The Love Treatment: Sexual Intimacy between Patients and Psychotherapists
The Radical Therapist
I am a sucker for psychology books, so when the paperback edition of The Love Treatment appeared on the rack at Woolworth’s, I picked it up and leafed through it. Its premise, I discovered, was that the taboo on sexual intimacy between psychotherapists and their patients should be re-examined, not only because it was being broken all the time anyway but because in the right circumstances such intimacy might have therapeutic value. My immediate hostility to this idea—I’d heard any number of horror stories from friends who had slept with or been propositioned by their therapists—did not keep me from admiring its brilliance. Psychotherapy, as conventionally practiced, had proved a useful tool for exploiting women, and so had the ideology of sexual revolution—why not combine them? It didn’t take much imagination—or excessive cynicism—to foresee the practical result of giving (mostly male) therapists a professional rationale for going to bed with their (mostly female) clients. After all, the argument that sex is therapeutic had been a favorite of amateur psychiatrists for years.
My basic objection, though, was not that the freedom to consider sexual relations as a therapeutic option would inevitably be “misused” but that the notion of sex as therapy was in itself peculiarly oppressive. It implied a certain degree of detachment on the therapist’s part and bore an uncomfortable resemblance to the familiar male fantasy of “liberating” a virgin (or a frigid woman or a lesbian) with the gift of his virility. Sure enough, in a chapter called “A Confession,” Dr. Shepard presented just such a situation. A lesbian had come to him for therapy because she wanted to try heterosexual sex but could not overcome her fear of penetration. The problem, in Shepard’s view, was that no man could reasonably be expected to be perceptive and patient enough to offer her the extremely gradual initiation she needed. Except—but of course:
…I felt that I could easily do for her what her dates wouldn’t.
For one thing, she made her dilemma intelligible to me. For another, I found her attractive enough to know that I could respond adequately. Also, my love life and sex life were fulfilling enough to allow me to abstain patiently when she became frightened.
The taboo had restrained him, but looking back he wished it hadn’t. “I would hope,” he concluded (rather pompously, I thought), “that my concern with my reputation does not interfere with my therapeutic effectiveness again.” Even granted that Shepard was accurately and disinterestedly discerning this woman’s needs (a large grant), the whole project sounded pretty depressing. Who would want to be the recipient of this sort of social work? As far as I could tell, therapeutic sex was just another version of dissociated sex, a phenomenon that—especially in this era of sexual pseudo-revolution—had driven too many women to therapists in the first place.
When I read the whole book, I realized that in a way I had missed the point. The issue isn’t really sex; it’s what therapy means, and how it is to be practiced. The substance of The Love Treatment is ten interviews, presented as case histories, of people who have devoted a large part of their energies to playing verbal, emotional, and ultimately sexual games with their therapists, who play the games right back or, more often than not, initiate them. Some of these experiences turn out to be illuminating; more are destructive; most appear to be just a waste of time, though possibly more exciting than sitting home and watching TV.
Nobody seems to have a clear idea of what therapy is supposed to accomplish. Therapists and their charges flounder around together and occasionally make some kind of connection; mostly there is a lot of emotional busywork, misunderstanding, and lack of communication, just like in real life.
In this context, sexual involvement seems no more or less exploitative or irrelevant than anything else that passes for therapy. Actually, the title of the book is misleading, for only one of the intimacies described even pretends to any therapeutic purpose, and in more than half the cases the therapy lapses once the sex has begun. The Love Treatment gives the impression that the chief social function of psychotherapy is to allow people to meet in a contrived situation that breaks down conventional barriers. If this is so, is it necessarily bad? In his concluding chapter, the author asks, “What is psychotherapy? Is it therapy for the mind—relief of anguish? Or is it the broadening of experience—learning more about how the world functions and how one can live in it ably?” and answers, “For me, it is both.”
True, if psychotherapy is defined to include any human interaction engaged in for these purposes, then it is arbitrary and even churlish to make a rule against sex. Obviously, a sexual relationship can relieve loneliness and frustration, and even when it is unpleasant or oppressive it will almost always teach its participants something about themselves and life. There is still the sticky question whether paying a professional expert is the best way to get this kind of experience, but given the limitations of our society, the practical answer for many people may well be yes. So why be puritanical about it—any more so, that is, than about other upper-middle-class frivolities?
If I can’t be quite that blasé, it’s because I don’t think psychotherapy is ever really inconsequential. In our postreligious culture it has become a focus for people’s deepest longings and fears. Its attraction is that it is, or pretends to be, subversive; it is supposed to break rules, to expose social lies. For this very reason it can be particularly effective as a conservative force. The promotion of conservative policies as radical reforms is a well-known obscurantist tactic of liberal politicians; it is equally useful to liberal therapists.
