The erotic transference can be seen as the Janus face of clinical work in psychoanalysis: it may either arise out of the positive emotions necessary for the building of new shared realities, or be fueled by falsified and distorted constructions. In the former case, the erotic transference expresses the capacity to anticipate, or “dream,” the emotional relationship with the object – which is why Freud valued its transformative aspect as one of the “forces impelling [the patient] to [...] make changes” – whereas in the latter it is equivalent to a flight from psychic reality and may be imperceptibly transformed into an actual delusion.

The Erotic Transference: Dream or Delusion

This contribution seeks to illustrate the various clinical forms of the erotic transference and the different ways of treating them. It is no simple matter to distinguish between the mental states that emerge in the course of the erotic transference, nor is it easy to tell them apart from other analytic phenomena, for this type of transference seems to be not so much an isolated clinical fact as in effect a frontier region contiguous with many kinds of clinical experience. The erotic transference is observed in a number of psychopathological syndromes, such as the neuroses (in particular, hysteria), depression, borderline states, and even psychosis.

Two types of clinical situation can be distinguished. The first corresponds to an analyzable transference potentially capable of transformation, and resembles a state of dreaming reminiscent of an ideal infantile love. The second, which is malignant in nature and appears similar to a drugged or delusional state, proves much more difficult to treat. I shall present some clinical examples to demonstrate the differences and possible therapeutic approaches.

Freud and transference love.

The notion of erotic transference is very old-established, in fact dating back to the earliest days of psychoanalysis: the history of our discipline (Jones, 1972) indicates that the main reason for the split between Freud and Breuer was the latter’s inability to withstand the erotic transference of Anna O. (1)  Psychoanalysis, according to this version, has paradoxical origins, the erotic transference having caused one of its two pioneers to abandon it.

A partial explanation of the significance of the erotic transference was given by Freud in 1914, who discusses it systematically in ‘Observations on transference-love,’ emphasizing that no doctor who experiences it “will find it easy to retain his grasp on the analytic situation and to keep clear of the illusion that the treatment is really at an end” (Freud, 1914, p. 162). He adds that the phenomenon is one of the “particular expressions of resistance,” and, in particular, that the patient seeks “to destroy the doctor’s authority by bringing him down to the level of a lover” (ibid., p. 163).

In other words, Freud is clearly stating that the erotic transference is an attempt by the patient to escape from what would later be called the dependent infantile transference (“destroy[ing] the doctor’s authority”). However, this analytic situation is not merely an expression of resistance, but in fact contains the potential for development. Freud writes (ibid., p. 165) that “[...] the patient’s need and longing should be allowed to persist in her, in order that they may serve as forces impelling her to do work and to make changes, and that we must beware of appeasing those forces by means of surrogates” – by suggesting, for instance, that the offers of love be set aside, or, on the other hand, that they be accepted even if only platonically.

If nothing else, it is clear that the analyst must avoid ending up like the pastor in Freud’s famous anecdote, who hurries to the bedside of a dying insurance agent to convert him, but leaves with an insurance policy while the agent remains true to his convictions.

What matters for Freud, therefore, is to keep the erotic transference alive so that its roots in infancy can be uncovered. He recommends treating the patient’s love as something unreal – which, he adds, is not easy in the case of certain women who are “accessible only to ‘the logic of soup, with dumplings for arguments,’” who “tolerate no surrogates”: with “such people one has the choice between returning their love or else bringing down upon oneself the full enmity of a woman scorned” (ibid., p. 166 and 167).

Caught as he (2) is between Scylla and Charybdis – between gratification and frustration – the analyst must put his trust in his analytic skills if he is not to be seduced by the patient’s Sirens (Hill, 1994, p. 485).

What is unreal for Freud is that this love is a virtually stereotypic repetition of the patient’s experience of his past and of his infancy; while this love is not ultimately directed to the analyst, what love, one wonders, is not in fact a repetition of the past?

At the end of this paper, Freud inquires whether the love for the analyst can indeed be deemed unreal, and, respectful of the extraordinary nature of this analytic phenomenon, suspends his investigation at this point.

Freud hesitates between the alternatives of the loving transference as a defense against the relationship of dependence and as real love. Is this transference a compulsion to repeat the past, a defense against the new, or, on the other hand, a potent analytic bond – a force “impellingpm [the patient] to [...] make changes” – i.e. to embrace the new?

The reality of the new relationship is confirmed by the observation that interpretations intended to take the patient back to the past often merely wound him just when he is relinquishing his age-old defenses against affectionate experiences and turning with passion toward the analyst.

A historical interlude

By way of introduction, I should like to recall a well known event from the history of psychoanalysis. The year 1977 saw the discovery in the vaults of Geneva’s Palais Wilson of a box of private documents, including the diary of Sabina Spielrein and the Freud–Jung correspondence. Some of these documents were published in an interesting volume edited by Aldo Carotenuto (1980), who was the first to reveal the story of the love between Sabina and Jung. (3)

In 1904 Sabina Spielrein, not yet eighteen years old, was admitted to the Burghölzli psychiatric clinic in Zurich for symptoms diagnosed as a hysterical psychosis or crisis of schizophrenia. Here she underwent two months of analytic treatment with Jung, who used a technique which, while admittedly of its time (associations and abreaction of the traumatic infantile complex), was underpinned by the passion of the pioneer and the generosity of the man. The fact is that Sabina soon left the hospital and enrolled at the university to study medicine. Jung encouraged her and, as her therapy continued, allowed the relationship to become increasingly intimate, with a growing admixture of mutual idealization. In her sessions, Jung came to represent such a model of heroism that in Sabina’s fantasy he assumed the name of Siegfried, Wagner’s mythical hero. In the diary discovered in Geneva, Sabina describes in detail the atmosphere of passion and of mystical union with the figure of her hero. There thus developed a passionate transference of enormous proportions that endowed her with intense vitality and foreshadowed a grandiose destiny for both protagonists.

