email page    print page

All Topic Reviews
Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBecoming MyselfBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the NetChild and Adolescent Treatment for Social Work PracticeChoosing an Online TherapistChronic DepressionClinical Dilemmas in PsychotherapyClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCognitive Therapy for Challenging ProblemsCompassionConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsControlConversations About Psychology and Sexual OrientationCoping with BPDCouch FictionCounseling in GenderlandCounseling with Choice TheoryCouple SkillsCrazy for YouCreating a Life of Meaning and CompassionCreating HysteriaCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDeafness In MindDecoding the Ethics CodeDeconstructing PsychotherapyDeep Brain StimulationDemystifying TherapyDepression 101Depression in ContextDialogues on DifferenceDissociative ChildrenDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing CBTE-TherapyEarly WarningEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveErrant SelvesEssays on Philosophical CounselingEssentials of Wais-III AssessmentEthically Challenged ProfessionsEthics and Values in PsychotherapyEthics in Plain EnglishEthics in Psychotherapy and CounselingExercise-Based Interventions for Mental IllnessExistential PsychotherapyExpectationExploring the Self through PhotographyExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFear of IntimacyFlourishingFolie a DeuxForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFoundations of Ethical Practice, Research, and Teaching in PsychologyFreud and the Question of PseudoscienceFrom Morality to Mental HealthFundamentals of Psychoanalytic TechniqueGenes on the CouchGod & TherapyHalf Empty, Half FullHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHandbook of Evidence-Based Therapies for Children and AdolescentsHealing the Heart and Mind with MindfulnessHeinz KohutHelping Children Cope With Disasters and TerrorismHigh RiskHistory of PsychotherapyHow and Why Are Some Therapists Better Than Others?How Clients Make Therapy WorkHow People ChangeHow Psychotherapists DevelopHow to Fail As a TherapistHow to Go to TherapyHypnosis for Inner Conflict ResolutionHypnosis for Smoking CessationI Never Promised You a Rose GardenIf Only I Had KnownIn Others' EyesIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyInside the SessionInside TherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt's Not as Bad as It SeemsItís Your HourLearning ACTLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMaybe You Should Talk to SomeoneMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulnessMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMoments of EngagementMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessMultifamily Groups in the Treatment of Severe Psychiatric DisordersNarrative PracticeNietzsche and PsychotherapyOn the CouchOne Nation Under TherapyOur Inner WorldOur Last Great IllusionOutsider ArtOutsider Art and Art TherapyOvercoming Destructive Beliefs, Feelings, and BehaviorsOverexposedPathways to SpiritualityPersonality and PsychotherapyPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical Issues in Counseling and PsychotherapyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPillar of SaltPlan BPlato, Not Prozac!Polarities of ExperiencesPower GamesPractical Psychoanalysis for Therapists and PatientsPrinciples and Practice of Sex TherapyProcess-Based CBTPromoting Healthy AttachmentsPsychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy and ConfidentialityPsychotherapy As PraxisPsychotherapy East and WestPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersPsychotherapy Is Worth ItPsychotherapy Isn't What You ThinkPsychotherapy with Adolescent Girls and Young WomenPsychotherapy with Children and AdolescentsPsychotherapy without the SelfPsychotherapy, American Culture, and Social PolicyRapid Cognitive TherapyRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRebuilding Shattered LivesReclaiming Our ChildrenRecovery OptionsRelationalityRent Two Films and Let's Talk in the MorningSaving the Modern SoulScience and Pseudoscience in Clinical PsychologySecond-order Change in PsychotherapySelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSelf-Disclosure in Psychotherapy and RecoverySerious ShoppingSex, Therapy, and KidsSexual Orientation and Psychodynamic PsychotherapySigns of SafetySoul Murder RevisitedStaring at the SunStraight to JesusStrangers to OurselvesSubjective Experience and the Logic of the OtherTaking America Off DrugsTales of PsychotherapyTales of UnknowingTalk is Not EnoughTalking Cures and Placebo EffectsTelling SecretsThe Behavioral Medicine Treatment PlannerThe Body in PsychotherapyThe Brief Couples Therapy Homework Planner with DiskThe Case Formulation Approach to Cognitive-Behavior TherapyThe Challenge for Psychoanalysis and PsychotherapyThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Couch and the TreeThe Couples Psychotherapy Treatment PlannerThe Crucible of ExperienceThe Cure of SoulsThe Death of PsychotherapyThe Education of Mrs. BemisThe Ethical Treatment of DepressionThe Ethics of PsychoanalysisThe Gay and Lesbian Psychotherapy Treatment PlannerThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Healing JourneyThe Heart & Soul of ChangeThe Heroic ClientThe Husbands and Wives ClubThe Incurable RomanticThe Love CureThe Making of a TherapistThe Mindful TherapistThe Mirror Crack'dThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New Rational TherapyThe Older Adult Psychotherapy Treatment PlannerThe Other Side of DesireThe Pastoral Counseling Treatment PlannerThe Philosopher's Autobiography The Pornographer's GriefThe Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem of EvilThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Psychotherapy Documentation PrimerThe Psychotherapy of HopeThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Sex Lives of TeenagersThe Talking CureThe Therapeutic "Aha!"The Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Therapist's Ultimate Solution BookThe Trauma of Everyday LifeThe Trouble with IllnessThe UnsayableThe Way of the JournalTheory and Practice of Brief TherapyTherapy with ChildrenTherapy's DelusionsTheraScribe 3.0 for WindowsTheraScribe 4.0Thinking about ThinkingThinking for CliniciansThinking for CliniciansThoughts Without a ThinkerThriveToward a Psychology of AwakeningTracking Mental Health OutcomesTrauma, Truth and ReconciliationTreating Attachment DisordersTreatment for Chronic DepressionTreatment Plans and Interventions for Depression and Anxiety DisordersUnderstanding Child MolestersUnspeakable Truths and Happy EndingsWhat the Buddha FeltWhat Works for Whom?What Works for Whom? Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy

