Insofar as we view transference as a response to our deepest human needs (and anxieties), we might expect there to be no gender difference in transference manifestations. Nonetheless, although many analysts contend that transference love is gender-blind, I believe it to be more common among women, particularly women in treatment with men. At the same time, the erotic countertransference—the feelings of love the therapist has for a patient—appears to be more commonly a problem for male therapists. What this suggests about differences between the sexes is that they are socialized to different forms of mastery over both themselves and the world and are the products of different developmental experiences, but for all that are both vulnerable to falling in love, albeit in different circumstances. By examining the erotic transference, we may shed light not only on the underlying impulses and facilitating factors resulting in love, but on gender differences and how they affect love.
A woman analyst, Eva Lester, was the first to make explicit note of this most interesting gender discrepancy in erotic transference and countertransference. She pointed out that there are almost no references in the psychoanalytic literature to the phenomenon of male patients experiencing strong erotic transferences to their female analysts. Lester reported she had encountered strong erotic transferences in her female patients, but only mild, transient, muted, and unstable ones in her male patients. Karme, in a case report, discusses a male patient's erotic transference to her, but it consists mostly of allusions to triangular situations in associations and dreams, with only a few explicitly erotic dreams and fantasies about her.
When there is an erotic transference in a male patient-female therapist pair, it seems to differ in significant and signifying ways from the comparable experience in female patient-male therapist pairs. In the latter case, the erotic transference tends to be overt, consciously experienced, intense, long-lived, directed toward the analyst, and focused more on love than sex; in the former, it is less overt and less sustained, more often relatively short-lived, experienced indirectly in dreams and triangular preoccupations, frequently transposed to a woman outside the analytic situation, and it is generally sexual rather than loving in its manifestation.
While male patients' sexual fantasies may be quite graphic, they tend to be devoid of erotic longing. A sexual thought, such as "sucking her cunt" may appear as an ego-alien thought and be accompanied by embarrassment. Frequently, what one witnesses are the defenses against the erotic transference rather than the transference itself. Even so, male patients can be extremely sensitive to imagined slights, demanding attention, or special accommodations, even while denying any personal involvement or desire. Like women, they may idealize the analyst, but they tend not to merge idealization with erotic longing (just as it so often happens that men are unable to direct both romantic, erotic feelings and affectionate, dependency feelings towards one object).
Generalizing from the transference experience in therapy, one might simply conclude that women are more susceptible than men to falling in love were it not for the observation that male analysts appear to have a greater proclivity to falling in love with their female patients than women analysts do with their male patients. From the early days of the psychoanalytic movement, before the dangers of the erotic transference and its reciprocation had been explored and codified, we have accounts of numerous instances in which male analysts fell in love with their female patients. In fact, the temptation to fall in love in the therapeutic situation when the analyst is at low ebb and the patient is young and attractive (and has either hysterical charm or the mystery of madness about her), turns out to be a very strong one on both sides.
Jung's affair with Sabina Spielrein is one such example, but he had another relationship of even greater moment, both romantically and intellectually: a forty-year-long romantic liaison with Antonia Wolff, first his patient and later his colleague. Toni was the daughter of Arnold Wolff, a rich businessman, and member of one of the oldest, most distinguished Zurich families. In 1910, she went to Jung as a patient, partly because she had failed to adjust to the death of her father and partly because of difficulties with her mother. Sometime during 1911-12 their relationship changed its character, escaping professional constraints, and their ensuing love affair was serious enough to produce complicated repercussions on Jung's family life. According to one biographer, "Jung's affair with Toni might have been less troublesome if he had not insisted on dragging his mistress into his family life and on having her as a regular guest for Sunday dinner." But Jung was proud of the triangle he had created and preserved, whatever the sacrifices and conflicts it caused his wife Emma and Toni. Toni Wolff, like Spielrein, became a practicing psychoanalyst and seemed to serve as Jung's inspiration, contributing to and elaborating upon many of his central ideas. She wrote a description of the four typologies of women: Mother and Wife; Hetaera or companion and friend to Man; Amazon; and Medium, the mediator between the conscious and unconscious. And apparently for Jung, she was both Hetaera and Medium.
