Edith Gould - Erotized Transference in A Male Patient

(1994).
Psychoanalytic Inquiry, 14:558-571

A Case of Erotized Transference in a Male Patient Formations
and Transformations
Edith Gould, M.S.
Reported cases of sustained, overt erotized transference in the male patient
female analyst dyad appear to be relatively rare. In a paper on the subject
of differences in the erotic transferences of men and women, Person (1985),
citing Lester, points out that there are almost no references in the literature in
which male patients are reported to experience strong erotic transferences to
their female analysts (p. 170). Person maintains that there
seem(s) to be a difference in the expression of the erotic
transference in the female patient/male therapist dyad and the male
patient/female therapist dyad. In the former case, the erotic
transference is more often overt, consciously experienced, intense,
long-lived, and directed toward the analyst, and focuses more on
love than sex; in the latter, it is muted, relatively short-lived,
appears indirectly in dreams and triangular preoccupations, is
seldom consciously experienced as a dominant affective motif, is
frequently transposed to a woman outside the analytic situation, and
most often appears as sexual rather than as a longing for love (p.
170).
More often than not, resistance to the emergence of the erotic transfer ence
has been the case with male patients and their female analysts

Edith Gould, M.S., C.S.W. is a Training Analyst and Senior Supervisor of
The Psychoanalytic Institute of the Postgraduate Center for Mental Health,
New York City. She is the Coeditor of Psychoanalysis and Psychotherapy
and is in private practice in New York City.
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(Person, 1985p. 172). Perhaps the resistance to the emergence of the more
overt erotic transference in male patients with female analysts is influenced
by the differences in receptivity to erotic material on the part of male and
female analysts. Anxiety on the part of the female analyst in relation to the
erotic transference manifestations of the male patient may lead to avoidance
and the failure to address sexual material and its derivatives. The female
analyst's countertransference difficulties with being in the dual position of the
analyst/authority figure who is also the object of the male patient's sexual
desires may precipitate efforts to dilute the erotic transference and
interpretively urge the patient to relinquish anachronistic desires. Such
approaches may lead to analytic stalemates and, in many cases, termination of
treatment. The female analyst's countertransference anxiety related to a male
patient's pleas for sexual gratification may, in some situations, result in a
misreading of the erotized transference. What, on the surface, may appear as
sexuality per se may actually represent sexualized transformations of a variety
of preoedipal strivings, such as longings to be nurtured, soothed, admired,
recognized, protected, sustained, and vitalized. Although the reasons for the
paucity of overt erotic transferences on the part of the male patient to the
female analyst call for further investigation, a detailed exploration of this
question is beyond the scope of this paper. Attempting to fill a gap in the
literature, I offer this paper, about a case of an erotized transference in a male
patient that, once accepted and allowed to unfold, led to lasting changes in the
patient's self-experience and overall functioning. It is my view that male
patients do develop erotized transferences to their female analysts. Sometimes
overt, but more often muted and disguised, these erotized transferences, when
approached with an expanded perspective on their meanings and functions,
can be surfaced and worked through.
Subsumed under the general category of positive transference, or
transference love, are a number of designated transference types, such as
sexual transference, erotic transference, and erotized transference.
Lichtenberg (1989) has drawn a distinction between sensual needs and sexual
needs. Sensual needs and experiences involve the pleasure associated with
the myriad of soothing activities provided to the infant by caregivers. Sensual
pleasure may or may not serve as a switch, either diminishing tension states,
or heightening them toward states of
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sexual excitement and orgiastic release. Therefore the sensual transference
must take its place among the variegated array of positive transference
responses. Ornstein (1985) has pointed to Freud's and others' beginning
attempts to distinguish the erotic transference from the erotized transference.
