2015, interview excerpt with Dr. Rosiello: Is Therapy Right For Me? (2015, Publisher, www.ONSPublishing.com., pages 41-54)
What are the areas of Therapy that really interest you and why?
What's more interesting than listening to another person's inner world dynamics? What's more interesting than lessening another's pain, or helping someone feel relief from their life, even if it's just for 50 minutes. What interests me is the person sitting across from me in the consulting room and the emotional relationship that develops between the psychotherapist and the patient. There is nothing more interesting than relationships. That's all there is in the world, just relationships; relationships between people, or relationships to an object of art, or to a pet, or to the Self.
People become interesting the moment they're born, maybe even before birth, and they stay interesting even after their life has ended. Those who leave us in death always remain part of us; we have a relationship to the memory they hold in our mind. So, I'd say what interests me is the person who walks into my office and tells me who they are, who they were, or who they wish to become." (p. 46)
This interview—by Libby Kessman, CSW—originally appeared in Met Chapter Forum in the Fall of 2001. The impetus for the conversation was the publication by Jason Aronson of Dr. Rosiello's book, Deepening Intimacy in Psychotherapy: Using the Erotic Transference and Countertransference. Dr. Rosiello discusses how she works and why she wrote the book.
How was your book conceived?
The ideas for the book originated in a study group I have belonged to since 1988. In the mid-nineties, we were reading both classical and contemporary essays on the erotic transference. I found myself disagreeing with some of the literature, particularly the classical literature on erotic transference and much of the contemporary psychoanalytic papers as well. I was finding that my clinical experience differed from the clinical illustrations in the literature, and I disagreed with much of the theory on erotic transference. Typically, the literature on erotic transference suggests that the patient's erotic feelings are to be analyzed and interpreted in an effort to help the patient move to a more workable transference, the neurotic transference. This notion held true for both the classical and contemporary psychoanalytic literature until the last decade. The classical essays even went so far as to say that if the patients couldn't or wouldn't emotionally alter their erotic feelings, they were to be referred to another analyst. Erotic countertransference, most specifically, was to be kept entirely out of the analytic mix, and this view held true for most theoretical approaches. If the analyst felt erotic feelings in response to the patient's erotic feelings, these feelings were to be analyzed or supervised away, so that erotic feelings could not contaminate the patient's treatment.
This view seemed strange to me because we don't analyze any other transference out of the treatment. Why did this transference get such a lowly rating among other transferences? I remember right around the mid-nineties reading Jodi Davies' (1994) paper titled "Love in the Afternoon" in Psychoanalytic Dialogues. In this essay she spoke about feeling sexualized feelings for one of her male patients, and after much deliberation, she decided it was therapeutically important to disclose this information to the patient. She did, and her patient benefited from her disclosure and their work on this issue. Davies received some criticism on this paper, but I thought her work was extremely appropriate and very much what I was experiencing with my own patients. I thought, however, that Davies still held to the notion of developing the erotic transference into a less sexualized transference so that her patient could continue his emotional growth. I object to this approach because the patient may feel that he or she has to neuter his or her feelings in order to please the analyst and remain in treatment with the therapist.
It's my experience that some people just speak a rather informal sexualized or sensual language. With some of my patients I thought, Why don't I just go along with them and see where they're headed?
You mean, it's kind of a flirtatiousness?
It starts that way. Sometimes it starts as soon as the therapist opens the door and we realize that the patient seems just a bit overinterested in our getting to know him or her and in emotionally penetrating us. Of course, this sexualized dynamic could be a defense, but sometimes it's not a defense. Sometimes it's a means of communicating that can eventually be used to enter the patient's inner world. Sexualization or loving feelings can create very intimate emotional opportunities between two people. Obviously, such feelings can't be behaviorally enacted between therapist and patient. In our analytic world, we use words to communicate our emotions, not behaviors.
You know, in thinking about this interview and having read your book, I'm reminded of something Edgar Levenson (1972) said: "As analysts, we're paid to be vulnerable."
