Bonasia E. The Countertransference. Erotic Erotised and Perverse. (2001) - IJP (82) (2) 249-262

(2001). Int. J. Psychoanal.
, (82)(2):249-262
The Countertransference
Erotic, Erotised and Perverse1
Emanuele Bonasia 
The author begins by drawing attention to the dearth of psychoanalytic theory

on the sexual countertransference, which he attributes largely to
embarrassment associated with the personal superego and to fear of censure
by the psychoanalytic community. After a review of the relevant literature, he
points out that the term ‘countertransference’ arose in the context of
misbehaviour by the early analysts and that the countertransference was
originally seen as something to be controlled and suppressed, partly for the
sake of the reputation of psychoanalysis. Theoretical and normative reasons
are adduced for the disappearance of sexuality from psychoanalytic scenarios,
and the wish for sexual contact with patients is discussed. While it may be
deemed perfectly normal for an analyst to have erotic feelings towards patients
of either sex, psychopathology is, in the author's view, involved only if he acts
out. Clinical illustrations are given of manifestations of the sexual
countertransference in its erotic, erotised and perverse forms, which the author
considers it important to distinguish. He concludes that the relative absence of
theory on the subject means that not enough clinical use is made of the sexual
countertransference, which he sees as of great potential value to therapist and
patient alike.
Humani nil a me alienum puto (Terence).
Even if I am an analyst.
An alternative title for this paper might have been: ‘Bodies—those inconvenient
guests in the analyst's consulting room’, for I intend to discuss here the
analyst's fantasies and states of sexual excitement in relation to his patients,
whether of his own or of the opposite sex. I shall therefore be dealing with a
limited field of sexuality, namely that of its directly observable manifestations,
which are to a minor extent an expression of psychosexuality—and this, as we
know, actually covers a wide range of unconscious sexual configurations,
transformed and masked in various ways (Green, 1997).
Copyrighted Material. For use only by acre24. Reproduction prohibited. Usage subject to PEP terms & conditions (see terms.pep-web.org).
My choice of subject arose out of a series of unanswered questions posed by
clinical practice as well as by reflections on the countertransference in general
and the sexual countertransference in particular, on which theory has until
recently been conspicuous by its absence. On the one hand, I was confronted
with the experiential fact of my fantasies at specific moments of analysis with
patients, while, on the other, I noticed that, with very few exceptions, the large
number of published papers on the countertransference hardly ever mentioned
the therapist's sexual responses. Furthermore, not only the clinical reports
presented by my colleagues and myself but also papers written by candidates
for associateship and full membership, which I assessed, were also found to be
wanting in this respect.
What had happened to the ‘highly explosive forces’ (Freud, 1915, p. 170),
comparable to those threatening a chemist in his laboratory,
1Translated by Philip Slotkin, MA (Cantab.), MITI.

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with which the analyst works? Had sexuality disappeared from the analyst's
consulting room? Not, it seemed, according to my experience and to the
fleeting, fearful hints I would drop to some of my more trusted colleagues,
after which the subject would be hastily brought to an end with some student-
type banter intended to conceal awkwardness and embarrassment.
Alternatively, had sexuality vanished because new—in particular, relational—

theories and models, rejecting the notion of drives firmly anchored in biology
and the body, reduced its scope or eliminated it altogether? Or might these
models also be performing a defensive function with regard to sexuality? Or
was sexuality present after all, but perhaps being avoided in scientific
communications? If so, why?
While struggling with these questions and wondering how to make my

reflections public, I noticed myself becoming increasingly anxious as I steered
between the Scylla of a report ‘for adults only’ and the Charybdis of a distant,
intellectualised paper. I realised, too, that the most powerful resistances came
from two main sources: my personal superego and—with due allowance for
projections—the superego of the psychoanalytic community.
My anxiety was partly allayed by the discovery, in the course of my

bibliographical researches, that the American Psychoanalytical Association,
having unanimously noted the difficulty of tolerating intense feelings of love in
the setting, had held a panel discussion in 1992 on ‘Love in the analytic setting’,
in which the thorny issue of the sexual countertransference was addressed in
papers by Kernberg, Gabbard and others. A similar panel was organised a year
later (in 1993) by the American Psychological Association.
Some Notes on the Origins of the Concept of