Jung set the young Sabina aflame by confessing to her that he had similar thoughts to hers. This strongly suggests that she was able to read the mind of her analyst-cum-friend and could sense through premonitory dreams that he too wished to have a child with her. Jung, however, swung between an idealized declaration of his own love and the attempt to damp down an awkward relationship whose outcome was unforeseeable.

The diary reveals the young patient’s stubborn and relentless endeavors to make her analyst understand the nature and significance of the passionate fantasy that impelled her toward him. The dream of uniting with the hero was a mystical disposition that underlay Sabina’s creativity, just as she was composing some personal essays in which she engaged in a dialogue with Jung, thus – at the age of barely twenty-one! – foreshadowing some of the themes that she was to develop later in her scientific contributions. Jung, who had previously poured fuel on these fantasies, now sought to reduce their intensity by interpretation; Sabina, on the other hand, fought with all her might against him and against his attempt to withdraw and to ascribe everything to the vicissitudes of the libido.

Sabina remained prominent in the circle of Freud’s pupils, and was even dispatched to teach psychoanalysis at the Rousseau Institute in Geneva, where one of her training analysands was to be the young Piaget.

The erotico-passionate transference onto Jung, unanalyzed and untransformed, was not extinguished and stayed with Sabina Spielrein over the years. In some of the surviving letters to Jung, Sabina, now married and pregnant with her second child, complained that “Siegfried,” the son she had had in fantasy by Jung, might resurface as an inner presence likely to interfere with the forthcoming birth.

Some analytic contributions

Blum (1973) describes the various possible configurations of the erotic transference, ranging from relatively minor forms with positive and affectionate aspects to the extreme cases he defines as erotized transferences, accompanied by explicit offers of sex.

Blum takes issue with Rappaport’s (1959) view that the erotic transference always involves a deficiency of reality testing or an ego disturbance typical of borderline and psychotic patients; he contends that progress in therapy depends not on the manifest symptoms but on the patient’s capacity for development.

Another important contribution to the subject was made by Schafer (1977), who examines the reality or unreality of the loving transference and concludes that transference love is equivalent to a kind of transitional state, at one and the same time real and unreal, progressive and regressive, whereby the patient attempts to reconcile fantasy with reality and an old attitude with a possible new one. Schafer points out that every transference involves multiple realities and meanings, and that this is particularly true of the erotic transference.

Examining the nature of the “love” and “sexuality” encountered in the loving transference, the present author (De Masi, 1988) emphasizes the discontinuity between idealization, erotization, and sexualization that characterizes different forms of erotic transference with contrasting clinical outcomes.

Bolognini (1994) too considers the erotic transference, which he subdivides into four types – erotized, erotic, loving, and affectionate – the first being accompanied by psychotic and the second by neurotic functioning. Loving and affectionate transferences constitute clinical forms resembling healthy development, differing from each other according to the level of maturation of the Oedipus complex.

With these contributions in mind, I shall attempt in this paper to explain the meaning of the erotic transference in the various mental !7 states, with particular attention to the presence or absence of the sexual component proper. I shall call the forms that lack actual sexual elements loving or idealizing transferences, reserving the epithet erotic or sexualized for the type of transference in which the wish is specifically sexual. I shall also consider the “unreality” of this transference, which alternates between the “dream” of love and actual delusion.

Idealization in the loving transference

Anna, about thirty years old and of French origin, has come into analysis because the suffering she has experienced since adolescence has worsened over the years. She lives alone, concentrating on her career, from which she derives little pleasure. Her family, which includes two older brothers, has remained in France. Anna does not suffer from loneliness, and has not aspired to a love relationship since the ones she embarked on in the past all came to nothing.

_In the first part of Anna’s analysis, dreams of marshes and constricted spaces from which she would like to emerge seem to express a wish to escape from the isolation in which she has been confined for many years.

For a long time it is hard to identify an emotional bond with myself. For example, my attempts to discern in her any form of disturbance in anticipation of analytic separations are met with skepticism and incredulity._

_I am both surprised and caught off guard when, after several sessions in which she told me about the towns, perfumes, and casbahs of Morocco, she announces that she has fallen in love with me, adding that she would like to travel with me to these places. In my attempt to put her declaration of love in perspective, I manifestly evince some embarrassment, as the patient does not mention the subject again; moreover, she tells me in the next session that on the previous evening she almost yielded to the sexual advances of a man she had met at the home of some friends. In the ensuing sessions too, she behaves as if the declaration of love had never been made. _