The erotic transference referred to the sexual nature of an oedipal
transference neurosis and was seen to be genuinely sexual and therefore
ultimately defensive in the analytic process (Ornstein, 1985). The erotized
transference, on the other hand, referred to a deeper regression (deeper, that
is, than the oedipal level) to a preoedipal sexuality in the transference where
other pregenital aims found powerful experession, for instance, dependency in
the guise of sexuality, and signalled a particular archaic attachment to the
object or part-object analyst (Ornstein, 1985). Loewald (1980) writes of
the intermingling of preoedipal and oedipal themes. For Loewald, The
oedipal stage itself contains core features of primary identification and
symbiosis (Loewald, p. 399) that remain potentially alive and subject to
reactivation, throughout life (p. 400). Blum (1973), addressing the subject,
writes: The erotized transference is a particular species of erotic
transference, an extreme sector of a spectrum. It is an intense, vivid,
irrational, erotic preoccupation with the analyst characterized by overt,
seemingly ego-syntonic demands for love and sexual fulfillment from the
analyst (p. 63). Person (1985) maintains that the manifest content of the
erotic and the erotized transference, while similar, generally proceed from
different motivational bases (p. 161).
Adhering to Blum's distinction between erotic and erotized transference,
this paper is a description of a multifaceted erotized transference in a male
patient. What initially seemed to be primarily an oedipally derived,
incestuous erotic transference was revealed, as treatment progressed, to
contain preoedipal needs and urgent self-enhancing efforts. These preoedipal
strivings were expressed in an erotized preoccupation with me, replete
with pleas and demands for actual gratification. The case of Mr. T illustrates
an expanded perspective on erotic transference that may counter the
pessimism associated with this type of patient who, in Freud's (1915) words,
responds only to the logic of soup with dumplings (p. 167). For this patient,
preoedipal needs, along with particular self-sustaining needs, were far more
pressing and immediate than conflicts related to unresolved
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oedipal issues. Intense wishes for merger with the mirroring and idealized
other were central, and embedded in oedipally toned material. The consistent
exploration and interpretation of the valid preoedipal logic of Mr. T's
experience enabled the analysis to surface the archaic longings embedded in
the erotized transference. Erotized material had to be interpreted in ways that
confirmed the patient's efforts at self-transformation from a powerless
dependency to a different form of attachment that was characterized by self
experiences and self-representations as strong, autonomous, masculine,
passionate, and loving. The patient's creative use of his own pressing
transference desires, elaborated in the transference interpretations, added new
and valuable dimensions to his self experience.
In Mr. T's case, what Loewald refers to as core features of primary
identification and symbiosis were predominant in the clinical picture for
some time. Until they were activated and recognized in the transference,
transformations of core developmental difficulties could not occur. For Mr. T,
narcissistic needs for self-assertion, self-enlivening experiences, and
symbiotic-like union were central. Therefore, interpretations of his erotized
transference along oedipal lines were experienced as failures on my part to
understand what was needed from the analytic relationship at the time. I now
attempt to describe certain transference formations and transformations that
were mutually determined by the analytic relationship and this patient's
shifting, subjective psychological organization.
Mr. T is a 68-year-old married, retired professional man. At the time of
this writing he had been in twice-weekly treatment for six years. He sought
therapy because of chronic depression, marital conflict, and a disturbing
sense of boredom, affectlessness, and emptiness. His wife was described as
cold, self-involved, and domineering, and she frequently threatened him with
separation. Repeated episodes where she froze him out, communicated with
him through notes, and exiled him from weekends at their country home left
the patient panic-stricken and desperate. The couple lived in a sprawling
suburban house, with the patient occupying the lower floors and his wife the
upper floors. Mr. T passively acquiesced to this segregation of quarters that
his wife imposed upon him. The image of his wife at the top of the stairs
imperiously lobbing commands, while he cowered on
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the lower landing, came to represent the experience of gross inequity in his
relationships with most of the women in his life.
Mr. T first married when he was in college. The marriage, of brief
duration, ended in divorce mainly because of his chronic impotence. Shortly
after the divorce, the patient met and married his second wife. Although he
dreaded a repetition of his impotence with his second wife, he was able to
sustain a somewhat successful sexual relationship with her. Mr. T attributed
this to the fact that his second wife was of a different religion. Their
relationship was chaotic and unstable, fraught with conflict, and complicated
by both of them being dependent on alcohol. His second wife died suddenly
as a result of combining alcohol and barbiturates. They had had a particularly
heated argument, and the patient had left the house, returning several hours
later to find his wife dead. Severely depressed after his wife's suicide, he
quickly sought refuge in a relationship with a woman in her twenties. He was
in his late forties at the time. Mr. T's impotence returned, and the relationship,
never consummated, ended when the young woman peremptorily moved to
another state. Not long after this he was rescued by his third wife, a woman
five years older than he, who had had three prior marriages. Conflicts
between them ensued shortly after their marriage. They had a desultory sexual
relationship, with the patient being intermittently impotent, for about five
years. After that, all sexual and affectionate contact between them ceased.