Countertransference
As pointed out by Barron & Hoffer (1994), whereas Freud succeeded in

transforming the transference from a dangerous enemy of the treatment into a
precious ally, for a variety of understandable reasons, both personal and
theoretical, which I shall not go into here, he never managed to do the same
with the countertransference.
The term first appeared officially in the scientific literature in 1910, in the
following passage from ‘The future prospects of psychoanalytic therapy’: ‘We
have become aware of the “counter-transference”, which arises in him [the
doctor] as a result of the patient's influence on his unconscious feelings, and we
are almost inclined to insist that he shall recognize this counter-transference in
himself and overcome it’ (Freud, 1910, p. 144f.).
But how is he to overcome it? I shall return to this point later.
The term had already appeared unofficially in a letter Freud wrote to Jung in
1909 in response to a request for help in relation to the latter's amorous and
probably sexual involvement with Sabina Spielrein:
I myself have never been taken in quite so badly, but I have come
very close to it a number of times and had a narrow escape … They
[these experiences] help us to develop the thick skin we need and to
dominate ‘countertransference’, which is after all a permanent
problem for us; they teach us to displace our own affects to best
advantage (Freud, 1974, p. 2301).
Again, how is one to acquire the ‘thick skin’ needed for what is after all a
permanent problem for us’?
This was a burning issue at the time, as quite a number of male analysts were
then involved in sexual relationships with their female patients. Concerned for
the reputation of the new institution of psychoanalysis, Freud suggested to
Jung in 1911 (letter of 31 December) that an article on the countertransference
be circulated privately among the members of the analytic group, but this was
never in fact written.
It is clear from the foregoing (1) that the countertransference at issue was
sexual in nature; (2) that the risk was of a physical relationship between patient
and analyst; (3) that,
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given the state of the art at the time, the initial barriers were appeals for
control, for developing an impassive outer skin, and for self-restraint—i.e.
prescriptive appeals later to be reflected in the rules of neutrality (Strachey's
translation of the German Indifferenz) and abstinence; (4) and that self-
analysis(Freud, 1910) and then, as stated in Freud's later recommendations
(Freud, 1912), analysis of the candidate with an expert, were deemed to be the
technical means of ‘overcoming’ the countertransference and acquiring the
necessary ‘thick skin’.
This latter contribution is full of happy intuitions and contradictions that bear
witness to the emotional and theoretical birth pangs of Freud's creature; the
famous metaphor of the surgeon who ‘puts aside all his feelings, even his
human sympathy’ (p. 115, my italics) establishes the credentials of the ideal
analyst—as someone who coldly stands aloof from all his feelings and ‘human
sympathy’.
This ideal of ‘analytic normality’ has momentous consequences, some of which

are still with us in the form of a certain idealisation of psychoanalysis, and at
the same time appears to be an important element in the discrepancy, to which
Nissim Momigliano (1987) draws attention, between the technique described in
Freud's theoretical writings and his clinical practice, which was in fact
characterised by positively excessive human sympathy and warmth (as when he
lent patients money or gave them food). This dichotomy suggests that the
technical recommendations were at first largely directed towards his brilliant
but undisciplined pupils, who tended to lack self-control.
I shall not recapitulate here the well-known development of the concept of

countertransference, begun by Ferenczi and continued in particular by A. Reich,
Heimann, Little and Racker, but wish instead to show how it in fact evolved in a
direction diametrically opposed to that of the metaphor of the surgeon. Freud's
solution of putting ‘aside all his feelings’ could be described as schizoid and
came to be contrasted with the ‘depressive’ goal of integrating all feelings, albeit
with the sexual feelings hardly at all in evidence.
Despite the eventual corrective of the personal analysis, the comprehensive

review by Krutzenbichler & Essers (1991) of sexual violations of the setting
shows that noisy ‘blasts’ have followed each other thick and fast in the chemical
laboratory of analysis, with devastating effects on patients, on the therapists
who have acted out sexually in this way, on the reputation of psychoanalysis
and on individual psychoanalytic societies.
In this connection, it is apparent that, by and large, the psychoanalytic

community (with very few exceptions) has to this day not managed to advance
beyond the level of administrative sanctions, in the form, after initial denial (it
can't be true!), of expelling the guilty party as a scapegoat: ‘Be off with you,
deliver us from evil, and so be it’—at least, for the time being!
Rather than moralise about our institutions, I should like to preserve a