_I am convinced that it is important to take up this matter again, and after a few weeks I try to work with her to understand the reason for the silence that followed her declaration. Anna tells me that she was hurt by my response to her profession of love, and therefore blotted out any feelings connected with it. Her attraction to me was like a dream that had faded away when I was unwilling to share in it. As we discuss the situation, it becomes clear that the loving transference is not oedipal in character, but has to do with the aspiration to be one with the mother, in contact with the sensory beauty of nature. This must have represented the primal deficiency in her infancy that impelled her to engage in a privileged relationship with her father during her adolescence, when she even shared with him the experience of work and leisure. _

_As the analysis progresses, it gradually becomes possible to consider in depth the various aspects of the experience of the loving transference. _ _Anna explains that an important component of the dream of love was the wish for oneness with me: we would have traveled together, and she would have been able to see the world through my eyes. Now she realizes how much she instead aspires to achieve a separate identity of her own and to experience things at first hand. She does not deny that her declaration was also that of a woman in search of a love relationship, but feels that the dreaming aspect was predominant and that she expected me to respond in kind. My response had hurt her, and she had therefore withdrawn. Yet she thinks it important to have been able to experience such a passionate state of mind for the first time in her life. _ _ At an advanced stage in her analysis, the patient says that she no longer feels that she is in love with me as in that episode from the past; she is fond of me, respects me, and is grateful to me for the experience of analysis, but is keenly aware of the differences that separate us, so she cannot see me as similar to her or share her life with me in the same way. Anna has in effect for the first time become able to perceive the difference between generations; now she can see me as a parent figure, unlike her experience of her father, with whom she had a relationship that was both privileged and confused. _

A particularity of this patient’s loving transference is the absence of a sexual component; she herself claims not be censoring erotic fantasies about me – she simply does not have any. In the past, this woman had sexual experiences without emotional involvement. Examination of the sequence – the declaration of love in the session followed by sexual acting-out in the outside world – clearly shows that the actingout was a defensive maneuver directed against the declaration (and against my unempathic response), which had left her too exposed. However, the dream of love experienced for the first time in the analysis seems to be an initial attempt to achieve at last the emotional involvement necessary for the genuine passionate cathexis of a love object.

As to my countertransference position, I must say that the patient’s declaration at first seemed to be that of an adult woman to an adult man – hence my assumption that it contained an erotic offer. In other words, I took the patient’s communication at face value and even briefly commented that the cultivation of a love relationship appeared inconsistent with her need to develop an analytic relationship. This misapprehension on my part was, I believe, the disturbing factor that caused the patient to feel that she had not been understood and to distance herself from the situation. I now think that my response to the patient’s declaration of love was an example of Ferenczi’s (1933) “confusion of tongues.” It became clear from our subsequent exchanges that she had spoken the language of a child expressing its love for its mother, while I had been unable to understand and to respond empathically because I was influenced by the adult vision of love, which includes an erotic component.

Whereas the prospect of going on a trip together had appeared to me to be at variance with analysis, for the patient it represented a primary experience of contact with the mother’s mind, and hence consistent with her analytic development. Some time before, the patient had had a dream in which my wife invited her to go out and explore the world !10 around her, which ought to have enlightened me as to the nature of her declaration of “love.” Hence the absence of a sexual correlate, because what was involved was in fact a primal, ideal relationship with a mother figure that had been lacking in her experience. By not responding to her on the right level, I had compelled her to attempt to move on while leaving this important step in maturation unresolved.

The young male analysand described in the following clinical account is another example of an idealized infantile loving transference relating to the mother figure.

_Aldo is a twenty-one-year-old youngster who uses soft drugs to cope with anxiety states that have been exacerbated by the ending of a relationship. His breakdown seems to be connected with the collapse of the narcissistic defenses that have kept him together since early childhood, as a result of which he now feels that he is falling to pieces. _ _In the initial phase of the analysis the patient is very distrustful of me: he is uncertain, confused, and asks what psychological means I intend to deploy to gain power over him in order to change him. He suspects that I alter my behavior to influence his emotions; for example, if I am kind it is to make him feel some kind of affect, and if I do not speak my intention is to irritate him. The patient obviously sees me as someone with a false personality who modifies his emotions so as to seduce or to wield power over the other. _

_The patient too undertakes transformations – which are not only psychological – to secure respect and success; for instance, he has a rhinoplasty to improve his appearance. The urge to engage in constant narcissistic performances is seemingly dictated by a “voice” that dominates and tortures him. If he disobeys by not carrying out physical or psychological transformations on himself, the voice insinuates that he is responsible for all his failures, and that, standing aloof from any human relationship, he enjoys his state of isolation like a young Werther. _

_No change is of course sufficient: the voice becomes ever more arrogant and demands that he become “as wise as Socrates on the inside, and as beautiful as Apollo on the outside.” The capture of Aldo by this seductive or aggressive superego does indeed appear to be a tragic example of the torture inflicted by the ambiguity of narcissism. _ _After a period of difficult analytic work, part of Aldo’s personality becomes freer and he is able to perceive his emotions as his own. At this point a positive attachment develops in the patient’s relationship with me, expressed now in the form of a particularly impetuous and idealized love.

The dreams from this period feature beautiful tropical forests, brilliantly colored aggressive plants brimming with vitality, and primitive animals (mammoths); but then the plants and animals disappear suddenly and mysteriously as if swallowed up by the void._

Consideration of the patient’s dreams shows that this ideal-infantile link is doomed to suffer the same fate as the primitive animals and plants, which fell victim to extinction in the course of evolution and were lost to human memory.

