Deepening Intimacy in Psychotherapy : Using the Erotic Transference and Countertransference

Rating:
Summary: A groundbreaking work
Review: Rosiello's book represents new ground in dealing with erotic transference and erotic countertransference in psychoanalytic treatment. Her openness in her discussing her erotic feelings will provoke many readers, while offering many more a new way of working with these often difficult feelings. Negotioating patients through these often turbulent waters is Rosiello's specialty, and the numerous clinical examples should give many clinicians a new way of treating patients. Her close examinations of both her feelings as well as her patients' feelings can help many therapists add a new dimension to their work, and can offer insights in helping to reboot a stalled treatment. Her work cannot be praised enough for its bravery and honesty.

Rating:
Summary: A Provocative Look at Sexual Tensions in Therapy
Review: This is a brave and inspiring book by an experienced, analytically-trained clinician who learned from leading a group of gay men with AIDS that the traditional Freudian treatments of erotic transference-abstention and interpretation, usually as resistence-could stifle some patients. These dying men demanded that Dr. Rosiello take more emotional risk. She did with them and then with other patients. The book describes a series of therapeutic encounters, including an asexual man, a seductive lesbian patient, and a therapist who is smitten with a new patient in the waiting room and, after many false starts, finds Dr. Rosiello for supervision. I thought this vignette, which is followed by a retelling by the supervisee, to be the most useful for teaching purposes. Supervision often does not work well for erotic transference issues. Dr. Rosiello offers an explanation: "Sexuality or just plain sex is quite shameful since without mutuality, sexual desire that is recounted or experienced in supervision can feel humiliating."

There is also an excellent review of the analytic literature with some interesting insights (e.g., "the primary intersubjective condition of erotic life is that of 'experiencing the dizziness together'").

Dr. Rosiello rejects the classic view that the erotic transference-countertransference matrix must be ended or the patient referred to another analyst, persuasively arguing that for some patients it can deepen the intimacy and benefit the therapy. The book offers an alternative for treating these patients. And she asks some provocative questions, like, What makes something "sex?" What is happening when patients recount the explicit details of sex with therapists they are dating? Is it dishonest to dress asexually for the patients? How much of a therapist's sexual feelings are beneficial to share? She also discusses homoerotic feelings in therapy, a subject hidden, even now.

My only criticism is that while she is clear that she makes sure her supervisees are not in danger of acting out, she doesn't say how and doesn't discuss any of the ethical issues inherent in working with erotic transference. For example, she says that flirtation keeps things in play and she wouldn't assure a patient angry at her that expressing the anger would be safe, so why tell a patient it would be safe to express erotic feelings. One reason would be that in some states the therapist is required to tell the patient that sex between them isn't a possibility. Perhaps Amazon will pair this book with "Sexual Feelings in Psychotherapy," which focuses more on ethical issues. But this is a small complaint. I was fascinated by this book and inspired by the author's courage both as a clinician and a writer.