psychoanalytic standpoint and maintain that instances of sexual acting out are
also a consequence—the most conspicuous, but certainly not the only one—of
the silence that has fallen upon sexuality and the sexual countertransference.
Disappearance of Sexuality from Psychoanalytic Scenarios
In view of the national and cultural variables that influence the process of
psychoanalytic theorisation, it is of course inappropriate to generalise here.
Moreover, we need to distinguish between substantive disappearance (where
the analyst uses theories in which sexuality is marginalised) and formal
disappearance (in which the analyst uses theories steeped in sexuality but
tends not to mention it in official communications). However, I shall attempt to
identify some of the factors underlying these ‘disappearances’ with particular
reference to the Italian situation, although they are no doubt broadly
applicable, in my view, to other cultural contexts as well.
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(1) Theoretical reasons
The questioning of the traditional psychosexual model, the shift of emphasis on

to primary destructiveness, the abandonment of the drive model by certain
theories, the accumulation of observational data on newborn babies and the
mother-child couple, the widespread acceptance of mother-child models of
relationship and their extrapolation to the therapeutic relationship (whereby
what happens in the latter is deemed to be what happened, or what one would
like to have happened, in the former)—these are the main theoretical factors
underlying the relegation of sexuality to the background in both the theory and
the practice of analysis.
Green (1995) draws attention to the progressive desexualisation of analytic
theories, with a consequent return to a kind of puritanism in psychoanalysis;
and Barale and Ferruta (1997) investigate the theoretical dislocation between
sexuality and object relations and the tearing apart of the concept of
psychosexuality.
I share these views, subject to the qualification that relational theories as a rule
set the body aside, in its two-fold capacity as a source of sexual and sensual
pleasure on the one hand and of pain and suffering on the other. I see this as the
expression of a general human tendency, which I have discussed elsewhere
(Bonasia, 2000), to disavow one's own bodily aspect for reasons connected with
specific anxieties, including sexual ones. This tendency, reflected in the
devaluation of Freud's ‘biology’ in certain psychoanalytic circles, sometimes
results in a mentalism bordering on a mystical and spiritualistic vision of
psychoanalysis. In this connection, Di Chiara (1988, personal communication)
tellingly describes medical psychoanalysts as ‘doctors fleeing from the body’.
Furthermore, relational theories tend to underestimate the intense and

pleasurable bodily sensual exchanges between child and parents, and
consequently the mutual erotic component (both homosexual and
heterosexual) as well as the—physiological and pathological—defences against
it.
In this context, Wrye & Welles (1989) use the phrase maternal erotic transference
to denote erotic and sadistic wishes directed towards concrete parts of the
analyst's body, which they attribute to the sensual bond with the mother in the
preverbal period; they postulate that their expression is inhibited in analytic
treatment by shame or the fear of humiliation. The same authors (Welles &
Wrye, 1991) also draw attention to the male analyst's difficulty in accepting
patients’ fantasies of touching him—to which I would add those of touching his
patients.
(2) Normative reasons
These may be attributed both to the dictates of the personal superego and to
implicit or explicit rules prescribed by the scientific community.
On the latter point, it should be noted that working through the sexual
transference usually entails either countertransference responses of the same
kind or defensive responses (avoidance responses, counterphobic responses or
attenuating responses, such as exclusive concentration on the metaphorical
aspect of a concrete sexual fantasy).
Since we analysts work not only with the mind but also with the living flesh of
our feelings, passions and physical desires, it is understandable that normal
feelings of modesty and reserve make us disinclined to publicise clinical
interactions involving sexuality; nor are we helped here by the psychoanalytic
superego, moulded as it is variously by our personal analysis, supervisions,
reading, seminars and the predominant theoretical models.
Closely related to this agency is the fear of judgement and diagnosis by

colleagues. Wolf (1992) states categorically that any sexual attraction or
excitement in relation to patients, whether or not acted out, is a sign of
psychopathology. What we have here, due to the idealisation of analysis, is
perhaps a powerful intimidation set up in opposition to an equally powerful
temptation, as a result of which Wolf and like-minded analysts equate fantasy
with
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acting out; and acting out is indeed always a token of psychopathology.
Gabbard (1989) reports that, in a survey covering a big sample of

psychotherapists, 86% of the men and 52% of the women stated that they had
felt, or were, sexually attracted to patients. Is all this psychopathology?
Quoting Plato, Freud (1900) maintained that the difference between the ‘best
men’ and criminals was that the former merely dreamed at night about what
the latter actually did in their waking lives. A similar distinction can be drawn
between the ‘best’ analysts and those who abdicate the analytic function by
acting out—the former have the additional task of thinking about and containing
their sexual dream (or daydream, as the case may be).
In my view, the criterion for distinguishing between pathology and normality is