Since the associations and material have to do with the beauty of nature, the patient can seemingly experience a state of attraction and attachment to the object only by way of an idealizing passion, which impels him toward objects endowed with particular sensory intensity and beauty, but which prove to be ephemeral and transitory.

The type of loving transference I am describing here corresponds to a painful state of emotional exaltation that mixes object loss with the possibility of ideal union with the object. Precisely because such an absolute demand is the expression of a heightened return to primal needs, it is perhaps most likely to be exhibited by patients whose earliest experiences of dependence underwent traumatic interference.

This compound of affection and longing is encountered in some patients who, at difficult times such as analytic separations, remain attached to their analysis, fantasizing the gentle, ideal, and continuous presence of the analyst; a precarious balance arises in the analysis between an idealized state and an ongoing underlying sense of loss.

I postulate that such idealizing loving transferences are benign in character and convey the essence of emotional experiences that were suppressed in infancy, perhaps owing to a lack of receptivity in the primal object (the mother). These emotions will resurface in analysis when the appropriate conditions for an affective relationship with the analyst are established. This type of transference, characterized as it is by longing and melancholic feelings, is in part an attempt to compensate for the pain of loss during analytic separations; however, it is also an expression of that pain.

When the analyst becomes a permanent figure in the patient’s internal world, the experience of presence and of loss can be worked through and can become the prototype of a good emotional relationship.

The idealized loving transference is preoedipal in nature and exists independently of differences in gender; it can develop in both male and female patients. It is indicative of a relationship of longing with a mother who was present at the dawn of growth but suddenly disappeared from the infant’s life, thus compelling the infant to distance himself from the world of emotional relationships.

_A parallel reality _

Some of the analysts who have addressed the subject of the erotic transference (Rappaport, 1959; Gould, 1994; Person, 1985) have rightly pointed out that this mental state involves a loss of contact with reality. In the erotic transference – regarded as a repetition of the relationship with the mother or father of infancy – the analyst forfeits his role as a bridge to the past and becomes the object of erotic desire.

I should now like to consider the problem in terms of the relationship between, first, withdrawal into fantasy and, second, psychic reality.

Winnicott (1971, p. 26) draws an important distinction between dreaming and psychic reality on the one hand and fantasying on the other. In his view, dreaming has to do with emotional reality: “Dream fits into object-relating in the real world, and living in the real world  fits into the dream-world [...].” Conversely, “fantasying remains an isolated phenomenon, absorbing energy but not contributing-in either to dreaming or to living.”

Dreams and real-life experiences can be repressed, whereas fantasies have a different fate: “Inaccessibility of fantasying is associated with dissociation rather than with repression”  (4)  (ibid., p. 27).

In other words, Winnicott is drawing attention to the need to distinguish between the world of fantasy and creative imagination, on the one hand, and withdrawal into fantasy as some patients do, on the other. It does indeed seem that some patients value a life of withdrawal into fantasy more than the possibility of experiencing the reality of human relations. The existence of this fantasy world is the reason for the loss of reality that characterizes the erotic transference: the withdrawal into fantasy is counterposed with and replaces psychic reality. These two realities coexist for long periods without ever meeting. (5)

This situation is illustrated by the following case history from a recent supervision.

_After a difficult childhood, Fausta soon left home and married a man of her own age. However, it quickly became evident that he was unsuited to married life – having confessed to her that he was a homosexual – thus triggering a crisis in the patient’s life, as a result of which she came into analysis apparently suffering from severe depression.

Although the analysis was seemingly going well and the patient was benefiting from it, the analyst was becoming increasingly aware of an intense idealization of himself. He often appeared in her dreams as a guide or as someone intent on engaging in intimate affective exchanges with her. The idealization of the analyst was paralleled by  the disparagement of her current partner (she always chose partners whose characters left much to be desired and who readily lent themselves to disparagement).

The analyst had tried many times, perhaps without sufficient conviction, to draw the patient’s attention to this excessively idealized relationship, but although she seemed to accept what he said, it had had no effect. _

The erotic transference found overt expression toward the fourth year in a drama that followed an exchange at the end of a session. As the patient was paying her fee for the month, the analyst noticed that only his first name was written on the envelope containing the money. In response to his questioning posture, she explained that this was a way of making the therapist anonymous: only the analyst’s first name and not his surname appeared in her diary too. The analyst remarked that it also seemed to be a representation of a secret relationship; his comment was intentional, with the aim of encouraging the patient to confront the issue in her sessions. Next time, however, the patient failed to mention it, and instead talked about her problems at work.

_She began the next-but-one session by bringing a dream: “Last night you and I had sex for the first time. I’ve never dreamed that we were having sex, but at most that you were giving me a kiss. You were very gentle and sensitive, and I enjoyed that a lot. You were touching my nipples and I was having oral sex with you. I particularly noticed that you seemed to be enjoying it, but in such a way that I didn’t know if it was genuine or if you were exaggerating.”