I agree with that entirely.
It strikes me that you're taking this idea to a new level.
Manny Ghent's (1990) ideas on surrender are wonderful in the way he understands the notion of emotionally yielding to another individual. Not just the patient, but also the therapist must yield to emotions and be vulnerable in order for there to be therapeutic developments. Ghent is very spiritual in his response to the individual's inner world, and I've kept this idea as my analytic mantra in work with patients. If I am asking a patient to become vulnerable, then I'd better be prepared to take a similar emotional risk in the treatment if it's indicated or thoughtfully requested by the patient.
You present so many different kinds of erotic transferences, which suggests that one could have an erotic feeling toward anybody, same sex or not. I was really struck by how wide the concept of eroticism is in your thinking.
When I was doing the literature reviews for the different essays in the book, it seemed as if each essay developed more questions about the erotic transference and countertransference. As I was writing the first essay, I noticed I had referred to quite a few types of erotic feelings in patients, and that observation led to the second chapter, "Varieties of Erotic Transferences." In this chapter, I presented three male patients who developed three different erotic transferences: one seemed as if the eroticism was resistance, the next seemed as if it wasn't a resistance, and one patient was obsessional with sexual longings and behaviors.
As I was writing about these three male patients, I started to wonder about women who develop erotic feelings for the therapist. So I did a psychoanalytic literature search, and I found only a few where female patients had sexualized feelings for a female analyst. Actually, most of the literature on erotic transference refers to heterosexual longings between patient and therapist or to erotic feelings between same-sex gay patients and gay analysts. I found only one or two on homoerotic feelings between same-sex straight patients and therapists. Of these one or two on homoerotic same-sex longings between straight patient and therapist, not one of the therapists had promoted the erotic transference into a workable transference, nor had any them had provided his or her own countertransference feelings in the essays. I decided to write on homoerotic feelings between female analyst and female patients and also to write about my erotic countertransference. I wrote about one lesbian patient, June, who had a very intense erotic transference that was coupled with her feelings of aggression toward me. I also presented my work with a female patient who identified as bisexual and who had just begun expressing erotic feelings in our work. And, I focused on a straight female patient who began heating up her sessions with information about an affair she was beginning with her male boss. The more this patient spoke about her new relationship with her boss, the more I realized it was a transference enactment, in that our relationship was sexually heating up with each story she told of sexual behaviors between her boss and herself. Being in session with her was like the real story that created the installments of Pauline Réage's (1965) Story of 0.
Réage had been a young Parisian writer who was determined to seduce her publisher into a long-term sexualized relationship. In the way Réage enticed her publisher/lover into a sexualized affair by writing an exquisitely seductive book on sadomasochistic sex, I felt my straight female patient was enticing me with her tales of sexualized behaviors between her boss and herself. As it turns out, Réage and her publisher maintained a 30-year affair that was initially laced together with the chapters of her book. In a similar way, my patient and I developed a very intense erotic transference/ countertransference dynamic that aided in a creative and very intimate journey into her inner life.
Contemporary psychoanalytic thinking about sexuality conveys it as a fluid concept. I think therapists are scared to work as much in the erotic transference as you do. In working with supervisees, I have found that there are many different ways to use the information on the erotic transference to deepen the work.
That's true. And one reason might be that there are so many aspects of the erotic transference: one major component is sexuality, and another component contains the notion of love. After I'd been thinking about the erotic transference for some time, I realized that people seem to have a hierarchy about loving feelings being more intimate than sexual feelings. I believe many people would agree that loving feelings are indeed more intimate and intense than sexual feelings. For me, love is really a very emotionally warm and moving feeling, but it's not as intense and interesting as sexualized feelings. I have an easier time experiencing sexualized feelings than I do loving feelings. Sexualized emotions are more attainable than loving feelings. For me, love is more associated with the potential of loss and longing.
