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Chapter 1
Braving the erotic field in the treatment of adolescents
I have found my patient’s body – and my body – to be more directly the subjects of analysis with adolescents than with adults or with younger children. Erotic transference and countertransference can be particularly fraught because of the intensity of emergent bodily sensations in the adolescent and because of her or his normal developmental immaturity. Adolescents need help to name and integrate their newfound bodily experiences. Their minds need to grow into the bodies they now inhabit. It is a challenge for analysts to talk about feelings the adolescent may have barely begun to name. Indeed, budding sexuality and the memories and feelings it stirs in us of our own sexual beginnings are no small things to metabolize. And yet, with rare exceptions, the area of erotic transference/countertransference in the treatment of adolescents is largely ignored in analytic writing.1
The catastrophic prospect of boundary violations, particularly with minors, can lead to a timid avoidance of the erotic in our work with adolescents, yielding what I term an ‘erotic insufficiency.’ The analyst can fear exploiting the trust necessary for an adolescent to bring his or her emerging sexuality into analysis in a lively manner. Feelings that arouse the greatest conflict and guilt in the analyst are precisely those that are most vulnerable to our defensive rejection. In order to consider these ideas, I will relate a period in the analysis of a 12-year-old boy when the erotic transference and countertransference were at a height. I will also suggest that the terms erotic transference and erotic countertransference do not fully capture the intensely interactional nature of these experiences. I suggest erotic field better conveys this fluidity.
Erotic transferences and countertransferences with younger children can seem comparatively comfortable.2 One eight-year-old boy fantasized that he was a king and I his golden-haired queen, living in a castle together, and that we would never have to part. While the scene I’m describing is only the most conscious aspect of a deeper fantasy, I believe that there are also other reasons why my countertransference response was comparatively easy to bear. I could feel the poignancy of this idyllic picture, and sympathize with my patient’s frustrations at the inescapable realities of life, such as how old one is, and how old are one’s analyst, mother, father, etc. – and how much these exigencies determine. In this familiar oedipal scene, one cannot have what one wants and yet it is better to have wanted it and even to tolerate knowing that one has wanted it. But it was also my younger patient’s age and related physical immaturity that contributed to a less charged erotic transference/countertransference than with adolescent patients.
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Changing bodies, changing minds
The body of the adolescent is changing radically before his or her own eyes, as well as mine. Adolescent boys can shoot up a foot in height over a couple of years. ‘Brian,’ age 13, encountered me in the hallway before a session and said: “Have you always been that short?” His body was new in many ways, and led to new experiences in relation to himself, me and everyone else. Brian and I experienced together his pubertal development and the meanings it shifted within our relationship.
‘Naomi,’ a pubertal girl, having had the puberty/sex talk at school that day, came to her session and asked me with utter sincerity: “What’s puberty for?” I was struck that though I could answer the question in a limited biological sense, the larger psychological and emotional meanings would take years to comprehend.
‘Evelyn,’ a 16-year-old in analysis, spoke about being on the verge of having intercourse with her boyfriend. I asked her: “Do you think having sex will change anything inside you or between us?” At first she demurred, but soon said: “Having intercourse will be the end of childhood.” Something would definitively change inside her, as well as between us, and between her and her parents. She would cross a line from her child bodily self to an adult bodily self and there would no longer be a substantive divide between her experiences and those of adults in a sexual sense. Experience would be gained, but a precious boundary that allowed some element of childhood to remain (all too scarce for this girl) would be lost.
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Around this time Evelyn asked to use the couch. Her ‘use’ of the couch3 was different than any I have experienced. She was in constant motion and reminded me of a seal. She would flip from side to side and then flip over on her stomach to look at me. My experience was of not being able to think with all this motion and I wished Evelyn would just lie still. Evelyn was giving me an experience of how much commotion she felt at this phase.
Evelyn asked to use the couch in order to talk about sexuality. My agreement for her to lie down evoked intimate and erotic feelings in her toward me. Soon after starting to use the couch she told me of making out with her boyfriend in his car for the first time. She said: “I found myself tracing your initials in the steam on the window.” As we explored this action it seemed that I was both present in Evelyn’s erotic feelings and that she was summoning me to help her create some ‘brakes’ to allow thinking space while making out with her boyfriend.