The patient herself associated the dream to the exchange that hinted at a possible secret relationship. She said she very much liked it when her nipples were touched, and repeated that the analyst/partner’s pleasure in the dream was very intense, almost as if he was in part putting on an act. She commented that she could now talk to him about these things relatively calmly, whereas in the past she would not have done so. _

She then remembered the initial part of the dream before the erotic scene: “I came to your house and you were married. One of the people there was your wife... I felt at ease, but I noticed that you were looking at me in a particular way, as if you were winking at me... Then the atmosphere changed and it all happened... That surprised me, because although you hadn’t had any erotic experience with me, you seemed to know how to pleasure me, and I knew how to do it for you too... but it wasn’t really a sexual relationship; it was something else...”

Although the erotic dream was partly inspired by the exchange at the end of the session when she paid her fee, the analyst’s remark had triggered the parallel reality that had been cultivated by the patient for a long time: a fleeting, suggestive exchange of glances had sufficed to plunge her into the erotic situation.

The dream is in my view important because it features both realities – the oedipal reality (given that the analyst’s wife also appears in the first part of the dream) and the dissociated erotized reality. The patient demonstrates in the dream how easy it is to move back and forth between them.

A closer look at the erotic situation described in the dream indicates that the patient enjoys arousing the analyst, who in turn makes a point of showing off his arousal in order to heighten the patient’s performance and to arouse her. By working on this aspect of the dream, the patient understood that she was unable to resist the fascination of arousing her partner, and that she therefore always ended up choosing easily seducible partners.

She accepted the analyst’s interpretation and acknowledged her tendency – projected in the dream onto the analyst – to fake a pleasure that sometimes did not exist. She admitted that, in the analysis too, she perhaps skipped over things that were not to her liking. In other words, it was becoming increasingly clear that remaining in a superficial relationship without ever making genuine contact was a specialty of this patient, who had never in her life allowed herself to experience a genuine love relationship.

Love for her consisted not so much in the wish to relate to a valued partner as in the ability to experience in fantasy something that aroused her. For this reason she needed to find malleable men who were easily aroused. Now, in the analysis, it was becoming possible to visualize the dual reality in which the patient lived – that of the !16 analytic relationship, which was beneficial to her; and the parallel reality of her secret fantasy life on which she placed such high value.

The dissociated fantasy life has always been present in the patient. In her memories of childhood the glory days were when her father – even if he was taciturn and had a cruel streak, especially toward animals – took her riding with him. On those occasions she could dream of being his privileged companion, and was seemingly aroused by the mere fact of being an object of desire. In the dream this is evidently the mutual aim of both protagonists, analyst and patient.

This type of erotic transference manifestly betrayed the existence in this patient of a profound sense of desolation and lack of personal meaning. She plainly used love, whether divulged or cultivated in fantasy, as a compensation for this underlying void.

A suitable way of escaping from this painful sense of non-existence seemed to her to be, precisely, the creation of a fantasied erotic reality, which she would then think of as real. The awareness arrived at through her therapy of the falsification she had applied to her life enabled her to achieve greater integration, thus conferring meaning on her life in reality.

_The sexualized transference _

Sexualization is not only a defense mechanism, otherwise it would be impossible to explain why it can become a stable, antirelational psychopathological structure that eventually holds sway over the patient’s internal world.

An excellent example of this process is given by Meltzer (1966) in his description of anal masturbation. His model is that of a baby who tries to avoid the perception of anxiety as the mother walks away by idealizing his own bottom; the arousal obtained from the anal masturbation obliterates the perception of loss and replaces it with a sexual short circuit.

Meltzer (1973) also describes the process of mental sexualization occurring in certain psychotic states, perversions, and cases of drug dependency. Here the patient succeeds in creating a masturbatory state of arousal that distances him from reality; the transformation is so pleasurable that he is unaware of the dangers of the process and therefore fails to ask for help.

Sexualization corresponds to a withdrawal of the mind into the aroused body, and is characteristic of the perverse mental state. The psychopathological organization offers seemingly irresistible perverse pleasures.

In the sexualized erotic transference, which I describe as malignant, the patient attempts to draw the analyst into the same mental state.

Some aspects of this situation are illustrated by the following clinical vignette from the first two years of the analysis of a young female patient who brought a particularly prolonged sexualized transference into the analytic relationship.

Before her analysis, the patient, Aurelia, had been living with a young man who used drugs, and had given birth to a little girl by him. While she herself resorted to drugs sporadically, he was a persistent user and eventually died of an overdose. At the beginning of the therapy Aurelia appeared worried and depressed, but after about a year of analysis the atmosphere between us changed unexpectedly. Aurelia seemed to have forgotten all her suffering, including her partner’s death, and felt constantly aroused – which she experienced as a return to “life.” In the transference, on the other hand, I was seen as too “slow” and “conformist,” and was often the target of provocative comments that ridiculed both myself and the analysis. At this point she began to make manifest, unequivocal, and insistent sexual advances. Sometimes, on arriving for her session, Aurelia, instead of lying down on the couch, would even stretch out on the floor and make as if to undress. When I of course asked her not to do so, she would comment sarcastically on my timidity and hypocrisy. On other occasions she would extol the virtues of a drug and offer me a small dose. During this period Aurelia did indeed appear to be drugged herself – the predominant drug being the sexualization of her mind. In the countertransference I felt disturbed and worried. I was disturbed because I felt so to speak bombarded, exposed to constant projective identification, intended by the patient to change my mental state and to transport me into her own state of arousal; and worried because Aurelia was not only acting out in her sessions, but also indulging in increasingly violent and dangerous promiscuous sexual activity outside.