whether the analyst acts out—that is, whether he loses control—in which case
the analytic function is eclipsed. The problem becomes that of succeeding in
integrating the sexual fantasy within the countertransference and being able to
use it for the patient instead of acting it out against him—that is, of completing
the operation of turning the countertransference into a precious ally of the
treatment, as has already been done with the transference (Kernberg, 1995).
(3) The wish for sexual contact with patients
Strean (1993) stresses the importance of acknowledging that the wish for
sexual relations with patients—usually of the opposite sex—is universal, human
and understandable.
The results of Gabbard's survey, as well as those of investigations among other
kinds of therapists, seem to bear out this hypothesis. Such wishes must indeed
be universal, to judge from the following admonition of Hippocrates dating
from 450 BC: ‘Into whatever houses I will enter, I will go into them for the
benefit of the sick, and will abstain from every voluntary act of mischief and
corruption; and further, from the seduction of females or males, of freemen and
slaves’ (quoted in McLaughlin, 1961, p. 107; my italics).
The way psychoanalytic societies have hitherto managed the manifestations of

sexual acting out (an initial stage of incredulity and denial, attempts at
collusion, and subsequent expulsion of the scapegoat) could also be seen as a
reaction to the appearance of a latent collective wish.
The following dream of my own which I have had many times over the years
can, to be sure, hardly be described as latent. In it, I am engaged in an intense
emotional relationship with a beautiful female patient. Sometimes the irreparable is
about to occur in pleasurably irresistible fashion and, thinking of the sanctions likely
to be imposed by my Society, I say to myself: well, it won't be so serious if it is just
this once! On other occasions, it has happened: I imagine either that I have got
away with it or that I have been caught in the act and expelled from the Society.
Alternatively, when I feel that it has already happened, I may try to deny the
event to myself. On still other occasions, I feel in my dream the intense pain of
forgoing an impossible love so as to remain a psychoanalyst.
Whereas the manifest structure of the dream suggests a latent oedipal

constellation, its over-determination exemplifies the wish referred to by Strean
(or at least my wish), ambivalence towards psychoanalysis and the
psychoanalytic function, the complex vicissitudes of the countertransference,
including sexual ones, and the concept of countertransference in the strict
sense (Racker, 1953, 1957), in which patients also represent the analyst's
parental figures. This latter point only adds to the difficulties of accommodating
sexuality in the analyst's consulting room, in that it elicits the incest taboo
(Tansey, 1994).
The Erotic, Erotised and Perverse Countertransference
So far I have deliberately referred to ‘the sexual countertransference’ without

distinguishing between different varieties. However academic such a distinction
may seem, it must
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now be made, even though the three forms I identify cannot readily be found in
the pure state.
By erotism I mean ‘normal sexuality’. Here I share the position of Kernberg

(1992) that polymorphously perverse fantasies, when given free rein, are an
integral part of this sexuality, whereas the characteristics of pathology are fixity
and compulsiveness. I also agree that adult sexuality in both sexes entails the
integration of aggression and bisexuality (that is to say, a capacity to identify
with the other sex is inherent in it), together with feelings of love and
tenderness. This is so even if the ‘normal’ life of a couple may, for various
reasons, include moments of erotisation and perversion, which must be
distinguished from stable interactions of this kind connected with the couple's
pathology.
By erotisation, sexualisation or libidinisation—leaving aside the various senses in

which these synonyms have been used in the literature—I mean a psychotically
tinged defence mechanism in which the ‘sexual’ element has the primary
function of concealing the pain of loss and separation (for instance, one of my
male patients spent the night after his mother's death engaged in intensive
lovemaking); and I define perversion, in the same sense as Stoller (1975), as a
sexualised defence directed mainly against hate and destructiveness.
An analysis of the scant literature on the subject (Tower, 1956; Searles, 1959;
Racker, 1953, 1957; Bolognini, 1994; Gabbard, 1994; Tansey, 1994; Kernberg,
1995) shows that the contributions of all authors, starting with the pioneering
paper by Tower, on the one hand exhibit the diffuse attitude of phobia or
condemnation typical of the psychoanalytic community, while, on the other
hand, agreeing that a sexual response on the analyst's part is ubiquitous and
normal, whereas pathology in the analyst is manifested in compulsion and
fixity. It is also unanimously accepted that such responses, where correctly
used, have a therapeutic potential, although opinions diverge on how the
healing effect should be understood. Not all the authors distinguish between
the erotised and the erotic transference, the latter being seen by most as a
replica of the analyst's Oedipus complex. Again, there are insufficient reports of
perverse sexual reactions in which hate and destructiveness predominate.
Whereas we can recognise and accept the presence in ourselves of ‘normal’