Related Topics
The Love CureReview - The Love Cure
Therapy Erotic and Sexual
by John Ryan Haule
Spring Publications, 1996
Review by Louis S. Berger, Ph.D.
Nov 4th 2005 (Volume 9, Issue 44)

Everyone--patients, licensing boards, the legal profession, insurance companies, and most particularly therapists themselves and their professional associations--"knows" that "no aspect of sex in the context of therapy is ever justified"(p. 137). For example, in my own state, Texas, the licensing act simply prohibits "any conduct that is sexual or may be reasonably interpreted as sexual in nature" and even prohibits sexual relationships with any former patient or client.[1]

What can one say about these kinds of formal rules, laws, sanctions and the host of informal mores and simplistic jargon (discussed in chapter 2) pertaining to sexual conduct of therapists? First of all, they obviously are indiscriminate, rigid, absolute, totalizing; they are intended to cover any therapy. Second, these kinds of positions on sexual matters are seen as self-evident; what reasonable person would challenge them? Accordingly, they are just stated and accepted uncritically, dogmatically. Third, the ethos implicitly or explicitly assumes that an imbalance of power exists; the Texas rules, for example, specifically refer to "actual or perceived power or undue influence they [therapists] hold over current and former patients and clients".[2] The clear assumption is that the "doctor"-patient relationship necessarily is tilted and has a one-way potential for victimization (doctors can't be victimized, but patients can; therapy cannot be a balanced relationship). In sum, these are the shallow simplistic views of the "collective consciousness" (Jung), of "the 'persona field,' the world of social roles and expectations, with its well-advertised but largely unconscious and frequently contradictory ideals and taboos" (p. 59). It is a world of smug, complacent dogma, where everyone knows and militantly defends the self-evident true rules.

John Ryan Haule opens his book by saying that "most essays on therapy, Eros, and sex, are treatises on what one should do or not do, and why. This one is not. My aim is to open up a way of seeing" (p. 9).† The standard dogmatic approach signals a problem: "virtually every school of therapy since Freud agrees that stereotyped thinking about a subject betrays an 'unresolved issue' and requires airing" (p. 65)[3]. Haule wants to unfold "an adequate and detailed understanding of human meetings as erotic enterprises" (p. 15), and he does. His exploration of the subject is thorough, intricate, meticulous and rich; I will highlight what I see as the central points, but urge the interested reader to go to the work itself.

I want to stress straight away that although he does not emphasize the point, the author's exploration is most relevant to one particular class of therapies, those that are "experienced as a human relationship of central importance in people's lives" (p. 10). Specifically, he is speaking of a psychodynamically informed, long-term, highly complex, in-depth process--broadly, Freudian and/or Jungian[4]--which these days is seen at best as an archaic anomaly, at worst as passť, ineffective, sexist, misguided, an unscientific enterprise based on wild theories unsupported by empirical data, an approach to be shunned.[5] Thus, this subtle, complicated, clinically highly sophisticated and nuanced examination of the erotic in psychotherapy probably will have little interest for those (especially the therapists) involved in the mundane, neurobiologically oriented, managed-care driven (ten-minutes-once-a-month medication checks, or perhaps several insurance-approved "talking" sessions, or teaching of behavioral management, or "skills training"), symptom-removal focused† "therapies" that dominate the mental health scene. In these mainstream approaches, the therapist is essentially a technician, a mechanic who fixes the patient's "disabilities", and for those involved in these kinds of medical-model following therapies (therapists, patients and their families, insurance companies, licensing bodies, the legal system), the widely accepted naive ethos and codes probably are quite appropriate and even necessary. Eros is best kept out of the picture.[6]