_I was convinced that a sexualized, drug-addicted nucleus was trying to destroy the analysis, presenting it as a banal and hypocritical relationship that was worthless in comparison with the sexual pleasure we could have achieved together. The struggle was waged not only between herself and myself, but also, and in particular, between two different parts of the patient, as the sexualized part sought to take possession of her healthy part.

I therefore did my best, in the analytic work, to support her healthy part in order to release it from the power of the sexualized part. After a long period of such work, this aggressive, violent sexuality, which often frightened her in her dreams and waking fantasies, gradually became less virulent. _

_This period of the analysis ended with a dream that marked the point when the patient succeeded in more consciously escaping from this sexualized madness: “In what felt like a science-fiction movie, I was looking for a house with my daughter. A couple of friends pointed one out to me, but when I approached it I saw that it was actually a grave, with a white-painted casket; the only way to live in it was to lie down inside having sex with a man. I decided not to go in because I realized that if I did I’d lose my daughter for ever.” _

The dream represents a form of sexualization that is clearly symbolized as very dangerous: the sexualized object, which is capable of capturing the patient’s self, displays an uncanny face. The patient becomes aware that this repetitive, greedy sexuality risks swallowing her up once and for all, dragging her off into an irreversible deadly mental state. The dream betrays an awareness that remained unconscious until it was worked through within the analytic relationship.

In other words, complex analytic work enabled the patient to distinguish clearly between what seemed to her good because it aroused her and gave her pleasure (something that was now proving to be destructive) and what was remote from pleasure but was actually constructive and relational (in this case, the bond with her daughter).

An erotic transference that includes a powerful sexual component in which “the logic of soup, with dumplings for arguments” is prevalent differs from an idealizing loving transference. Here the patient’s declaration completely lacks the dreamlike, gentle aspect described above in connection with the idealizing loving transference. Seduction or the attempted projection of arousal onto the partner is characterized by constant pressure and, instead of giving rise to any positive feelings in the analyst, induces in him an unpleasurable emotion. This is because the strength of the projection is likely to suggest to the analyst that what is involved is a delusional idea, if the idea is delusional partly on account of its capacity to monopolize, attract to itself, and dissolve any other idea, thus causing it to appear as false.

Under the pressure of the patient’s projection and in the climate of unreality that forms, the analyst feels powerless in the face of the “dumplings for arguments,” and must fight against the annoying sense that his belief in his analytic skill or in the existence of analysis is nothing but an illusion on which he has fed. The analyst is exposed by the patient to the delusional experience of hallucination, and the patient’s illusory power is wielded precisely by the attempt to undermine the analyst’s sense of his analytic identity.

The patient, after all, needs to transport the analyst too into the Garden of Eden; the state aimed for in relation to the object appears similar to a temporary alteration of consciousness, replete with mutual, false identifications.

This state differs from an actual psychosis in that a psychotic ultimately believes that his erotized world (usually centered on his own body) can sever any link of dependence between himself and the outside world; in our case, by contrast, the patient depends on, and searches for, suggestible and dependent objects. In seeking a convertible or suggestible object in the analyst, the omnipotence of the !20 fantasy of fascination can readily lead the patient to believe that he has turned the analyst into an object that really is seducible. If the analyst actually does act out or is assumed to do so by the patient – even in relation to something as seemingly banal as a change of session time – this may intensify the patient’s arousal and be interpreted by him as meaning that he has achieved his purpose.

The point, however, is that the analyst is seen as a potentially arousable interlocutor (who is moreover easily interchangeable with other partners in the patient’s life) who can and must share the illusory world projected onto him by the patient.

The analyst’s confusion about his identity is in fact a token of the patient’s dilemma: he does not know whether he is a sexual adult or a small child aroused by his own omnipotence.

I contend that sexualization of the analytic relationship does not involve a potential for emotional development, and should be considered very differently in analysis from an idealizing loving transference. A sexualized transference of this kind should be treated as a psychopathological structure that seeks to colonize the analysand’s mind. Interpretations should aim to help the patient escape from the power of the psychopathological structure by describing its nature and working in alliance with the healthy part of the patient.

My technique with Aurelia, intended primarily to release her from the confusion and seductive power wielded over her by the pathological object, can be seen as one of the possible therapeutic approaches.

For in the malignant transference the patient’s attitude is as a rule characterized by a deep-seated failure to understand the nature and colonizing power of this mental state: the sexualized exaltation presents itself to the patient as a pleasurable and desirable solution and is put forward as such to the analyst too.

Notwithstanding patients’ explicit belief in the goodness of this mental state, it is not difficult to apprehend in their dreams a representation of the uncanny, anxiety-inducing, and deadly character of this dependence, as encountered in the case of Aurelia.

_The delusional transference _

So far I have described some configurations of the complex entity of the erotic transference. The most unfavorable outcome of this mental state is its transformation into a delusional transference.

The word “daydreams” can be used to denote secretly cultivated fantasies that coexist, or are maintained in parallel, with an individual’s relational reality and everyday life. However, the point may sometimes come when the balance between the two realities is shifted in favor of the one constructed in the imagination. If that occurs, the dissociated reality takes over, obliterates the perception of psychic reality, and becomes a delusion.

