Stephen A. Diamond Ph.D.

Evil Deeds

What's Love Got to Do With It?: How Therapy Helps

Psychotherapy can heal "love phobia" and "intimacy inhibition."

Posted Sep 27, 2012

Tuesday, September 25th, marked the first celebration of National Psychotherapy Day. National Psychotherapy Day is the brainchild of PT blogger and clinical psychologist Dr. Ryan Howes, who deserves credit and congratulations for conceiving of, organizing, and getting it off the ground.

In honor of National Psychotherapy Day, I will be posting a series of my previously published pieces on the practice of psychotherapy. A different posting each day this week, Monday through Friday. In effect, extending National Psychotherapy Day into National Psychotherapy Week here at Psychology Today. Hope you enjoy!

When it comes to matters of love and intimacy, most people tend to think that all they need to do is identify, meet, and choose the right person. Find the right fit. Decide on the specific criteria (typically based on fantasy) required and seek someone who closely conforms to that wish list. Just look at the wild popularity of various online dating sites promoting this consumeristic approach to procuring a romantic partner. Sort of like going out and purchasing shoes, jeans or a new suit. Or maybe a home. This "shopping for love" approach can be effective, but only when one is truly psychologically ready for relationship. Again, it's like looking for a new home: The more properties one sees, the more realistic and clearer idea of what's most important to us we acquire. And when the "perfect" place suddenly presents itself, we are prepared to make the purchase. But only if we're ready to make that commitment and investment. In other words, what if, as the flamboyant father of Gestalt therapy, psychiatrist Frederick "Fritz" Perls suggested, finding love has at least as much to do with becoming the right person as meeting him or her?

For psychoanalyst Erich Fromm, this task of becoming or being the right person is absolutely central to the psychotherapy process in general and, moreover, underlies most if not all of the patient's psychosocial problems: "Whatever complaints the neurotic patient may have," says Fromm, "whatever symptoms he may present are rooted in his inability to love, if we mean by love a capacity for the experience of concern, responsibility, respect, and understanding of another person and the intense desire for that other person's growth. . . . Analytic therapy is essentially an attempt to help the patient gain or regain his capacity for love" (Psychoanalysis and Religion). How does psychotherapy help patients in their search for love? What are the optimal conditions for finding true love? What does it take to cultivate and sustain loving relationships over time? And how prominent a part in the psychotherapy process does love really play?

While Fromm may have overstated his case, the fact is that psychotherapy patients, like all of us, whether single, coupled or married, are constantly looking for love: either from parents, peers, prospective mates during dating, boyfriends and girlfriends, spouses or, sometimes, from extramarital affairs. (See my prior post.) We all seek love in other ways as well, like wanting to be admired, noticed, valued, understood, appreciated and recognized by others, or even idolized by the public, as in the extreme case of certain celebrities. Often, psychotherapy patients (and those not in therapy) unconsciously persist in seeking the love they never fully received from their father and/or mother in their adult relationships, in their careers, through their relationships with friends, co-workers or even their own children. (See my prior post.) Real love is a precious and rare commodity.

As children, we are all born deserving of love, and desperately need it for our very survival. But, sadly, sometimes tragically, we don't all get the kind of real love we deserve. Indeed, few of us do. Not because we don't deserve it. Rather, because our parents or caretakers--for reasons that vary from death or divorce to substance abuse to neurosis to personality disorders to traumatic circumstance--are unable or unwilling to consistently provide it. At least, not enough of it. Such parents fall short--frequently far short--of being what D. W. Winnicott called "good enough" mothers or fathers as regards the ability to express and provide real love to their children. By "real love," here I mean three essential things: Unconditional acceptance: not of every behavior, but of who we basically, temperamentally and uniquely are. Appropriate limit-setting, boundaries and discipline, all of which are indispensable expressions of such "real love" on the part of parents and caretakers. And, thirdly, this "real love" consists also of a deep capacity for concern, constancy, stability, respect, empathy, warmth, compassion and the maturity to place, when appropriate, one's own personal needs and desires secondary to those of one's children and what is in their best interest. Without receiving such real love regularly from at least one parent, developing into a fully-functioning, loving adult is much more difficult. But certainly not impossible. Indeed, this is one of the most ubiquitous issues psychotherapists see: what we might term intimacy inhibition.