Shepard makes much of daring to discuss “the last taboo,” but in fact he is only trying to bring psychiatry into line with the prevailing sexual ethic of the liberal, affluent middle class: “A sexual revolution is occurring in this country…. It is no longer imperative to marry, or even love, a person with whom one is intimate.” His evaluations of his case histories reflect an unquestioning acceptance of this ethic: “It is equally possible that Kathy’s viewpoint is clouded by resentment against non-exclusiveness”; “Judy is a girl who can’t reconcile polygamous sexuality with decency.” Nowhere does he suggest that Kathy and Judy might have good reasons for their feelings.
Yet we know—or should, by now—that men often use “nonexclusiveness” as a rationale for depriving women of affection and security, and push “polygamous sexuality” only to despise women who take them at their word. Shepard’s assumption that a woman who resists the sexual revolution has a hang-up is simply a variation on the “brainwashing” theory of female behavior, itself a triumph of liberal psychiatry, which holds that women are responsible for their chains and can free themselves by freeing their minds. This argument conveniently ignores the social and economic pressures that make women conform and is commonly used to persuade us to act against our interests.
On this and similar issues, The Radical Therapist, a collection of articles from the movement journal of the same name, displays all the seriousness The Love Treatment lacks. Its editors and contributors, a number of them practicing therapists, share the conviction that psychotherapy has become socially and politically regressive. The argument is familiar, though it bears repeating: most therapists are white, male, upper-middle-class professionals who have a stake in the existing system and are therefore ill-equipped to understand how it perpetuates emotional disturbance; on the contrary, their theory and practice actively oppress women, blacks, and working-class people. At worst the psychiatric establishment functions as an unofficial penal system, passing off political judgments as medical, equating health with conformity, subjecting deviants to forced confinement and treatment, denying the legitimacy of their perceptions and their right to take responsibility for their actions; at best, the costly, time-consuming “help” it purveys distracts people from the objective conditions that make their lives miserable.
The longest and best section in the book is devoted to women’s liberation; two movement classics, “The Personal is Political” by Carol Hanisch and “Brainwashing and Women” by a Red-stockings Sister, make the definitive attack on the brainwashing theory.
Predictably, the writers’ proposals for change are neither as unanimous nor as cogent as their criticism. They are all struggling with a touchy paradox: therapy implies the possibility of individual solutions to what radicals regard as social dilemmas. As the editors’ “Manifesto” puts it, “We acknowledge at the outset the uneasy tension between the words ‘radical’ and ‘therapist’ in our title.” But the majority of contributors (Joe Berke and Morton Schatzman, protégés of R. D. Laing, are conspicuous exceptions) consider themselves radicals first, therapists second if at all, and do not so much attempt to resolve the tension as evade it.
Several of the feminist essays simply dismiss therapy and psychological interpretations of behavior as diversions from the real issue. Other articles define therapy as a process of equipping people to fight their oppression: the therapist’s task is to combat people’s confusion and self-blame, or to create a supportive community directed toward personal and social change, or both. The two positions are not really that different. Both assume that people act in response to immediate external pressures rather than fantasies or childhood experiences, that individual, introspective therapy is reactionary, and that the only remedy for personal unhappiness is collective action. Much of what the second group calls “therapy” the first group would call “consciousness-raising.”
As a political document The Radical Therapist is a valuable book, but as psychology most of it is hardly less shallow or self-serving than the fun-and-games approach of The Love Treatment. Yes, of course, there is a real enemy out there. Nevertheless my own experience tells me that I do not live only in the present, that I don’t always act in what I consciously perceive to be my self-interest, that my fears aren’t always rational. I am the product not only of present conditions but of my own history, which is not exactly like anyone else’s. I often feel as if I am playing out scenarios that were written a long time ago. And though I understand very well that as a woman I am oppressed, not evil or inferior, understanding is one thing and feeling is another.
These are not political problems in the ordinary sense, and they are not necessarily susceptible to political solutions. I would feel insulted and patronized if a therapist I went to were to take the advice that Rick Kunnes, an activist psychiatrist, dishes out: “Always attempt to help patients understand the political causes of their ‘symptoms.’ Suggest to your patients that they work with existing political organizations.” Suppose I join an organization and still feel so depressed I can’t get up in the morning? Who needs still another variety of political indoctrination, however suitably “left,” disguised as psychiatry?
Ultimately, my quarrel with both books is that I am still romantic—or is it just quixotic?—about the possibilities of psychotherapy. As mapped out by Freud and his epigoni, it promises nothing less than an opportunity for human beings to recover their wholeness—to exorcise their most profound terrors, to accept their bodies, to regain access to the full range of their emotions. It is a religious quest, cast in materialist language that secular pilgrims can grasp, and a scientific one too. (These days it is fashionable to disparage the “medical model” for psychotherapy. But if psychic pain manifests itself in genital malfunctioning, as Freud and Reich demonstrated, or in circuitous brain patterns, as Arthur Janov and Lee Woldenberg have suggested, then surely therapy has its medical aspect; it is our view of physical disease as an “objective” affliction, for which the sufferer bears no responsibility, that is distorted.) Politics can offer us hope for a new world; therapy can offer us hope for a second chance.