The delusional state can be seen as a falsification undertaken in the imagination, of which the patient is unaware, and which imposes itself on consciousness, thus progressively distorting the sense of reality.

Delusion differs by virtue of its concrete character from other forms of imagination such as daydreams, the fantasies of infancy, or play, of which defensive aspects, curiosity, or exploration of the world are important components. In other words, there is a qualitative difference between the positive forms of imagination needed to keep the future open or to construct new shared realities, on the one hand (as in the ideal loving transference), and delusional falsifications, on the other (as in sexualized or delusional transferences). The delusional state is the outcome of a prolonged psychic withdrawal in which the organs of perception are used to generate artificial states of well-being. That is what happens in the delusional loving transference.

I had an experience of this kind with my patient Maria. When her therapy began, she was not delusional, had not had psychotic episodes, and did not exhibit any obvious symptoms of such a state. I had learned from her that she had in the past fallen unhappily in love with older men – and once even with a priest – but I had unfortunately !22 not foreseen that this situation would be repeated with the force of a delusion.

In my analytic experience until then, a dream or an allusion had sufficed to warn me in time of the onset of an incipient erotic transference, thus allowing me to intervene so as to steer the analysis in the right direction. However, no such communication had been forthcoming in Maria’s therapy; instead, we often had to confront a painful attachment that made analytic separations difficult and traumatic. I saw Maria as a deprived and depressed person, but not as someone with psychotic propensities as subsequently proved to be the case.

A few months into the analysis, the patient brought a dream that I did not understand until the erotic transference emerged a few years later:

_In the dream the patient was with a group of people and then decided to take the elevator by herself to a higher level, but on arrival found that she could no longer operate the controls and remained incarcerated in the elevator. _

At the time nothing was further from my mind than the thought – which only occurred to me much later – that the dream might represent an ascent into psychosis (the elevator obviously described a manic state) from which the patient was afraid she would never be able to emerge. For a long time I had thought that Maria was suffering from a form of melancholic depression; this seemed obvious to me from the type of aggressive, painful attachment displayed in the transference. Her history featured a childhood and adolescence afflicted by an aggressive and violent mother, the father having died early on. Although I thought that this infantile experience had burdened the patient’s development, every attempt to put her in touch with the suffering of her infancy had failed.

In the course of time, Maria developed a delusional relationship with me, as became obvious with her project to marry me. This intention was not a dream – it lacked the relevant emotional and symbolic aspect – but an objective that she pursued concretely and in full !23 awareness. Her “dreams,” on the other hand, went unmentioned by the patient; she in fact maintained a stubborn silence about these entities, which were actually daydreams of an intensely illusory nature. For Maria had decided not to disclose these “dreams” to me lest they were destroyed by my unwillingness to share them.

At any rate, they were not like the dreams of a neurotic patient trying to communicate the nature of her emotions to herself and the analyst. Instead, they were newly created realities that were doggedly cherished by the patient and had to be protected at all costs.

Maria’s “dreams” were not really dreams at all. Rather than metaphorical representations, they were realities from which Maria derived a particular narcissistic pleasure. Nor were they bearers of an unconscious meaning to be uncovered; their meaning was manifest, clear, and concrete, and for that reason they were exciting and seductive.

One of the complex and paradoxical aspects of the analytic therapy of psychosis is that for long periods the “psychotic part” is absent, invisible, or impossible to apprehend, and that, when it does emerge, it does so unexpectedly when the psychotic transformation has already occurred. It seems to me that in her analysis, Maria had for a long time kept secret a world dissociated from reality and that the dissociated reality had ultimately taken over and become a delusion.

When the decision to marry me emerged into the light, I at first treated it as a symptom to be analyzed, but as a result Maria’s relationship with me became increasingly stormy. In her exasperation, the patient said she wanted to break off the analysis and to consult a woman analyst with a view to undertaking a new therapy.

_After one such consultation she brought me a dream in which she was a guest in my female colleague’s garden in a marvelous, timeless atmosphere; but then everything was interrupted by an attendant, who took it upon himself to close the gate and put an end to the rendezvous. _

This dream clearly showed that the patient hated me for attempting to put an end to her delusion – which she was, however, skillfully hiding – while already rebuilding it in the lateral transference with my colleague. It also emerged from the dream that the enchanted garden corresponded to an experience from her infancy that she had never mentioned to me. Quite often her maternal grandmother would take Maria with her to a villa in the country where they would spend months on end together, the two of them withdrawn from the world, and the patient had no desire to go back to school to see her friends again. I believe that this seduction by the grandmother, who transported her into an ideal, timeless atmosphere (in effect a psychosis à deux), had laid the foundations for her search for a special, delusional condition with me.

Maria’s material as reported above is also clinically important in that the character of her “dreams” offered an insight into how her psychotic part, when no longer contained, had overcome the rest of her personality.

Maria did not go into analysis with my female colleague, who did not have a place for her, but chose another male analyst. I later heard that she had had three manifestly psychotic episodes – all with delusional sexual content – for which she had been hospitalized.

_Final considerations _

As a general rule, it is in my view possible to draw a useful clinical distinction between the benign loving transference and the malignant sexual transference.