Intimacy inhibition has to do mainly with the marked fear and avoidance of emotional intimacy. Specifically, the vulnerability, insecurity, anxiety, passionate emotions, loss of control, dread of being engulfed, devoured, penetrated, castrated, suffocated, overpowered or abandoned, as well as vast potential for rejection true intimacy inevitably entails. Fear--especially fear of "the feminine" or fear of "the masculine"--frequently informs intimacy inhibition. (See my prior post.) As can the primal fear of the unconscious in general. Interpersonal trauma of some type is almost always historically present. Paradoxically, true intimacy requires a strong sense of self, good personal boundaries, and healthy self-esteem. When these qualities are not present, typically as a result of having never received sufficient real love during childhood, true intimacy is just too threatening to accept or allow. Consciously, we may seek it. But unconsciously, sometimes very subtly, we sabotage it or run at real intimacy's first appearance. This is why so many psychotherapy patients (and non-patients) have such difficulty dealing with dating and romantic relationships. They are afraid to love and often don't feel worthy of being loved.

This "love phobia" or intimacy inhibition is frequently what brings people into treatment, whether explicitly or implicitly. For example, if one doesn't believe deep down in his or her own inherent lovability, how can real love ever be accepted from another when freely offered? Even from one's own offspring? And how can we reasonably expect something from someone we are incapable of giving either to them or ourselves? As Fromm put it, "People believe that to love is simple but that to be loved is most difficult. . . . They do not know that the real problem is not the difficulty of being loved but the difficulty of loving; that one is loved only if one can love. . . ." So this is a different type of love-ability, having to do with one's receptivity and openness to another and the ability to lovingly accept someone for whom he or she truly is. Without this capacity, a loving relationship cannot fully be entered into or cultivated, since demanding love and acceptance from a partner without being able to reciprocate in kind is doomed to disaster.

This issue of psychological readiness for real love and relationship is central to both the Grimm's story of Briar Rose (Sleeping Beauty) and the difficulties underlying forming and sustaining intimate romantic relationships, particularly with the opposite (or sometimes same) sex. (See my prior post.) We all still unconsciously carry around the hurt, humiliation and anger of our old childhood wounds, bringing this highly charged emotional baggage with us into our adult relationships. To the extent we stay oblivious of such baggage, we continue this compulsive defensiveness against closeness despite consciously longing for it so. We unconsciously seek the love we never received during childhood from significant others rather than taking responsibility for learning to provide that love to ourselves in the present. Much as in the fairy tale of Briar Rose, we grow prickly or thorny when it comes to intimacy, insofar as we remain unconscious (asleep) of our anger, rage, resentment and bitterness about prior rejections, disappointments, abandonments and other narcissistic injuries. This neurotic state of unconsciousness causes us to act out defensively, avoiding, undermining and prematurely scuttling the very relationships we consciously seek. In such a state of mind, any real relatedness or true emotional intimacy is impossible, or at least, limited. Sex, of course, may be another matter entirely.

Paradoxically, sex can be used to avoid psychological intimacy and exert power and control over potential partners to bind or escape the anxiety of authentic relationship. Yet, as with any phobia, it is precisely this anxiety that must be confronted, understood and tolerated (as opposed to defensively acted out) during the treatment of love phobia. As with overcoming any deep-seated fear, true intimacy or real love calls for great courage. It requires courage to create and maintain intimate relationships, since we all have our fair share of protective prickliness to penetrate and get past. (We definitely need courage, but also, good timing or luck to successfully connect deeply with another, since both participants must be more or less simultaneously ready to relinquish their hostile, narcissistic defenses if real love is to flower rather than be nipped in the bud.) Fromm's emphasis on the ability to love is certainly to the point here. Almost anyone can start a relationship. But making it intimate and maintaining it over time demands the capacity for real (rather than merely romantic) love. (See my prior post on Jung's notions of anima and animus. )

Still, how accurate is Fromm's bold and sweeping assertion that psychotherapy is all about being able to love? I would say only partially. Sometimes yes. But not always. Not for everybody. If it were the case, those individuals with close, supportive, loving relationships in their lives would theoretically not need or seek psychotherapy. But, clearly, they do. For example, there may be patients perfectly capable of interpersonal love, but chronically blocked in their creative capacity. Or those suffering from some traumatic experience or persistently painful physical condition. Unemployment. Loss. Grief. Discouragement. Despair. Anxiety. Anger. Rage. Resentment. Paranoia. Mania. Psychosis. What happens in psychotherapy cannot necessarily be reduced to "helping the patient gain or regain his capacity for love." That is, at least, not in the strictly romantic or interpersonal sense suggested by Fromm.