As already intimated, Haule's position is that the role of love or Eros in therapy is a highly intricate and very important matter that deserves careful, clinically-informed exploration in spite of the usual assumption that the subject has been dealt with adequately and is closed. But "inhibition [of acts] and erotic energies are not mutually exclusive" (p. 26). Human meetings in general are erotic enterprises, and especially the erotic in psychodynamically-informed dyadic therapy deserves, requires, much more than the stereotypic responses and applications of simplistic, behavior-centered rules. This deeply experiential encounter is erotic in the sense that it is permeated by presence of Eros, the dual-faced Greek god of attraction who binds in friendship but who is also the god of sexuality. Haule highlights this distinction, emphasizing that commonly these two aspects of the erotic are conflated. This distinction (admittedly often difficult to make, elusive, but nevertheless meaningful) and all its many implications for therapy is a key element in Haule's critique.

Haule explores the relations between these two facets in general, but especially as they manifest in the therapeutic field. The erotic energies of which Haule speaks and which he deems a central ingredient of therapy may well have

a sexual flavor.... But insofar as they come unbidden and are observed and tolerated without our fastening on them, emphasizing them, or "acting them out," we may locate them in the realm of "the erotic" rather than in that of "the sexual." We want to keep a substantial distinction between these two terms, erotic and sexual; for the one is essential to our work while the other is highly questionable. (p. 77)

††††††††††† We can also make a distinction within the erotic in therapy that pertains to human development. In therapy we can distinguish between two broad modalities: those addressing infantile remnants, and those belonging to maturity--roughly, the parental, and the egalitarian. As to the former, Haule cites Freud as saying that one needs to give patients "enough of the love which they had longed for as children" (p. 85). As we know, most children suffer to a greater or lesser extent from serving various pathological (especially, unconscious) needs of parents, siblings, and later, those of many others (e.g., teachers). They rarely grow up having been seen clearly and deeply by important others, seen as who they really are--that is, of having been "met" sensitively as unique individuals that have a unique, unfolding core. So, as adults we usually have erotic needs that are manifestations of residues of these less than ideal developmental experiences. Unwittingly we still long for "a primal experience, the unquestioned acceptance and security with which an adequate parent loves an infant dependent upon her in every way" (p. 87). In therapy that means that we do not want to be objects of the therapist's dispassionate scientific curiosity or therapeutic zeal, or worse yet, to become a therapist's "successful case".† Thus, for most patients the earlier phases of therapy revolve around this erotic need. This love †††

is surely not kindness and good intentions, nor is it demonstrated by gushing speeches.... [as patients we] want to be taken seriously.... want the real thing....† We want to be someone's you, to be valued for the unique individuals we are. (pp.85-86)

Haule draws on the psychoanalyst Heinz Kohut's 'self psychology' for guidelines on how to appropriately and effectively provide this binding aspect of the erotic, that which Kohut idiosyncratically called "empathy" and which is much like the important British analyst Donald Winnicott's notion of the "holding environment"--a complex psychological analogue to physical holding.

As the patient's old developmental lacunae become filled,[7] the emphasis shifts to the egalitarian, mature relationship. These relational shifts are reflected in shifts in the therapeutic approach, and it is here that further difficulties and complexities unfold.[8] Haule makes it very clear that as long as the patient is primarily enmeshed in issues concerning holding, every form of sexual enactment is precluded (p. 129), but that this cut-and-dried rule now becomes untenable:

Sexual interaction is one modality among many within the domain of Eros. Therefore, if sex is a kind of erotic interchange and therapy is erotic from start to finish, we now find ourselves in a more embarrassing position than we did before investigating the nature of the love cure. We have established no definitive grounds for excluding sex from the therapeutic temenos [sacred space].... (p.123) We may well be suspicious that any form of sex in the context of any therapy will be ill-advised and even counter to therapeutic intent. But we have reached the point where we have to admit that the love cure, by its very nature, has to consider sexual enactment as a very dangerous open question. This places us in great discomfort vis-Š-vis the persona field with its satisfying certainty.... (p. 134) Because the love cure takes its guidance solely from the emerging or unfolding self of the patient, it cannot accept rules that precede the encounter with that unique individual. Therefore, the question of sexuality has to be left open in principle.... [This] forces therapist and patient to deal with an immense array of issues, many of which would have been prematurely closed had the issue of sexual enactment not been left open. (p. 16)