When I was in analytic training, I had a sexual dream about a male patient of mine. In the dream, we had an affair, and when I woke up, I was so relieved it was a dream because I was worried about losing my license and everything I'd been working for. So, I think when you talk about these things, they're what people feel anxious about, especially when you go to the point of talking about how you changed the way you dress. I was really struck by the chapter in which your supervisee wrote about her experience and how comfortable you have to feel in yourself to allow the erotic transference to unfold.
I love that chapter on supervision, and I'm really grateful to Dana Lerner for writing a companion paper about her supervisee experience with me. I think Dana's experience in working with the erotic transference with her male patient was different from how I have experienced it in treatment with different patients. Her patient was deeply in love with her, and she was experiencing similar, very real feelings for him. When she came for supervision, she presented sexual issues she and her patient were almost consciously ignoring. They were both quite afraid of the intensity of loving feelings they were experiencing with each other. One of the first questions she raised in supervision was, "How did this erotic material get started between them?" She felt attracted to her patient from the moment she saw him in her waiting room, and she said she was sure he felt nearly the same attraction, too. Supervising her on this case was very intense for both of us. Dana had such deep emotions for her patient, and she was struggling to treat constructively this patient who could not admit or allow his erotic feelings or hers to enter the consulting room verbally. Eventually, over time, her patient would allow her to talk about their "secret sexuality," and, of course, what was interesting is that he allowed Dana to address the erotic transference/ countertransference dynamics in the same phase of treatment in which he announced he was about to marry his sweetheart. It was a phenomenal case to supervise on the clinical material alone. Nothing is easy, however, and during our work together, Dana expressed erotic feelings toward me in supervision. So, in the supervision chapter, both Dana and I address those developments between us as well.
One of the things I really liked about your book is your writing style. I really couldn't put it down. I felt as if I was reading the most compelling literature.
That's a beautiful compliment and one that's so ironic to me because I never considered myself to be a writer. I believe I'm a good storyteller, and within storytelling I relate other people's narratives that interest me. I know there's supposed to be a structure to writing psychoanalytic material: in the beginning of the paper we cite the purpose and then create the theoretical hypothesis as we present our own ideas, which we sometimes illuminate with clinical data. I have found that if I write an outline I tend to forget to refer to it while I'm writing. I have also realized that the psychoanalytic notion I start writing about takes twists and turns that I didn't anticipate creating, so I'm always surprised at where my writing takes me.
So you write as if you're writing a work of art.
Well, I write the way I think. It's got a free associative quality; it's a rather fluid process. I find that in writing I'm actually on a journey through my mind that I didn't entirely anticipate. It's like opening up a door in your mind and being surprised at what's behind it, and it's just a lucky thing that I happen to be seated at the computer while these words exist and my fingertips move the keys on the keyboard. In writing, I try to ask the reader to accompany me while I think about ideas. My writing style presents a certain vulnerability in my wanting to take emotional risks when I'm writing about an idea or a concept, and so I think it appeals to people who are interested in other's vulnerabilities and inner experiences.
I'm struck by how open you were about yourself in this book, which is unusual in the literature for people who write about their patients. I mean, you really put yourself out there.
Well, I think the heart of psychoanalysis lies in the therapist. I believe our practices depend on our character and how we present ourselves and relate to people. One reason my patients attach to me or have emotions about me is because I try to become as real and as vulnerable as I can be. I create a demand within myself to be as emotionally available as I can be with patients. My feeling is that if I'm asking my patients to take emotional risks in their treatments, I must be willing and capable of taking similar emotional risks in their therapy if it is therapeutically appropriate.
The book struck me as a very personal, very interior kind of book, but I noticed a few times you would say things like, "Well, I don't just work with patients who develop erotic transferences." It's almost as if you were talking to the analytic community saying, "I'm not a loony!" and I was wondering if that was on purpose, too.