Information about the patient's childhood is scant. He grew up in the
Southwest, the only son of a wealthy ranch owner. His father was rarely
available, and the patient has no conscious memories of any interaction with
him before puberty. The patient describes his family as matriarchal,
dominated by a cluster of powerful and controlling women: his paternal
grandmother, his mother, a number of aunts. He remembers his mother as
willful, alternately remote and seductive, fragile, and subject to frequent
emotional outbursts. The patient had few friends and turned to his paternal
grandmother for comfort and companionship. When the patient was 13 his
father abandoned the family, running off with a very young woman. According
to Mr. T, they went on to have a successful and happy marriage. The patient
has always maintained contact with his stepmother, whose strength and
liveliness of spirit he admires. The elopement of his father with her left the
patient to care for his depressed and shattered mother, who
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never recovered from being abandoned by her husband. The patient and his
mother moved to San Francisco, where they lived with the maternal
grandmother. A vivid memory of this move remains. The patient and his
mother were traveling west on the train, playing cards. His mother,
consistently winning the hands, bitterly remarked, Lucky in cards, unlucky in
love. The patient remembers feeling queasy and uncomfortable. As he
recounted this piece of his history, he added, And that was the year I had my
first orgasm.
The patient turned to alcohol when he was in college and welcomed the
escape from painful feelings of social awkwardness and inadequacy that the
alcohol afforded him. His alcoholism became an increasing problem as he
grew older and was the cause of his being fired after 10 years of working for
one of the most prestigious firms in his field. Mr. T. never worked again. He
gave up drinking three years before he entered treatment and referred to this
achievement as a religious conversion the hand of God. Mr. T entered
psychoanalytic therapy, with annual interruptions for three-month periods
when he and his wife wintered in warmer climates.
As treatment progressed it became apparent that the patient's distant early
relationship with his father, and his father's abandonment of the family during
the patient's adolescence, had interfered with the development of an idealized
relationship where Mr. T could consolidate self-experiences as strong and
masculine in connection with a powerful father. In the treatment, an idealized
paternal transference enabled the patient to restore previously thwarted
efforts to develop such self-representations during childhood and
adolescence. His father's absence and the patient's consequent
overinvolvement with his mother, whom he experienced as depressed,
unresponsive, and seductive, contributed to his dependency, separation
panics, deadened sense of self, muting of sexual passion, and self-
representations as weak, passive, unassertive, and unmasculine. There were
times I was transferentially experienced as the seductive mother or the
optimally responsive mother who maintains a safe distance/presence. His
stepmother rescued his father from an unhappy marriage, and, transferentially,
the patient experienced me as rescuing him from his grim marriage. The
patient perceived his father's relationship with his young wife as an
enlivening one. This was paralleled in the transference, where his experience
of his attachment to me brought him to life, and
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contributed to an identification with his strong father who had the courage
to leave an unhappy marriage and go on to have a more fulfilling life.
During the first phase of treatment, Mr. T's positive transference was
primarily of a sensual nature. He related to me as his paternal grandmother,
about whom he had warm memories, associating her with a sense of safety
and comfort, symbolized by the presence of a fireplace in my office. Within
the treatment, he seemed to bask in a preverbal, passive sense of connection.
Against the backdrop of this preoedipal, sensual ambience, the focus of our
work was on the patient's desperate longings and attempts to assert himself in
his relationship with his wife, whom he experienced as a vitally needed other.
