moments, however, that made the bind I believe we both were in unendurable.

3

During the first six months of my analysis, as I became progressively wild with desire for C., she began responding with intermittent, specializing gestures: she’d frequently encourage me to stay past the allotted time of my session (here I’ll add that many psychoanalysts have pointed out that extending the structural container of a session is a fundamental boundary breach); she let me know she was offering me “first pick” among her patients for session times when her schedule changed; she confessed that she’d purchased and started reading books I’d mentioned in session; she shared the name of her perfume with me; she sent me emails with snippets of poems or articles that made her think of me; she told me how consuming it had been for her when we’d encountered each other at the same dance performance; once, after a particularly upsetting session, she emailed me reflecting on it and told me how grateful she was to be my therapist.

We still had sessions where I discussed my life outside my feelings for C., but we also had sessions that became grossly indulgent and pleasurable. We laughed genuinely and a lot; talked about writing, movies, music; even casually discussed our opinions of people we both knew in the queer milieu I existed within and that she had some proximity to; played games of cat and mouse around her desire for me. Sometimes it was serious, still, and hot in the room, sometimes playful as she laughed adoringly at one of my unabashed attempts to woo her. I loved her mind, I loved how much she wanted to know mine, and she communicated directly and indirectly just how much she liked my devotion and attention. She even coyly confessed once that she knew she was “being bad” by returning my flirtation. I would often leave her office breathless, my face burning, so turned on. C.’s chair stood to the right of her office door, and to leave I’d walk by inches away from her. I often felt powerful as I crossed the small room toward and past her after one of these “bad” sessions, as intoxicatingly forbidden to her as she was to me.

I was infatuated with C., and from this vantage read these experiences and her gestures only as messages that she was also infatuated with me. She understood this because I told her so, and because most anyone— let alone a psychoanalyst—knows when they are in the position of having total sway over someone else’s desire. That I was winning her over felt mostly triumphant, but, in retrospect, there were small ways in which I was also communicating my discomfort. I don’t remember how she responded when I asked her one day why it seemed like she couldn’t resist giving me preferential attention, but my question didn’t stop her from continuing to give it. In another example, I was usually the one to note that time for my session was up, and when she said we should keep going, I asked her if she was sure that was okay. Moments like these (and there were many) were my way of asking, “Are you sure you know what you’re doing?”

In the months after I began seeing C. three times a week, our dynamic intensified, and I moved from feeling some mixture of electrified, confused, and sometimes agonized to primarily agonized. Her transgressions, which became more pronounced and frequent, fed into my belief that I really thought I might have a shot at being with C., that we were truly in love. (I am still often confused about what was “real” for me and between us. Maybe this is partially because C., in her denial, could only momentarily integrate or accept either of our respective feelings enough to treat them as real). Though C. still sometimes explained that my fantasies about her would never hold up in the outside world, I had less and less reason to believe her.

By October 2018, almost a year into my analysis, I was increasingly vocal with her about how I was too distressed by our dynamic to continue my treatment, about the fact that my closest friends thought the whole thing was thrillingly debaucherous but also had serious concerns about my wellbeing and her approach to my treatment. They would ask, Was it helping or hurting me to mirror my obsession? Was it for the sake of my healing when one day, near the end of that October, C. reclined further than she ever had on the proverbial couch and shared a dream she’d had about us? In the dream, she and her partner were on one side of a river bank. While her partner was preoccupied by some task in the background, she sat gazing across the river at me on the other side. When I asked her what she’d felt in the dream, she gazed at me dewy-eyed and replied, “Longing.” It’s difficult to portray how conflictingly gratified, unsettled, pained, and utterly disoriented I felt in that moment and in the long wake of her disclosure. I remember telling one of my best friends about it, how she shook her head, raised her eyebrow, and said, “C. better have a really great reason or plan behind what she’s doing.”

*

From my reading and conversations with other relational analysts and analysands, I understand that it isn’t inherently wrong for an analyst to acknowledge a patient’s effect on them. This is the fundamental premise of relational, psychodynamic modalities—the therapist is not a blank, faceless figure onto whom the patient projects their desires. Rather, the identities and experiences of both patient and therapist play a role in how they relate. It can even be therapeutic for an analyst to acknowledge their own countertransferential experience when there is an erotic dynamic at play.

One analysand I spoke to said that, in moments of erotic countertransference, her analyst would say things to the effect of, “I feel really pulled to disclose or act on how I feel about you in ways that are unusual for me. Let’s try to understand what’s going on here.” In this type of disclosure, the analyst acknowledges and even welcomes the felt impact of the patient as material to be analyzed. In this case, the analysand described how her analyst always directed any discussion about the erotic transference back to what it revealed about her own attachments to people in her life. This dynamic contains vital information that can be therapeutic for the patient only insofar as it is seen to reveal broader patterns of relating outside the therapy room, which is where we spend most of our lives. When C. handled the transference as something unique to our relationship, it stopped being applicable to anything outside us, except to reinforce that I was forever doomed to repeat my pattern of pursuing unrequited care and affection.