It was absolutely on purpose. A few people have said to me, "You only work with patients who have an erotic transference?" I find that question surprising. How could anyone think that was the only type of patient I have? Or, I wondered if they were asking if I created the erotic transference in my patients. Most of my patients do not develop erotic transferences, and I do not develop erotic countertransferences to most of my patients, including a few who have declared erotic feelings for me. Only a small group of my patients have developed erotic transference feelings, and I have had erotic countertransferences only for a few patients.
What I find interesting, at this point, is that since I've been presenting papers and publishing on erotic transference and countertransference developments, I've gotten a few new patients who begin treatment saying, "I've never told my previous therapist these things before." Of course, it's complex, because it takes two to tango in treatment and both people have to be comfortable enough to speak of sexualized feelings. But it's a sad statement about tolerating sexuality in our business, and this intolerance might be the result of the inability to work with erotic feeling or because of sexual abuses in the work.
I think the most really radical thing in your book is that sexualized feelings are a way to connect for some people. It's such afresh idea and yet commonsensical, too.
Well, many people relate in a sexualized and flirtatious manner. In the corporate business world, there are rules against sexualized behaviors, which means lots of people must be relating in a sexualized way. Personal trainers at the gym know this, dance instructors know this, and service industries and advertisers entice customers through covert sexuality or sensuousness.
Speaking of the physical, I thought the chapter where you integrated your tango lessons into one of your treatments was so wonderful. It felt very natural for it to be an outgrowth of your tango lesson. It felt so uncontrived.
Libby Kessman, CSW, is faculty member and supervisor at the Psychoanalytic Psychotherapy Study Center (PPSC) and is in private practice in Manhattan.
You're referring to the female patient who has a fetish about amputees. Yes, I felt quite disgusted listening to her sexual feelings about her desires (the patient also experiences intense disgust). In one session, I found myself daydreaming about my tango lesson and actually had the body experience of the swirling tango movements and of watching my feet move along the floorboards of the dance floor. In a sense, tango dancing highlights disjointed body parts, one's torso moving in one direction and one's legs moving in another. At first I thought I was escaping my patient's narrative through my countertransference desire to leave the room emotionally for a more comfortable environment. I realized in a moment, however, that my body's experience of moving to the tango in my daydream could be the experience my patient was having as she related her desire for amputees. Instead of dismissing my countertransference, I told my patient that I was experiencing something I wanted to disclose to her. I related my daydream and wondered if it made any sense to her in regard to her narrative. She was fascinated and thought my experience had captured the dizziness she was feeling as she talked about her wish to have sex with an amputee.
So the erotic encompasses disgust as well as what is more conventionally thought of as erotic.
Yes. To my mind, there's a possibility of sexuality in all things we relate to, because humans are sexual beings.
What advice do you have for therapists who are intrigued by your ideas but feel tentative or timid about applying them in their practices?
I think being tentative in a treatment with erotic feelings is a really good idea because it heightens our awareness of risk. Still, I don't believe we can work with an erotic transference until we feel ready. I have one supervisee who is currently struggling with working with the erotic transference. She identifies as lesbian, and she's working with a patient who's lesbian. For the longest time she would come in and say, "I know there must be sexual feelings that my patient is having in relation to our work, but they seem too elusive to find in the moment." I know that sometimes as therapists we worry that if we don't work with all the emotional material the patient presents, we'll lose the patient. And I know that some patients do leave if we can't work with their material in the moment they're presenting it. But usually our patients forgive us if we're struggling to take an emotional risk with them. In the same way we wait for patients to present their inner lives, they seem unconsciously to wait until we've emotionally conquered the inner struggles they create with us. It's something we know about each other in developing intimacies.
I've enjoyed our conversation. Is there something you would like to say about your next book?
I actually have begun the first essay that I hope will be in the next book. It's about memory and fantasy and sexual desire.
Libby Kessman, CSW, is faculty member and supervisor at the Psychoanalytic Psychotherapy Study Center (PPSC) and is in private practice in Manhattan.