In all of these instances, the teens were experiencing rapid bodily changes that they brought to analysis for consideration. I will turn briefly to erotic transference and countertransference in the psychoanalytic literature on adults in order to create a backdrop from which to consider the far more scant literature on transference/countertransference with adolescent patients.
Erotic transference and countertransference in the adult literature
Person (1985) defines “erotic transference” as interchangeable with “transference love,” meaning “some mixture of tender, erotic, and sexual feelings that a patient experiences in reference to his or her analyst and, as such, forms part of a positive transference” (Person, 1985: 161).4 She describes the erotic transference as “both goldmine and minefield” (1985: 163). Passionate feelings are likely to be confusing to patient and analyst and thus their consideration can yield great rewards. Simultaneously, intense feelings in the patient or analyst are also prone to either some form of acting out or defensive avoidance.
A patient’s erotic feelings toward an analyst can sometimes be intensely driven and even psychotic in the Kleinian sense of losing touch with reality. Blum describes “eroticized transference” as a “particular species of erotic transference, an extreme sector of a spectrum. It is an intense, vivid, irrational, erotic preoccupation with the analyst, characterized by overt, seemingly ego-syntonic demands for love and sexual fulfillment from the analyst” (1973: 63). In my experience there are patients who waver between a capacity to allow strong feelings toward their analyst without becoming psychotic but who may lose hold of reality considerations in the throes of intense feelings.
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Person points out that (even in the adult literature) erotic transference “has always been tainted by unsavory associations and continues to be thought of as slightly disreputable” (1985: 163) compared with analytic reflection on other forms of transference. In a sense this is strange, as Freud struggled mightily (in introducing his concept of infantile sexuality) to help us see that there are intense and passionate forces in us all from the beginning. And yet, perhaps we have to accept that passionate and deeply rooted forces always create some defensive alarm. How much more so when the patient has not reached adulthood?
In a well-known and groundbreaking paper, Searles (1958) squares off against the orthodox notion, prevalent at the time, that intense emotional reactions on the part of the analyst are pathological:
(180)
Racker (1953) likewise contends that the Oedipus Complex will express itself in every countertransference, while the form, consciousness of it and intensity vary:
(316)
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I am using countertransference here to denote the analyst’s experience of an intensely interactional transference-countertransference dialogue (Greenberg & Mitchell, 1983; Langs, 1981; Little, 1951; Ogden, 1997; Racker, 1957; Searles, 1958; Winnicott, 1949).5
Erotic transference and countertransference, adolescent style
Lena, in a paper discussing the erotic transference of a 16-year-old boy to his female therapist, contends:
(2016: 43)
Atkinson and Gabbard likewise comment: “[E]rotic material in an adolescent’s transference may create in the analyst a level of concern or even fear of parental retaliation should the parents become aware of the material” (1995: 174). I would add that the fear of the parents’ potential response can also be a projection of the analyst’s own parental superego, which can lead to repression or avoidance.
Alvarez’s (2012) paper ‘Types of sexual transference and countertransference in work with children and adolescents’ is a rare and substantive contribution to this topic. She distinguishes amongst “perverse,” “disordered” and “normal” sexual transferences in children and adolescents. Perverse denotes a dangerously addictive sexuality with sadistic and masochistic elements. Disordered indicates an addictive but not fully perverse sexuality. And by normal Alvarez implies the child or adolescent’s desire “to make someone’s eyes light up” (2012: 126) and “the need for a responsive interested object capable of being delighted” (2012: 126).
Paton discusses a scenario when an adolescent sexualizes the therapeutic atmosphere to “avoid feelings of unhappiness and vulnerability” (2017: 28), which would be similar to Blum’s description of eroticized transference and could overlap with Alvarez’s perverse or disordered sexual transferences.
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Jackson (a male analyst) describes an 18-year-old woman’s adjustment to the couch:
(2017: 18)
Jackson (2017) warns that when sexuality emerges within the transference and countertransference with our adolescent patients, “threatening to disrupt our thinking and shatter our psychic equilibrium . . . we should not underestimate our propensity to avoid, negate and defend ourselves against these dynamics, even when we are conscious of them” (2017: 6). He notes that it can be difficult to distinguish between being safe and containing of our adolescent patients’ erotic feelings and “something that is rationalized as safe and containing but which is essentially evasive and defensive on the part of the therapist” (2017: 12). Similarly, Atkinson and Gabbard (1995) describe an erotic transference of a male patient with a female therapist and note that the therapist in such a pairin...