erotic responses, albeit with difficulty, embarrassment and reluctance, matters
are more complicated with the erotised and perverse countertransference
reactions defined at the beginning of this section.
The authors who have written on such reactions (Strean, 1993; Gabbard, 1994)
discuss them in relation to therapists who have come into analysis because
they have acted out or found themselves about to do so and these
manifestations are presented as pathological.
While confirming my view that pathology lies in enactment and the fear of
being on the point of enactment, it seems to me that, if we come to terms with
the ideal of ‘analytic normality’ and are able, à la Terence, to tolerate the fact of
also possessing psychotic and perverse characteristics, the analyst's erotised and
perverse fantasies may be useful instruments for casting light on the emotional
situation of the patient and of the therapeutic relationship, which, if
appropriately worked through, can assist the progress of the analytic work.
Clinical Illustrations
Erotic countertransference
Notwithstanding the difficulty of making clear-cut distinctions as mentioned

above, it seems to me that this type of countertransference can be subdivided
into two main configurations: an oedipal and a post-oedipal variety.
1) The oedipal variety (Bolognini, 1994) may be manifested in phobic avoidance

of a female patient's sexuality where she represents the analyst's oedipal
object. Alternatively, it may be reflected in conscious sexual and amorous
fantasies, whose excitement results primarily from the patient's status as a
prohibited object
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par excellence and from the fantasy of transgression. It is usually accompanied

by guilt feelings towards the patient's husband or partner or towards
colleagues seen as condemning the analyst's feelings of love or any seductive
and colluding interventions on his part. In particular, the sense of guilt may be
responsible for a certain timidity or inhibition in interpreting the patient's
resistances to her own sexual desires; this inhibition may fuel the expectation
that it is up to the patient to take the initiative in making the love fantasies
explicit, with feelings of rage and frustration if this does not occur.
2) The post-oedipal variant seems to me to be typical of the final stages of an

analysis when a female patient and a male analyst are pleased with each other.
In so far as it stems from oedipal and pre-oedipal sources, its predominant
components are reality aspects of the history of the analysis, of its favourable
development and of the possibility of seeing the patient as a real, lovable and
desirable person. Pain and renunciation are entailed in working through the
relevant feelings.
The following case history offers a good illustration of these two transference/
countertransference constellations and the transition from the former to the
latter.
Luisa was a woman of 35 who came into therapy with a hysterical structure
accompanied by frigidity and pronounced sadomasochistic characteristics that
made her relationship with her husband highly conflictual.
During the course of her long and difficult analysis, then in its seventh year, she
had caused me to experience feelings such as rage, the wish to throw her out,
impotence and despair. However, in the last few months of the therapy she had
become considerably more cooperative. Then came a session in which I found
myself having intense amorous and sexual fantasies about a female friend of
hers, whom I also knew slightly. After an inner struggle with these emotions, I
realised that they were in fact displaced from the patient herself on to her
friend.
Because my desires were protected and masked in this way, and, after all,
guilty, it seemed to me that Luisa too was at grips with the same problem, and I
made a more active effort to concentrate my interpretations on how the patient
was hiding her fantasies. During this phase Luisa brought a dream: ‘I am in the
street and I meet a male friend with whom I stop and have a pleasant chat, but
immediately after, along come two or three women who look at me very
threateningly’.
I told her that the dream was helping us to understand her difficulties with men
in general and with me in particular: if she went out into the open (in the street)
and stopped to have a pleasant chat with me, the result would be threatening
looks and attitudes from other women (the maternal superego). I added that
the pleasant feelings she experienced were sexual in nature and that they had
to be kept hidden so that she could live in peace with the other women.
Shortly afterwards, a dream of mine drew attention to the changes taking place
in the analytic relationship and in Luisa's internal world: I am with her in my bed,
both of us pleasantly embracing and turned on. I suddenly realise that my wife is in
the house and that her presence is no longer disturbing as it used to be in the past.
The dream also testified to the change taking place in Luisa's maternal
superego (my wife), as a result of which she was now often able to come to her
sessions with a smile on her face. I, for my part, had lately noticed a feeling of
trepidation as the time of her session approached: I would have liked to have
an affair with her, although I knew that this was out of the question. I now did
my best to pick up her timid expressions of gratitude and, on occasion, of
regret at having made me suffer so much.
Her fear of meeting my wife and receiving withering looks from her as she
came into my consulting room still alternated with moments of rage and
coldness, which I interpreted as a defence against feelings of love for me. After
a few weeks, with some embarrassment she
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brought a dream from which she could recall only my presence and vague
romantic and erotic feelings: as noted also by Racker (1953, 1957), Carloni
(1982) and Meotti (1984), Eros calls forth Eros.
My erotic countertransference served as a kind of radar in drawing attention to