After C. told me about her dream, I went into the next session feeling rattled and filled with anticipation. I was totally thrown off by how remote, cool, and frightened she seemed. She was unable to completely acknowledge what had happened, let alone offer me an explanation for her actions. C. never provided me any reasons for why she shared her dream with me, or for any other of her transgressive gestures. Her defensiveness only let up a few sessions later when she finally admitted that her denial was fueled by deep shame and self-reproach about how far she’d overstepped this time. My current analyst recently reminded me that erotic transference of some degree is unavoidable, and is at once a resistance to treatment and needs to be analyzed in order for the treatment to progress. Shutting it down or enacting it in place of seeking to understand it stymies the analytical project of working through unconscious content. My treatment became unworkable as C. continued to equivocate between denial and acting out her countertransferential experience. I think now that her inability to manage her competing senses of responsibility, care, confusion, shame, and— at times—anger directed at me is what made me finally terminate my analysis.

From the point when she shared her dream with me and so transparently wrestled with that decision, I begged her repeatedly to guide me through officially terminating my therapy. How was I to willfully leave the person I was in love with and on whom I was so dependent? This is the part that remains most painful to revisit. C. prioritized her need to rectify herself over my need for her to provide a final act of care in helping me depart. Throughout the end of my treatment, C. repeatedly cautioned me that acting on our relationship physically would be devastating for me because it would recreate the narcissistic love I’d received from my parents. I don’t know because we never went there, but I would argue that she had already enacted a version of this narcissistic care, and that the point at which I had to ultimately extricate myself from the analysis was also unbearably devastating. Though it left me utterly unmoored, leaving on my own terms also turned out to be an incredibly important step in building self-validation and trust.

4

The epigraph for this piece comes from psychoanalyst Adam Phillips’s introduction to Tribute to Freud by the poet and classics scholar H.D. The first half of the book is H.D.’s reflection, written after the fact, on the years she spent in analysis with Freud in prewar Vienna (1933–34). The second part is the record she kept while she was actively in the analysis. Both of H.D.’s texts reveal her omnipresent preoccupation with ancient Greek religion and mythology. H.D.’s writings place ancient tales alongside her dreams, childhood recollections, familial dynamics, depictions of her political and historical moment, and experience of, as Phillips suggests, an idealized Freud. In doing so, she foregrounds how and why we mythologize our own life experiences—to cope with, make meaning of, and thus make more bearable their existence.

Phillips points out that H.D. knowingly needs Freud to remain idealized in her own personal mythology. However Freud “explicitly encouraged” this, he understood that H.D.’s pull to view him as “blameless” was her own (the first part of her book is dedicated to “Sigmund Freud/blameless physician”). He welcomed this transference, inhabited his symbolic role in the language and terrain of her psyche, and offered her the freedom to know her emotional and creative self more intimately.

By using the language and symbolism of her own psychic life to explain what my admiration meant to her, C. made it impossible for me to distill what was mine and what was hers. She was the one who’d helped me realize that I needed to salvage my own desire from other people’s, to break my pattern of remaining transfixed by another’s judgment or unavailability. I was able to do this in terminating the analysis despite C.’s insistence that I submit to her desire and hand the reins back to her. But she had dropped them long ago, had allowed us to gallop away into a bizarre, boundaryless perversion of my analytic process; and though I broke some aspect of my pattern in leaving it, there have also been difficult consequences.

I was dependent on dissociative substances before and at the time I entered analysis with C., but my use noticeably ramped up (and remains present) as I lost faith in the treatment. Over the course of seeing C., I slid from doing a gram of ketamine over a week or two to doing a gram a day, every day. I am newly and obsessively hypervigilant in situations where I suspect power is being abused. This isn’t always a bad thing, but I haven’t yet learned how to handle this hypersensitivity. In my job as a high school English teacher, I recently switched schools because I was dogged by nightmares and relentless, intrusive awareness of how the head of school directed attention toward my most physically attractive and precocious teenage students. This situation disturbed many of my coworkers, but I couldn’t tolerate witnessing and not being able to protect my students from potential irreparable damage at the hands of an adult who was supposed to have their best interest in mind. Whereas before my experience with C. I was deeply open to therapy (I have been in and out of it with mostly wonderful practitioners since I was eight), in the year after I stopped seeing her, the thought of entering a therapist’s office made me physically nauseated. I’m incredibly grateful I found my way to my current analyst, but I felt a tremendous amount of paranoia and fear when I first began seeing her. I was mistrustful of both her and myself, worried that I would either scare her away with my desire or that she would scare me with hers. This two-pronged mistrust has naturally also bled into my romantic relationships. I’ve recently begun internalizing that what happened in my analysis wasn’t my fault, that I didn’t ruin it with my desire. This remains a difficult task. In one of my very last sessions, C. had an erratic outburst where she declared that what had transpired between us was a result of “your shit” (she practically hurled these words at me). This is one of the most laughably revealing (what else was my therapy supposed to be about if not my shit? Was it the presence of my shit or hers that had become so problematic?) and yet hauntingly loud moments from the whole experience.

At first, I could only conceptualize this piece as an act of revenge—I’d use it to out C., damage her reputation. When I considered my intentions more closely, however, I thought first and foremost about her current clients. Despite her egregious mishandling of my case, it’s not my sense that C. serially oversteps boundaries with her patients. I think she was unprepared and illequipped to deal with what emerged between us. I have no way of knowing this for sure, but I’d like to imagine that many of her patients benefit from her care, that her ethical breaches are not habitual. Offering this anonymous account of my experience in the hopes that it may be helpful to patients or analysts in the field is a continuation of the repair I’ve found on my own terms since I stopped seeing C. Phillips writes that “H.D. goes her own way and gets what she seems to want from the analysis.” I too have gone my own way, and am still working to take what I want from my analysis with C., to understand its significance in my own language.