Otto Rank is another analyst who seems to have participated in a passionate relationship with one of his patients, Anais Nin, whether or not they technically became lovers. One of Rank's biographers, James Lieberman, believes that they were. Nin spoke of herself in her famous diary as Rank's patient. Though she does not say they were lovers, Lie-berman states that it is generally assumed they were, both by readers of the diary and his informants. Nin, who was married to the engraver and filmmaker Ian Hugo, never divorced, but lived apart from him much of the time, pursuing her interests and relationships. In 1931 she began an intimate and lasting friendship with Henry Miller in Paris. In 1933 Miller, impressed with Rank's work, wrote to him, met with him as a patient, and soon enough pronounced himself cured. Through Miller, Nin, too, went to see Rank as a patient. Shortly after her therapy ended, Nin decided she would become a therapist, and apparently "trained" with Rank. The following year, after Rank had moved his practice to New York, he asked Nin to join him there. According to Lie-berman, she was willing to help Rank start a new life just as he'd done for her. But she delayed and Rank wrote her desperate letters reminding her of things he had done for her in her hour of need and asking her to reciprocate: "Well, I am dying now. Come to my rescue." She did join him in the States, where Rank set her up as a psychotherapist and his collaborator (and where she took him dancing in Harlem). Rank wanted Nin to condense some of his books, a task that struck Nin as overwhelming. Eventually, the excitement of playing help-mate to Rank and psychotherapist to patients lost its allure for Nin. Rank and Nin became less compatible as she felt asked to subordinate her autonomous creative life to his. She complained that his pleasures were too much of the mind, and it was apparently she who left him. She went back to Paris, having concluded that her attachment to Rank was a continuation of a father fixation. Lieberman quotes her on her liberation from psychoanalysis (or at least from Rank):
I entered with impunity the world of psychoanalysis, the great destroyer of illusion, the great realist.
I entered that world, saw Rank's files, read his books, but found in the world of psychoanalysis the only metaphysical man in it: Rank. I lived out the poem and came out unscathed. Free. A poet still.
There are many other instances, continuing even to this day, that show the proclivity of male therapists to fall in love with their female patients whether they act on these feelings or not. Some of the enacted affairs are well-known, even infamous, within the psychoanalytic community. Others remain relatively obscure for the perpetrators can come from all parts of the theoretical spectrum and all levels of training. Anyone who has worked in the wards of a mental hospital knows the frequency with which feelings of erotic transference and countertransference are engendered and sometimes acted out between patients and the various tiers of their support staff. Still other affairs are the stuff of popular fiction and films. The movie Lilith, for example, based on Salamanca's novel of the same name, portrays the destruction of an occupational therapist in training (Warren Beatty) who is seduced by a schizophrenic patient (Jean Seberg).
Lucia Tower points out, "Virtually every writer on the subject of countertransference...states unequivocally that no form of erotic reaction to a patient is to be tolerated. This would indicate that temptations in this area are great, and perhaps ubiquitous." Speaking of such relationships between women and their male analysts Phyllis Greenacre remarks: "That this is not so infrequent as one would wish to think becomes apparent to anyone who does many reanalyses. That its occurrence is often denied and the situation rather quickly explained by involved analysts as due to a hysterical fantasy on the part of the patient...is an indication of how great is the temptation." Many women analysts can confirm from the evidence of their own practices the frequency of such encounters, since they often have to deal with the results. This is so because women patients who have had sexual relations with therapists are frequently sent to women analysts in order to assure the patient that such an experience will not be repeated. The magnitude of the male therapist's proclivity for sexual acting out is further suggested by looking at the figures on sexual encounters between women patients and physicians (not just therapists). In the results of a survey of 460 physicians published in 1973, Kardener and his coworkers found that between 5 and 13 percent had engaged in erotic behavior with patients, although the psychiatrist was in fact the least likely to do so. In a more recent study of psychiatrists, Gartrell and her coworkers reported that 7.1 percent of male respondents and 3.1 percent of female respondents reported sexual contact with their own patients, but 88 percent of all such contacts took place between male psychiatrists and female patients. (It might be added that this article reports the highest percentage of female therapists ever implicated in this kind of sexual misconduct.)
The relative restraint of female therapists is not because of any special virtue on their part. Differences between the sexes in their experience of the erotic countertransference—and their enactment of it— reflect differences between them outside the consulting room: the reaction of a younger dependent female to an older, authoritarian male is traditionally conducive to an erotic relationship. By contrast, it is traditionally taboo for an older, experienced woman and a younger, inexperienced man to have erotic feelings for each other—though this prohibition appears to be weakening. (This dichotomy parallels the family experience in which father-daughter incest, while not sanctioned, is less abhorred than mother-son incest.) In short, women have a tendency to eroticize relationships with men in authority, men to split sex and dependency. This happens in the therapy situation and outside it as well. While both sexes may be drawn to love across a power differential, men tend to need the safety of the power advantage, women to fall in love within the apparent shelter of male power. Thus the relative subordination of patient to analyst makes the emergence of an erotic trans-ference-countertransference reaction more likely in a male therapist-female patient configuration, because it is congruent with our society's prevailing romantic fantasies (fantasies which seem relatively untouched by the changing roles of women in the workplace). And so it is that the consideration of why a phenomenon like transference—a response to humankind's most basic needs—has a gender component ends up telling us much about men and women, and about love.
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