He was, at that time, unable to be comfortably alone, suffering from severe
anxiety states, along with a sense of depressed aimlessness, when his wife
was away. His purchasing a new car, one that he chose without his wife's
input and permission, became a significant turning point for him. For the first
time in his relationship with his current wife, he felt stronger, and more
hopeful that he could direct the course of his own life and not have his
powerful dependency needs and fears of abandonment cripple his strivings
for autonomy. These themes of autonomy and assertiveness, action and
decisiveness, continued to play an important role outside of and within the
treatment situation. It was during one of the moments when the patient was
describing the parallel between the soothing sense of peace of being in the
room with me and of being with his grandmother that, according to Mr. T,
we fell in love. Mr. T grew teary and believed that I, too, teared up. This
moment marked a dramatic turning point in the treatment. The patient became
gripped by an intense erotized transference, and was determined to convert
the feeling state of the sessions into extra-analytic action. The comforting
preoedipal embers had burst into a full conflagration of sexual passion. Over
the next several years, there ensued a period of numerous invitations to dinner
and to the opera, pleas for an extra-therapeutic relationship, proposals of
marriage, an avalanche of cards and letters, and even three occasions where
he sang love songs over my answering machine. His overtures included
passing references to masturbatory fantasies involving me, and a number of
overtly sexual dreams where we were pictured together.
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At one point, in the midst of this therapeutic maelstrom, he announced that
he was making me the beneficiary of his will. The exploration of this at first
led to Mr. T's assertions of his desire to give me something. He had no
children, and he had been looking for someone to whom he could leave his
money. As I continued to pursue the meanings of this declaration, he revealed
the underlying seductive motive, quipping with a grin and a wink, People are
very good to people who are leaving them money (see Rothstein, 1986).
During the second year of this overtly erotized transference phase, on the
fourth anniversary of treatment, Mr. T came into a session with a cake and
candles. He lit the candles and blew them out, for both of us. Encountering
me on the street one day, he quickly planted a kiss on my cheek and ran off
saying, in a mischievous tone, We're not in the office now.
The frustration of Mr. T's romantic overtures and the fact that our actual
relationship was confined to the office setting seemed at times to be
unbearable for him. During these periods he would become openly hostile and
provocativelighting up a cigar during the session, calling me Babe,
telling me he felt like hitting me, and railing against women in general. These
more aggressive behaviors ushered in an adversarial transference
(Lachmann, 1986; Wolf, 1988), which allowed the patient to practice what
he felt to be more swaggeringly masculine and potent positions. These more
assertive (see Stechler, 1987) and potent postures with me represented the
revival of the other pole of his ambivalent relationship with his unresponsive
mother during adolescence, symbolized by her rejecting comment, Lucky in
cards, unlucky in love. In addition, Mr. T's aggressive stance with me, at
those times, served to repair the sense of impotence he had felt in the face of
his mother's depression and rejection of him.
My attempting to interpret his transference plight along oedipal lines, that
is, that he could not tolerate the pain of being an oedipal loser, unlucky in
love, further infuriated Mr. T. He viewed these comments as diminishing the
power and reality of his love. At such times I felt assailed and helpless.
Confronted by his relentless transference demands, which only escalated as I
attempted to assert my own power of interpretation, I began to seriously
consider terminating the treatment. We had reached what seemed to be an
impasse in the
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form of an incessant struggle, with his plying me with invitations and, out of
my own growing desperation, my reminding him of the rules of the therapeutic
relationship, to which he would respond with, There you go getting didactic
again. Then, like a deus ex machina, came what the patient would in the
future refer to as Good Friday. The patient's wife was facing potentially
life-threatening surgery. Mr. T was quite anxious over how he would conduct
himself throughout the time of his wife's illness and hospitalization. He most
dreaded feeling nothing, and not being able to react responsibly and
masterfully. That he had felt nothing at his father's funeral had haunted and
disturbed him for years, reinforcing a self-representation as a person unable
to respond emotionally, to experience a loving and compassionate connection.
In talking with him about these fears in connection with his wife's impending
medical ordeal, I said, Perhaps I can help you with this. According to the
patient, this comment led to what he called a revelation later that night. In
the following session he reported that he had awakened out of a deep sleep
and felt my presence. He thought, I love her and she loves me. Her spirit is
within me. In describing this experience Mr. T added, It wasn't about sex. It
was something even more powerful. I felt like I won the lottery and the
winning ticket was in my pocket. The patient likened this experience to the
conversion experience of giving up drinking. A profound revelation had led
to a sudden and radical shift of understanding and behavior.