analogous erotic movements on the patient's part; the intensity of my feelings
was in part (only in part, because she was not projecting into the void) a
projection of the intensity that the patient was not yet able to own for herself
and which it would be up to me to give back to her in modulated and digestible
form.
As a result of the working through of the oedipal erotic transference together

with my corresponding reactions, it became possible for the post-oedipal
constellation, as I have previously called it, to unfold, and it is, I think, well
illustrated by the following extract from a session three months before
termination.
P: It is also painful to talk to you about my desires, partly because I am

ashamed, but there is another reason too … In the last few days I have
realised that, deep down, all these years, I have wanted you to notice me as a
woman and to tell me openly that you had …
A: Now the fact that you are telling me about it is painful because it
basically means that you must give up this dream of yours …
P: Yes, it is as if something was being lost… but I also feel that the whole of
me is in here today. I remember that in the past you told me that I would
come here only with my head, as if I did not have a body, let alone a vagina …
but today I am very aware of having one and that you are here too with your
own body … (a short pause). I should like to cuddle you and make love to you
and I feel that I could be nice and receptive … and then it seems that this wish
of mine is also a way of expressing gratitude to you … there, I don't know how
to tell you …
A: [Moved and pleasantly surprised] In fact you are telling me very clearly
…
P: [fervently] Yes, I want to tell you that I am grateful … even if you have
not always been nice, but I have felt welcomed and recognised by you and I
have appreciated al the trouble you have taken to help me …
The atmosphere was very intense, and I too felt a wave of physical passion
and emotion for Luisa. I noticed that I was for a moment tempted to lower
the temperature by connecting her feelings with her relationship with her
father, thereby taking the situation outside the consulting room, but felt that
this would be a mistake, which the patient would experience as rejection.
P: I am finding it hard to control myself and only talk to you about it…
A: [Registering a stiffening of the body] Where do you feel this difficulty?
P: It is a stiffening of the muscles as if I had to keep the whole of my body

in check … Now I understand, or rather, I feel what you were saying about
control … it's about controlling what I am feeling for you … I feel my arms
going tense because I would like to fling them round your neck and feel your
body close to mine …
Tenderness, physical desire, pleasure at the good work done, satisfaction for
Luisa, who had cast off her frigidity and was now able to express her warmth,
sadness at the imminent separation and renunciation, and envy of the man
who would enjoy the new Luisa—these must be the feelings of a father as he
leads his daughter, now grown into an adult woman thanks partly to her own
efforts, up the aisle to entrust her to another man (Searles, 1959: Bolognini,
1994).
In the next session, Luisa was again cold and unfriendly. However, she readily
understood that she was feeling disappointed and angry with me. Basically, she
told me, she had disclosed her innermost feelings, but nothing had happened. I
replied that it was understandable for her to have expected a declaration of
love from me too. She would of course have liked that very much, but it had not
come, and now she wanted to ill-treat me, to wound me by claiming that the
analysis had done nothing for her. But she knew too that this was not true …
and, after a brief silence, she added that she had picked up a response on my
part, because,
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when I had replied to her wish to express gratitude to me, my voice had
betrayed involvement and warmth.
Sadness and sorrow on both our parts was in the air, in this phase of
renunciation and its associated pain.
Erotised countertransference
As stated above, I am using the word ‘erotisation’ in the limited sense of a

specific defence against the pain of loss and separation; in other words, it is the
hypersexualised variant of the manic defence. The terms ‘sexualisation’ and
‘libidinisation’ have often featured in the literature as synonyms to denote
fantasies and forms of sexual behaviour whose main purpose is not the
procurement of pleasure but the avoidance of pain, with the omnipotent
intention of transforming a painful reality into a pleasurable one. Whereas
erotisation is a constant factor in perversions, whose main function is to defend
against hate, in my experience this mechanism can also be observed in patients
who are not structurally perverse and may—in specific contexts, even in
relatively normal people—represent an archaic resource with which to confront
situations of psychic pain where hate is not the main affect.
The erotised transference, which is so frenzied and intense, usually appears at