When psychoanalytic concepts first began to waft toward me on the cultural ether, I felt an immediate affinity for them. Mostly they confirmed what I already knew or suspected: that the motives for much of my behavior were not what they appeared to be; that in the dim past I had suffered some sort of irremediable loss of spontaneity and happiness; that what I could not remember was precisely what was most important; that my deepest feelings were connected with my parents and my childhood; that my love for my father had sexual overtones; that although everyone insisted sex and other bodily functions were natural and nothing to be ashamed of, nobody really believed it.
Later, when my understanding of the subject had become more sophisticated, I rejected Freud’s contention that neurosis was the price of civilization and accepted Wilhelm Reich’s view of sexual repression as the cement of authoritarian social and economic systems. It didn’t seem to me then that there was any inherent contradiction between therapy and radicalism. Reich, whom I admired—and still admire—more than any other therapist, had been an activist. Clearly we had to change the conditions that produced psychic misery; in the meantime, therapy could help individuals and at the same time teach us more about what needed to be changed. What I never seriously considered was how therapists were supposed to go about transcending the conditions that had produced them.
For years I’ve done a lot of talking about going into therapy, and I’m always eager to read about any new development, but so far I’ve stopped short of taking the step, which is exactly how I conceive of it—“taking the step,” like getting married. (Phyllis Chesler makes this analogy in her contribution to The Radical Therapist; it is uncomfortably apt, in several ways.) The more self-consciously a person looks for a mate, weighs one prospect against another, sifts other marriages for bugs, the more difficult it must be to marry with wholehearted romantic conviction. The same psychology applies to the search for a therapist, except that the relevant emotion is not love but trust.
The fact is that psychotherapists as a group do not impress me as trustworthy. I’m not even talking about the grosser forms of psychiatric authoritarianism, but about subtler betrayals. Lack of seriousness is one. Evasion of sensitive subjects or discouragement of emotional displays that make the therapist uncomfortable is another. (Several women have told me they never discussed sex with their therapists; one friend learned from her therapist, after five years, that he had trouble dealing with anger.)
Worst of all is the condescending, punitive attitude built into a therapeutic tradition and language that typically invalidates people with labels like “frigid,” “compulsive,” “masochistic,” and so on. This cast of mind leads otherwise perceptive therapists to regard psychic suffering as a moral flaw rather than a desperate and often creative battle for survival. Even Laing, who has argued so persuasively for the need to identify with the sufferer’s subjective experience rather than impose alien “normal” standards, claims to respect psychotics more than neurotics because the former have rebelled against alienation, while the latter have given in. More conventional therapists would see the psychotic as the one who has given in, or given up, but the impulse to judge is the same. It implies that the therapist is a superior being who has somehow escaped the common human fate.
Perhaps bourgeois Victorians needed to be shocked out of their complacency by having a respected authority reveal the nasty underside of their high-minded rationalizations. Today the problem is somewhat different. Thanks to our exposure to psychoanalytic insights, we all aspire to be honest, open, spontaneous, loving, sexually uninhibited. Accordingly, we despise ourselves for being hypocritical, defensive, calculating, fearful, and sexually uptight. Even if we know better, we are convinced that if we’ve been thrown out of paradise, it’s all our fault. Only in rare flashes—during an acid trip or a love affair or our first view of the Grand Canyon—do we stop blaming ourselves for having to live in the world and comprehend (not just understand) that for all our compromises and failures and scars we are better, stronger, and more beautiful than we know.
Radicals have learned that revolutionary politics must proceed from this healing assumption, and I believe the same holds for a truly revolutionary (that is, effective) therapy: if I am to try to face the whole truth about myself, I have to have faith that I can stand it in the end. This is not to deny that one of the therapist’s critical functions is to challenge people’s illusions and evasions—again there is a parallel to the revolutionary—but only to suggest that this function need not imply moral superiority or preclude empathy with human pain and struggle. How can I trust a therapist who is not unequivocally on my side?
These complaints are in essence political, not only because most therapists are privileged individuals who have every incentive to be superficial, to discourage anger, to consider themselves superior, but because therapy involves a human relationship, and all relationships, even among social equals, are shaped by politics. In a society set up so that one person can grab on to some autonomy or security only at the expense of someone else, the therapist who accepts, who guides us into the unknown without ulterior motives, may be as millennial a fantasy as the perfect lover—or the incorruptible revolutionary. But I can’t give up on it entirely; the urge to preserve and extend my sanity is as irrepressible as the urge to love or revolution. Probably some day I’ll take the step—I can always get a divorce.