How did I understand this sudden transference shift? Mr. T's revelation
was clearly a reaction to my offering to help him cope more effectively with
his wife's illness. In that moment he began to experience me as possessing the
strength that he needed to borrow. At this point my understanding of Mr. T's
erotized transference shifted. For this patient, the erotized transference
functioned as the vehicle through which he could sustain a sense of himself as
strong and masterful. His need to establish and maintain the connection with
his powerful father was implicit in his erotized transference strivings.
Through assertions of his love for me, he was identifying with his strong
father who had left his wife for a younger woman. Mr. T's statement about
having the winning lottery ticket in his pocket referred to an unconscious
thematic connection between money and love, a theme that threaded its way
through the treatment. His father
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died and left him a fortune, perhaps for the patient the only expression of his
father's love for him. The patient, in turn, speaks of leaving his money to me,
an attempt to influence me in the direction of gratifying his needs for love. He
gambled with his mother, playing cards on the train, and lost. When I said,
Perhaps I can help you with this, he felt that his fate had been reversed. He
became lucky in love and won the lottery, an experience that repaired the
injury he felt as a result of his mother's unresponsiveness to him. For Mr. T,
my comment was the proof that he was a loved person. Good Friday,
leading up to the celebration of resurrection, represented the enlivening and
strengthening of his sense of self in connection with my offering of help. He
no longer felt weak, alone, and unloved. Addressing his erotized transference
as incestuous longing for his mother and as resistance to accepting being an
oedipal loser, had been experienced as an empathic failure. These
interpretations left Mr. T feeling weak, alone, misunderstood, and empty
because they revived his experience of his mother's rejection of him. The
interpretations were disruptive rather than mutative, and resulted in a
profound sense of deflation where the patient felt smaller and diminished
and returned to depressed, enraged, and anxious states. My reminding him of
the rules of treatment intensified his feelings of being rejected by me. His
overt, erotized transference formations were attempts to bolster an enfeebled
sense of self. The intense, urgent, and compulsive nature of his behavior
before Good Friday pointed to the presence of attempts to restore his
weakened and deflated self. These needs were more urgent than those
involved in his oedipal dilemma. As I focused more on the function and
meaning of his transference passions, implicitly accepting them, and the ways
in which these feelings sustained him and enhanced his sense of strength,
masculine power, and vitality, his more aggressive demands for actual
gratification subsided. Mr. T's erotized transference was a creative action,
initiated in order to experience himself as active and assertive with a woman.
Embedded in his erotized transference was the potential for resurrection
through structural change. I desire, therefore I am. Passion, desire, activity,
assertiveness, and effectiveness were qualities he associated with being alive
and masculine. This became the focus of our explorations for some time. Mr.
T's dread of a weakened and affectless state of being, and the repair of that
through the analytic relationship, took
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priority over other issues. His statement The only place in my life where I
am passionately engaged is here attested to the vital significance of the shift
in the transference relationship. Mr. T viewed the Good Friday experience
as a conversion, akin to a religious experience that signaled a spiritual
bonding between us. He said he understood the Eucharist for the first time.
Soon after our mutual epiphanies about the meanings of passion and
longings for union, the patient embarked on a religious quest. He avidly read
texts on comparative religion and philosophy, often sharing his thoughts and
discoveries with me. He took to meditating and trying to pray in a church near
my office before each session. It appeared that he was attempting to sustain
the mergerlike spiritual connection with me when he was separated from me.
What he wanted to achieve in these meditation sessions was a state of being
emotionally and spiritually moved. His efforts to sustain an internalized
representation of me were expressed during one period where he had become
preoccupied with trying to remember the exact placement of my office
furnishings, down to the last curio. He would produce sketches drawn at
home, which included us sitting face to face, and check their accuracy once
back in my office. He was thoroughly delighted when he succeeded in
accurately reproducing a rendering of my office. These efforts symbolized
Mr. T's developing capacity for evocative memory (see Adler, 1985).
His use of religious metaphors had begun to signal increasing self-
consolidation and the establishment of evocative memory. On the fifth
anniversary of treatment, he brought in an inflatable cake, demonstrating
movement from concrete to more symbolic forms of functioning. Panic
reactions to separations from his wife and from me disappeared, and anxiety
related to our annual separations was reduced to tolerable levels (see
Krystal, 1974). Speaking about a recent winter break, Mr. T said, The idea
of missing you and not seeing you seems greater than ever, though it seems
more manageable now. I'm no longer dependent on walking in and seeing
whether you're smiling. In the past, the only good meetings were when you
laughed. Now it's not necessary, not a criterion of how I felt about the session.