The benign loving transference is represented by the cases of Anna and Aldo, reported above, both of whom developed an idealized love relationship with me after a period of emotional distance. In the analytic process in these cases, the unforeseen blaze of emotion was usually followed by periods of silence. The work of therapy involved keeping this relationship alive so as to allow it to develop.

A similar situation is described by Edith Gould (1994): after initial disorientation and countertransference difficulties with a male patient’s stormy loving transference, the analyst realized its potential for development and responded with empathy. This gave rise to an important change: the initial love-based “siege” was transformed into a deep emotional bond helpful to the progress of the analysis.

Owing to its potential for development, it would be inappropriately reductive to analyze it in terms of a resistance to the relationship of analytic dependence. Nor does it seem correct to interpret the loving transference as a reactivation of the past in the present, as this might well be construed by the patient as a defense by the analyst against the formation of a bond that concerns him personally. In his essay, Freud (1914) leaves the matter unresolved, stressing the transformative power of transference love – a force “impelling [the patient] to [...] make changes” – and not merely its defensive or regressive character.

The benign loving transference does not excessively disturb the analyst, who is called upon to share an ideal, infantile type of experience. He must be capable of calibrating his response in such a way as to avoid interfering with the development of the patient’s experience and as far as possible to support that experience. This type of transference is indicative of the patient’s initial capacity to dream an affective relationship and demonstrates his entry into an emotional and relational world.

The sexualized transference, on the other hand, may give rise to a countertransference response that is not at all easily controllable. Whereas in the loving transference the patient wants to experience an emotional state with the analyst, in the sexual transference he aspires to change the analyst’s mind. Such stubborn and violent manipulation often results in a countertransference response of alarm or rejection.

If sexuality proper is distinguished from its pathological version (i.e. sexualization), even certain early infantile sexual manifestations – e.g. in children who will later develop a perversion (De Masi, 1999) – must be seen as anomalous, abnormal components of sexuality.

For if a child does not obtain emotional responses favorable to mental growth from his primary objects, he will try to sustain himself by forms of arousal that amount to actual sexual withdrawal. This situation recurs in the sexual transference: the analysand distances himself from the relational experience by resorting to forms of arousal or masturbatory activity. While this process may be encouraged by deficiencies in the analyst’s analytic function, it may also be observed in their absence.

This involves a vicious circle similar to that seen in the perversions, in which, mixed with the sense of desperation, a sexualized object is idealized and set up against the absent love relationship. The sexualized transference is located inside this vicious circle, and one of the analyst’s tasks is to remove it from the circle. The timing of interpretation is all-important: it must be appropriate and continuous, especially in the case of a delusional transference, so as to prevent the psychotic nucleus from colonizing the rest of the personality (Rosenfeld, 1997).

A complementarity between the mental states described here – idealization, erotization, and malignant sexualization – can now be glimpsed, if only in their discontinuity. The more the relationship of mutual receptivity in analysis fails, the weaker the element of idealizing protection becomes, while at the same time the sexualized or perverse aspect is potentiated, thus causing the patient to lapse from the initial erotized relationship into a form of sexualized madness.

The sexualized transference is feared by patients themselves owing to its tantalizing character. Analysis with a man may ultimately prove impossible with some female patients, who may, if at all, turn to a woman analyst instead.

The arousal generated by this “other” (dissociated) reality also explains why the sexual transference may be imperceptibly transformed into an actual delusion, as in the case of Maria described above.

Furthermore, any sexual acting-out by the analyst – aside from ethical considerations – is of course likely to prove catastrophic for the patient. In the case of an idealizing loving transference, the analyst !27 with his desire occupies his analysand’s potential space for development, thus rendering it is unavailable to the analysand, whose onward path will thereby ultimately be blocked. In an overtly sexualized transference situation, the analyst eventually finds himself in the same regressive position as his patient, whose pathological part thereby triumphs over the now irremediably defeated healthy part.

The patient’s basic structure (depressive, hysterical, borderline, or psychotic) probably correlates with the quality of the erotic transference. The more severe and deep-rooted the pathological structure, the fewer the possibilities of emotional development in the transference and the more difficult the transformation of that structure will be.

As I have attempted to show in my clinical examples, every form of human sexuality and love may be encountered in this type of transference, ranging from tender, intimate, and gentle love resembling a dreamlike state, via overwhelming passion, to a level of arousal that makes sexuality as compulsive as an addictive drug.

Within this complex, multifaceted spectrum, the analyst must find his bearings and constantly switch between elements of development and regression, so as to lead the patient sustainably into the realm of emotional relating and mental growth.


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(1) According to Sulloway (1979), this version has become something of a myth, not only because it was actually Anna O. who broke off the therapy, but also on account of documentary evidence that the birth of Breuer’s daughter, supposedly conceived on his second honeymoon, predated the patient’s loving transference.

(2) [Translator’s note: For convenience, the masculine form is used for both sexes throughout this translation.]

(3) See Kerr (1993) for a fascinating account of the events concerned and of the relations between Freud, Jung, and Sabina.

(4). Winnicott points out in a footnote (1971, p. 30) that this mental state of omnipotence must be distinguished from the “experience of omnipotence,” which has to do with the alternate experiencing of “me” and “not-me.” The latter experience belongs to dependence, while the former has its origins in hopelessness about dependence.

(5) This discrepancy between fantasy and reality is the reason for the “impossibility” of the love object in the erotic transference (Bolognini, 1994).