the beginning of an analysis and is seldom accompanied by a corresponding
countertransference response. Instead, in view of the crude idealisation of such
a transference, the analyst's response is usually one of greater or lesser
irritation (De Masi, 1988), associated with the patient's invasion and distortion
of his identity.
If there is a symmetrical countertransference response to the initial erotised

transference, it is as a rule attributable to narcissistic imbalances in the analyst,
often resulting from grief-inducing life experiences (such as divorce, the death
of significant persons, or illness). This is the background to the majority of
instances of sexual acting out (Strean, 1993; Gabbard, 1994).
Another area with a high risk of erotisation and possible acting out is the phase
of termination of an analysis; in this case it is an obvious defence against
working through the separation.
However, there is a variety of reasons why an analyst may experience moments
of erotisation, sometimes in more disguised form, at particular phases of an
analysis, as the following example shows.
Filippo was a 50-year-old teacher in his fourth year of analysis. His mother had
died a few days before. While he was telling me, in a voice that betrayed little
feeling, of his pain at her loss, at the inexorable passage of time and at his own
ageing, I found myself immersed in exciting heterosexual fantasies. After a few
minutes I began to wonder about this odd phenomenon and at first thought
that my reaction resulted from an emotional refusal to make contact with
Filippo's painful thoughts.
Listening to him more attentively, I became aware of a seductive element in his

tone of voice, which we had encountered before and connected with an aspect
of passive homosexuality in him. Might my heterosexual fantasies have also
served to ward off a homoerotic response to my patient?
I began to tell him that he was feeling very alone and sad and that he perhaps
wanted a sexual relationship with me in order to feel that I was as close to him
as possible.
In a more involved tone, the patient confirmed his sense of emptiness and told
me how he had been surprised and frightened, the night before, when his
father had asked him to sleep with him in his mother's place. He had sensed a
sexual element in this request. He had gone to sleep in another room, but had
had little rest: in intense pain, he had felt very alone and imagined that his
father must be feeling something similar in the other room. At one point, he
had been sorry that he had not slept with him in the same bed.
He added that he had felt uncomfortable and embarrassed when lying down on
the couch, noticing his desire to be received
257
warmly by me, but fearing that there might be something sexual in it.
I told him that he seemed to be confusing the wish for me to sympathise and
share his pain and the wish for exciting sexual contact with me, whereby he
could conceal the suffering afflicting him at that moment and transform it into
pleasure.
In the next session, Filippo told me that his wife had had an interview with an
analyst who had said to her, among other things: ‘You don't seem to be
acquainted with suffering!’ The patient reported that, on hearing this, he had
felt angry with this analyst, and added: ‘You should throw him out of the
psychoanalytic society!’ I answered that perhaps I too should be thrown out,
because I was trying to ‘acquaint’ him with his suffering at his mother's death,
and this made him angry with me. In the next day's session, Filippo brought a
dream indicating a possible modification of his erotised defences:
‘My brother was wearing a woman's top for fun. He had dressed up as our mother
and the whole thing was beginning to annoy me. Then my mother appeared; I
showed my affection for her and was very pleased to see her, although, deep down, I
felt intense longing.’
I told him that his brother in the dream represented himself and that he was
beginning to get annoyed at the ‘masquerade’ with which he had responded to
the loss of his mother, whereby he was pretending to be her. Now, I went on, he
could feel his affection for his mother to the full and was happy to show it—but
at the same time he was aware of intense, painful longing, because she was no
longer there. At this point Filippo burst into tears. In the next session he told
me how grateful he was to me for helping him to take off his ‘top’ and feel more
authentic, even if this was painful.
In this case, the patient's initial account had aroused painful echoes in me of
the death of my parents and the working through of my own ageing. The
sexual fantasies could be seen as resulting equally from my personal
contribution and from the patient's erotised mechanisms. Again, the
elaboration of the countertransference experience and its use in the
interpretation had made it possible to identify the defensive ‘sexual’ cloak over
the painful emotions passing back and forth between the members of the
analytic couple.
Perverse countertransference
In perversion, as already mentioned, sexuality and the wish to do harm to the