In the past, if we laughed together I felt I was winning you.
Throughout the treatment Mr. T consistently used his highly developed wit
as a way of expressing his self-states and as a method of
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coping with his transference anxieties. At the point of his departure for one
winter vacation, he began the session with, Today I'll start with a joke. In
addition to my request for a walk in the park and dinner with you, that we go
on the Hudson River Dayline trip forever. Having recently read Gabriel
Garcia Marquez's book Love in the Time of Cholera, I understood the origin
of this allusion. In the book, the protagonist Florentino Ariza waited 53 years,
7 months, and 11 days for his love for Fermina Daza to be requited. The book
closes with the couple sailing into eternity on a riverboat. Mr. T's request
had a very different feel to it. It was an expression of desire rather than an
insistent demand for actual gratification. Mr. T felt that we had entered a
state of grace. My office was the garden of Eden, a place of unspecified
eternal love with no demands. He said, Love is a state of grace, a higher
state, rewarding, the state one strives for in religion.
As I worked with Mr. T, the nature of his transference configurations and
desires underwent various transformations. Broadly speaking, an initial
positive transference, which represented a reactivation of his comforting and
sensual relationship with his paternal grandmother, became the backdrop for
the emerging erotized transference, which contained powerful preoedipal
needs for recognition of his strong, masculine, vital, and autonomous self.
Once accepted, the intense and overt erotized transference gave way to what
may be seen as an idealized selfobject transference, which provided the
patient with the opportunity for increased self-definition and self-
consolidation. The more or less continuous, holding presence of a silent,
maternal, mirroring selfobject transference promoted the development of
evocative memory, which reduced Mr. T's panic reactions to separation. The
establishment of specific phallic-narcissistic (see Edgecumbe and Burgner,
1975) and phallic-oedipal self-images, expressed in feelings of enhanced
masculinity and strength via the erotized and idealized transference, was
another achievement of the treatment. These newly acquired self-
representations were expressed in a dream where the patient had pleasurable
intercourse with a woman. The patient noted that he had never penetrated a
woman in a dream before. The experience and integration of self-
representations as alive, vital, and passionate were additional developmental
milestones. That he experienced a profound grief reaction to the death of a
woman
- 569 -
friend meant to him that he was no longer a man without loving connections to
others. That he could accept and envision not actually having me as a lover
and wife, yet create a way to have me through the selfobject bond and through
his experiences with religion, which operated as sustaining metaphors of his
relationship with me, was also a developmental achievement.
It is my contention that what was primary for this patient in the analytic
relationship, specifically through the vehicle of the erotized transference, was
the repair of developmental processes that had been adversely affected by
specific failures on the part of both parents. Narcissistic needs for an
idealized paternal selfobject in order to feel strong, assertive, and masculine,
along with needs for a mirroring, maternal selfobject in order to feel loved,
safe, and alive, were met in the treatment relationship. My initial transference
interpretations implicitly carried the message that Mr. T's reactions and
desires were infantile, unacceptable, anachronistic, and had to be renounced.
The patient balked, grew angry, and experienced these interpretations as
traumatically disruptive, rejecting, and as deflating his assertive self as well
as thwarting his needs for an idealized relationship.
I conclude with a quote from Stolorow and Lachmann (1985):
When transference is viewed as an expression of a universal human
organizing tendency, analysis aims not for renunciation but rather
for acceptance and integration of the transference experience into
the fabric of the patient's analytically expanded psychological
organization. The transference thus integrated greatly enriches the
patient's affective life and contributes to a repertoire of
therapeutically achieved developmental attainments (p. 34).
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Freud, S. (1915), Observations on transference love. Standard Edition, 12:
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- 570 -
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Article Citation [Who Cited This?]
Gould, E. (1994). A Case of Erotized Transference in a Male Patient
Formations and Transformations. Psychoanal. Inq., 14:558-571

Edith Gould - Erotized Transference in A Male Patient

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Edith Gould - Erotized Transference in A Male Patient

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(1994).

Psychoanalytic Inquiry, 14:558-571

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