September 26, 2004
Love and Psychotherapy

Since we have been begun discussing love on our listserve, I thought I would share some anecdotal material and references that I value.

Recently, a psychotic patient with whom I have been working for about four years in intensive psychotherapy (2-5 sessions a week over the past several years), moved his persecutory delusions into the transference (with some assistance on my part).  He began to believe that I was the persecutor who was trying to destroy his body and mind. In one particular session, he started by threatening to kill me in the office.  He looked at me menacingly (he is over 6 feet and quite strong looking).  He rose from a sitting position and moved towards me with a great deal of rage.  I had to react quickly.  I told him if he were to do anything to me, I would call the police ( despite knowing that I would not have time to do this) and he would be brought to the hospital.  He immediately returned to the couch.  Over the next few sessions we were able to contain his paranoid hate/fear as well as my countertransference hate/fear of him.


In our last session, he began to speak of throwing his abstinence away (from crack) and risk becoming homeless again. Spontaneously, I blurted out "Oh my God!" with a sad tone in my voice. Amazingly, the paranoid tension in his face and speech melted. He looked at me and smiled! I saw some temporary thawing out of a deep layer of icy, paranoid mistrust.Theoretically, I think what happened was, in the language of Searles, a movement from the pathological to therapeutic symbiosis.

Below are some valued references:

Daniel Shaw (2003). On the therapeutic action of analytic love. Contemporary Psychoanalysis,  251-278.

Joseph Natterson (2003). Love in psychotherapy. Psychoanalytic Psychotherapy, 20 (3), 509-521.

Janet Sayers (2003). Divine Therapy: Love, Mysticism and Psychoanalysis. NY:Oxford University Press. This volume has chapters on Freud and freeing love, Marion Milner and recovering mysticism, Paul Tillich on being accepted, and Julia Kristeva on mothering.

H. S. Sullivan wrote cogently about love in his The Interpersonal Theory of Psychiatry published in 1953 by WW Norton for the William Alanson White Psychiatric Foundation.

Harold Searles believed (used in every issue of our ISPS-US Newsletter) that "...Innate among man's most powerful strivings toward his fellow men...is an essentially psychotherapeutic striving." His concepts of patient as therapist and therapeutic symbiosis exemply this.

Gaetano Benedetti has spoken about the analyst's "counteridentification" with the catastrophes suffered by our patients, setting in motion a mutual identificatory and growth-promoting process. See my interview with him: "Interview with Gaetano Benedetti, MD" in The Journal of the American Academy of Psychoanalysis and Dynamic Psychotherapy, 31 (1), 75-87. See also his Psychotherapy of Schizophrenia published in 1987 by New York University Press. Benedetti remarked on the difficulties the psychotic patient has in receiving empathy and "therapeutic positivization" because of various dynamic reasons including attachment to an inner persecutor/aggressor. Patients, as persons in general, have a hard time trusting and receiving the good will and love of others. I remember a line from a song by the great blues guitarist BB King: "No one loves me but my mother-and she may be jiving me too."


Ludwig Binswanger believed that the reciprocal love relation, or dual mode of love, constiuted the highest and most original form of human existence. An excellent source for Binswanger's thoughts on love can be found in Roger Frie (1997) "Subjectivity and Intersubjectivity in Modern Philosophy and Psychoanalysis" published by Rowan & Littlefield.

From a more theological perspective, and with great psychotherapeutic import, Martin Buber's I and Thou is a must read, as is Dostoevsky's The Brothers Karamazov, especially the comments of Father Zossima ("Love in action is a harsh and dreadful thing compared to love in dreams").

Clancey McKenzie MD from our ISPS-US group has devoted a great deal of thought and research on the beneficial effects of love, of caring for others. See his videotape "Love Energy Lectures" 2001 AMHA.

For those who 'love' to study love in animals see The Integrative Neurobiology of Affiliation edited by C. Sue Carter, Izja Lederhendler and Brian Kirkpatrick in 1999 for Massachusetts Institute of Technology.
Jaak Panksepp, one of my favorite neuroscientists, has a chapter in this excellent volume and has made a good case for deep feelings in non-human mammals.

Lastly, I would recommend Research on Altruism & Love: An Annotated Bibliography of Major Studies in Psychology, Sociology, Evolutionary Biology, & Theology edited by Stephen Post et al in 2003 for the Templeton Foundation Press.


Brian Koehler
New York University
80 East 11th Street 3339
New York NY 10003
212.533.5687
brian_koehler@psychoanalysis.net