On love and lust in erotic transference

The Transformative Therapeutic Relationship: A Challenge and Opportunity

The transformative therapeutic relationship is a unique interpersonal and intrapsychic phenomenon between analyst and patient. It occurs within the therapeutic framework, and is characterized by specific boundaries of time, place, and verbal and behavioral interactions. Collectively, these interactions may facilitate mutual trust, caring, respect, and affection between analyst and patient. The shared experience of the transformative therapeutic relationship can result in significant intrapsychic and interpersonal changes for both patient and analyst. Clinical case presentations are provided.

Maternal Erotic Transferences and the Work of the Abject

Kristeva's profound and comprehensive understanding of maternal eroticism allows us to examine the ways in which a negative maternal transference, structured through the work of the abject, can be viewed as a maternal erotic transference in its devitalizing form. Through the use of a clinical case, the revitalizing experiences of maternal eroticism within analytic process facilitate the emergence of a maternal erotic transference in its vitalizing form. The lack of erotic dimensions in maternal transferences, it is argued, may be viewed as present absences, and the development of a positive maternal erotic transference as an achievement. André Green's visual-spatial metaphor of foreclosed space is extended as an imploding force wherein abject signifiers do their devitalizing work. In contrast, the usable space of a healthy psychoanalytic process is viewed as the envelope around which abject signifiers emerge, becoming available for psychoanalytic work. A transformation related to the author's experiences with her dying mother is shown to have expanded her containing capacities, including new areas of patience and receptivity. These dynamics are placed within the context of a multiverse conception of maternal eroticism, including the analyst's disciplined receptivity, viewed as an eternal signifier of the maternal.

Consensual Sexual Relationships between Health Practitioners and Their Patients: An Analysis of Disciplinary Cases from New Zealand

Consensual sexual relationship between health practitioners and their patient are considered one of the most serious breaches of professional boundaries. Prevalence rates are difficult to establish since underreporting may occur, yet media attention may conflate the perception of prevalence. In this study we first reviewed the literature for risk factors for health practitioners and patients, professional standards, and responses of disciplinary bodies. Following this, we quantitatively summarised case characteristics and disciplinary outcomes from a 14-year cohort of New Zealand's Health Practitioners Disciplinary Tribunal proceedings. From the 26 cases identified, four themes were discussed in detail and illustrated with cases. These include: female practitioners working in correctional settings; zero tolerance but no registration repercussions; patient vulnerabilities when help-seeking for mental health issues; and the use of rehabilitative penalties. Despite the difficulties in conducting research on sexual boundary violations, this raises awareness, encourages proactive reporting, and inspires constructive strategies.

Is love curative?

This article explores the phenomenon of love in the therapeutic relationship and its role as a curative factor. Since Freud's (1915) description of transference love, a major goal of treatment is to understand its developmental antecedents. Most analysts agree that transference love is no different than ordinary love, except that it is overdetermined and requires the patient to view it as simultaneously real and illusory without reciprocity from the analyst. Nontransferential, realistic elements of the therapeutic relationship also play an important role in treatment. An important outgrowth of the therapeutic process is the development of a new object relationship between analyst and patient. This special or transformative friendship is a new object relationship characterized by genuine feelings of mutual respect, trust, caring, and even love. It facilitates the patient's capacity to form and maintain other loving relationships. Two case presentations are illustrative.

Tender Is the Night: romantic tragedy or the tragedy of boundary violations?

In the author's reading, Fitzgerald's Tender Is the Night (1934) is a sustained investigation of the incest taboo and of the psychological pressures that can lead to its collapse in the clinical situation. This novel allows the reader privileged entry into the "case" of a clinical boundary violation in a way that no scientific paper can permit. Drawing on Chasseguet-Smirgel's (1976) concept of the illness of ideality, the author uses this novel to demonstrate why none of us is safe from the possibility of erotic involvement with a patient.

Ethics and the sexual countertransference

In this paper I shall suggest that, in addition to 'conscience', the archetype of Eros plays an important part in 'benign relatedness' and that this is what constitutes an ethical attitude. I also propose that the idea of 'benign relatedness' can provide us with a workable concept for those serving on Ethics Committees especially when our Code of Ethics is unclear or limited. I attempt to show that the analytic attitude is essentially ethical and define what I see as the analytic attitude as a way of demonstrating this. By discussing the neurotic sexual countertransference and unconscious identity I hope to clarify the main reasons for unethical enactments. I use examples of ethical problems, including a personal experience, to illustrate the kinds that occur and lastly I discuss how mourning plays an important part in the resolution and avoidance of these problems.

Transference, counter-transference and repetition: some implications for nursing practice

AIMS

This discussion paper offers an introductory text for nurses and explores the psychoanalytic ideas of transference, counter-transference and repetition compulsion. Disguised case vignettes provide illustrations of the ideas as they might apply to nursing, including professional practice and occupational choice.

BACKGROUND

The literature suggests that transference can be a source of creativity as well as destructiveness and influence important communications with oneself and others including the choice of nursing and other health professions as an occupation. Recognizing possibilities of transference, counter-transference along with repetitive patterns of behaviours, can help nurses of all specialities to address situations constructively by responding thoughtfully and appropriately.

CONCLUSION

This discussion concludes with the suggestions that we know little about the motivational factors underlying nursing as an occupational preference; moreover, nursing does not have a culture of personal therapy. As such nurses are denied opportunities to understand the possible reasons underlying their occupational choice or gain experiential knowledge of interpersonal dynamics occurring between patients and colleagues.

RELEVANCE TO CLINICAL PRACTICE

Transference and counter-transference are thought to have some bearing on all relationships. Forming a natural part of the way human beings relate to each other, transference and counter-transference can bring about sincere human interest, caring and concern. However, there is also potential for disagreements. Recognizing the possible origins of relational difficulties can offer opportunities for professional development to nurses along with the benefits for health service users.

Transference and countertransference

TOPIC

The utility of transference and countertransference in professional nursing relationships.

PURPOSE

To provide an introductory text for nurses new to these concepts.

SOURCES

Literature specific to transference and countertransference illustrated by examples related to professional practice.

CONCLUSIONS

Transference and countertransference influence relationships in ways that under certain conditions may be unhelpful to all concerned. Understanding how transference and countertransference manifest themselves has implications for the safe structuring of professional relationships.

Therapist-patient sex. From boundary violations to sexual misconduct

It is the therapist's ethical, professional, and legal duty to establish and maintain treatment boundaries consistent with the provision of good clinical care. The therapist must guard against progressive boundary violations that are damaging to patient care and that may also lead to sexual exploitation of the patient.

Neutrality, abstinence, and the therapeutic alliance

Concepts of neutrality and abstinence are discussed in terms of the variant opinions about them, pro and con, with particular reference to efforts to dispense with them based on the unavoidable role of the analyst's personal influence and subjectivity in the analytic process. Stereotypes of both neutrality and abstinence are examined, and the therapeutic alliance established as the most appropriate context within which to articulate the essential and constructive role of effective analytic neutrality and abstinence. The alliance is not possible without the persistent exercise of both neutrality and abstinence; conversely, other components of the alliance are intended to facilitate and preserve neutrality and abstinence on the part of both analyst and analysand. These elements are essential factors in effective analytic practice.