Obviously just being naively permissive in some simplistic way is an untenable position, for any number of reasons. So at the very least, if we do not just rule out sexuality by fiat, it may be considered only in advanced stages of the therapy and even then only when "the unfolding of the patient's self seems to call for some kind of sexual enactment, as part of the work itself" (p. 141). In chapter 7, Haule meticulously explores and enriches by means of clinical examples the many and complex considerations that arise for all concerned. Much attention is given to the therapist's own dynamics, to aspects of the therapeutic process, to the nature of the patient, and to the implications of possibly violating the accepted dogma about sexuality in therapy. Comprehensive guidelines are provided for the therapist.

Chapter 8 thoughtfully and insightfully explores "Marrying the patient." Professional ethics codes are inconsistent on this subject:

Some absolutely forbid any form of social contact at any time. Others set more lenient limits whereby social encounters must be scrupulously avoided for two, three, or five years after termination. As a society, we are clearly doubtful about friendships and marriages between individuals who have had a therapist/patient relationship. But we are reluctant to forbid them utterly. (p. 154)

Here, too, Haule identifies and addresses the many complexities concerning this matter; he also includes stringent criteria that very few therapist-patient pairs could meet.

Anyone who is open to the issues addressed in this excellent, courageous book will gain from reading it, but I believe that it is clinicians who will profit most. I know that it has been and continues to be very helpful in my own work. As to philosophers, they can ponder a variety of issues raised implicitly, such as those concerning ethics, the philosophy of mind[9], and, most especially, questions raised about the limitations of the usual kind of cognitive, logical-rational, analytical philosophical thinking when one is dealing with the human dilemma.


†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††† NOTES

[1]. Psychologists' Licensing Act and Rule and Regulations of the Texas State Board of Examiners of Psychologists, July 1, 2005, pp. 67, 60.

[2]. Licensing Act, op. cit., pp. 67-68.

[3]. In their interesting The Guru Papers: Masks of Authoritarian Power (Frog, Ltd., 1993), Joel Kramer and Diana Alstad "view the degree to which a culture is authoritarian as a barometer of its dysfunctionality" (p. 4).

[4]. Even psychodynamically oriented therapies typically treat manifestations of sexuality and the erotic within therapy dogmatically, seeing and interpreting them as pathological transference and countertransference. However, as Haule shows in chapters 4 and 5, Freud, Jung, and Kohut have provided major exceptions to such psychoanalytic dogma.

[5]. I have addressed the conflicting views of different classes of therapy in a number of publications, especially in Substance Abuse as Symptom (Analytic Press, 1991) and in Psychotherapy as Praxis (Trafford, 2002) in which I dub the mainstream, problem-fixing approaches "technotherapies."

[6]. The role of Eros in these therapies could be the subject of another book.

[7]. The idea is that the belated maturation follows, in Kohut's language, "a program laid down by their [the patients'] nuclear self" (p. 101), the self that is already manifested in a rudimentary form in the womb (see Allesandra Piontelli's† From Fetus to Child, Routledge, 1992).

[8]. In my view, the emphasis shifts from primarily providing a holding environment to primarily engaging in what Paul Gray calls "Defense analysis using close process attention" (The Ego and Analysis of Defense, Jason Aronson, 1994; "Undoing the lag in the technique of conflict and defense analysis," Psychoanalytic Study of the Child, 1996, 51: 87-101); see also Berger, 2002, op. cit., especially chapter 5.†

[9]. A multitude of ontological and epistemological issues about the nature of self are raised indirectly (see my The Unboundaried Self , Trafford, 2005).


© 2005 Louis S. Berger


Louis S. Berger's career has straddled clinical psychology, engineering and applied physics, and music. His major interest is in clinical psychoanalysis and related philosophical issues. Dr. Berger's publications include 3 books (Introductory Statistics, 1981; Psychoanalytic Theory and Clinical Relevance, 1985; Substance Abuse as Symptom, 1991) and several dozen journal articles and book reviews.  His book Psychotherapy As Praxis was reviewed in Metapsychology in January 2003.


Welcome to Metapsychology.

Note that Metapsychology will be moving to a new server in January 2020. We will not put up new reviews during the transition. We thank you for your support and look forward to coming back with a revised format.

We feature over 8300 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than twenty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from for purchases through this site, which helps us send review copies to reviewers. Please support us by making your purchases through our Amazon links. We thank you for your support!

Join our Google Group!

Interested in becoming a book reviewer for Metapsychology? To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716