Sigmund Freud himself identified love and work as the two supporting pillars of life. Another of Freud's students, Theodor Reik, wrote: "Work and love; these are the basics. Without them there is neurosis." The clear implication is that healing neurosis (and possibly psychosis) requires restoring the patient's capacity for both love and work. Yet this too seems overly simplistic. There is more to life than love and work. For what happens when one cannot find satisfactory companionship or employment? Today, almost 10% of people in America are out of work, and millions more are underemployed. Or unable to work. Many Americans are single, divorced or widowed and without a significant other. Of course, loss of work or love can be emotionally devastating, wreaking havoc with one's sense of identity, security and self-esteem. Yet somehow most survive, and some even thrive. What enables them to do so? Something beyond the "work and love" which, in Freud's psychology, provide life's sole meaning. Something underlying or perhaps transcending these vital capacities and activities. Some alternate pathway to finding or creating meaning. How about the power of religion or spirituality, for instance? Or of creativity itself ?

In the deepest sense, psychotherapy (and life) is not, as Freud, Fromm, Reik and most modern psychotherapists assume, mainly about intimate relationships. Nor the capacity for work per se. For, in most cases, these are but secondary benefits. Consequences rather than causes. Neurosis can, and commonly does, run rampant in both the work and love life. Having work and relationships cannot protect us fully from the existential facts of life. Nor does it inoculate us against suffering. Moreover, such exclusive emphasis on the outer rather than inner life--what we do out in the world and with whom we do it--stems in part from a more extraverted rather than introverted perspective, and may not be fitting for all patients. (See my prior post on extraversion and introversion.) For instance, in some cases, relationships or work serve the compulsive purpose of escaping from one's self, one's existential aloneness and anxiety, and the fact of one's mortality. So, existentially speaking, these cannot be considered the sine qua non of mental health, nor of therapeutic treatment.

Psychotherapy, in my view, is more soundly focused on what C.G. Jung termed individuation: the unpredictable, lengthy, labyrinthine process of becoming more whole. Psychotherapy is about finding and fulfilling our destiny: While for most this may include romantic love, marriage, parenthood, career, etc., there are others for whom fate or destiny has something quite different in store. (See my prior post on the difference between fate and destiny.) Psychotherapy is about creativity: courageously claiming the personal freedom to express ourselves constructively in the world to our fullest potential. Finally, psychotherapy is fundamentally about acceptance: learning to accept ourselves and others, our fate, our responsibility, our existential aloneness, the unconscious, evil, the daimonic, and life on its own terms. (See my prior post.) Surely, this is a sort of love. Love of reality. Love of the world as it is. Love of all humanity. Love even of the dark and tragic, seemingly sometimes senseless side of life. And this is, for want of a better term, a spiritual love. Psychotherapy is, for these reasons, an essentially spiritual process. But it is precisely this reawakening, rekindling or stirring of spiritual love, this gradual opening up, this growing willingness to tolerate ambiguity and loneliness, this deepening receptivity to life, oneself and others during the psychotherapy process that can ready us for interpersonal love and intimacy, and which--when lacking, undeveloped or resisted--resides at the root of most mental disorders. For existential analyst Ludwig Binswanger, this is "the fundamental power that makes any therapy work--the power to liberate a person from the blind isolation, the idios kosmos of Heraclitus, from a mere vegetating in his body, his dreams, his private wishes, his conceit and his presumptions, and to ready him for a life of koinonia, of genuine community."

And what exactly is the mysterious, potent, transformative power that serves to awaken this newfound or renewed capacity to love in the psychotherapy patient? Freud, Jung and others since observed that the alchemical catalyst occurs in the dynamic and uniquely intimate relationship between patient and therapist, and very much resembles--yes, you guessed it--love. As psychotherapists, we try to provide some of what was missed out on during childhood, in the form of an accepting, supportive, attuned, nurturing, caring, consistent relationship upon which the patient can temporarily depend and draw sustenance, self-esteem and strength from. But even that falls short of substituting for what was withheld or unavailable during infancy, childhood and adolescence by one's parents or primary caretakers. Psychotherapy can't erase the painful reality of past deprivations. But it can provide the encouragement, compassion and, yes, love needed by the patient to accept the past without destructive embitterment. And to learn or re-learn to give real love to one's self and others now. But a broader discussion of this clinical utilization--and inexcusable occasional misuse--of the healing power of love in psychotherapy is best saved for Part Two of this post.

More Posts