object are intimately bound up with each other, even in sexual behaviours
where the subject is manifestly the victim of hostility, which, although masked,
finds expression in the fantasy of triumphantly demonstrating his own ‘sanctity’
and the brutality of the perpetrator of the violence (Stoller, 1975).
Teresa was a 29-year-old psychologist in the fourth year of her analysis. She
was in therapy for alternating moderate phases of anorexia and bulimia that
had commenced around the age of 14. Hysterical characteristics predominated
in her personality, with a pronounced masochistic component.
The first years of the analysis were taken up with the working through of the
pre-oedipal relationship with her mother. Teresa had felt that her mother had
not listened to her or shared her needs and emotions, and that, instead, she
had had to submit to her mother's expectations and control her own rage
either by obsessional defences or by turning it against herself.
The difficult relationship with her mother, who was left unsatisfied by her
husband, stood in the way of a solid female identification on Teresa's part,
leading her to adopt male forms of behaviour as expected by her father, by
whom she had felt appreciated mainly when she devoted herself to academic
work.
In a recent session dating from a period when her female side was beginning to
emerge, I began to have fantasies of pinning her down and raping her. I did not
feel at ease in the garb of a monster. All my attempts to get rid of this
disturbance, which seemed to me excessively psychopathological, were futile.
What if the patient had elicited brutal and primitive characteristics
258
of myself, appropriately but not too deeply buried in my unconscious?
Overcoming a certain reluctance, I began to tell her that I felt for some reason
that she was struggling with a wish to be pinned down and raped by me. After a
prolonged silence during which I was afraid of having blundered, I asked her
why she was not saying anything. The embarrassed reply was that my
intervention had reminded her of the masturbation fantasies of her childhood:
going into her parents’ bedroom, she would imagine being tied to the bedpost;
two men would come along, one old and the other younger (in addition to her
father, she had a brother five years her senior), who would grope her and then
penetrate her against her will.
She added that she had recently feared that I would take advantage of her
position as a patient and make sexual suggestions to her, which she would not
have been able to resist.
I then enquired whether something in my attitude might have given rise to this
fear. All that occurred to Teresa was that lately she had often been aware of a
cutting, provocative note in my voice. After thinking for a moment and
recognising that her perception was correct, I said that she was right, adding
that it was worth asking ourselves whether what was happening between us—
that is, my provocative attitude and her fear of a sexual suggestion she would
not be able to resist—might not have some counterpart in her history.
Teresa then told me that, as a little girl, she had often been left alone with her
brother at home and he had then begun to provoke and frighten her, shouting
and assuming a threatening posture. Sometimes he had burst into her room
half-naked and exhibited his penis to her.
The use of a complementary countertransference relationship in which I had

become the sadistic rapist object had enabled the patient to tell me for the first
time, after four years of analysis, of her masturbation fantasies and her specific
transference anxiety, and allowed her to recover significant memories of a
traumatic situation passively undergone. This was the point of departure for
examining the oedipal-masochistic constellation in its concrete and
metaphorical sexual aspects. Again, the overdetermination of the perverse
fantasy also made it possible to analyse the underlying hate directed towards
her mother, father and brother, as well as her analyst, who had not decided to
show his preference and love for her. My interpretation, of course, had nothing
magic, or indeed particularly intuitive, about it; it was activated, as far as
Teresa's contribution was concerned, by the gradual build-up in my
preconscious of her paralinguistic communications, which were sometimes
explicit and on other occasions almost unnoticeable—seductive glances at the
beginning or end of a session, a subtle play of self-revelation and self-
concealment, a way she had of forcing me to tell her things, a seeming
impenetrability on her part, and subtle verbal provocations aimed at ‘getting
herself jumped on’. What might these messages from Teresa have meant? At
least two main aspects can, I believe, be identified. The first was an attempt to
communicate not only the hidden wish but also, through the dramatisation of a
scene of sexual violence, the trauma as actually experienced by the patient
(even if it did not involve consummated incest) with her brother—and also her
father, who, Teresa was later to remember, had used to touch her breasts
during her adolescence and make jokes about the transformations taking place
in her body. Second, through the fantasy that she herself was now staging, the
patient was seeking actively to bring the unmetabolised trauma back under the
control of the ego.
Apart from the patient's projections, my perverse fantasy, on the level of the
real analytic relationship, also expressed the intense antipathy and hostility I
was experiencing to Teresa's unco-operativeness at this stage of the analysis.
These considerations are consistent with the finding of Gorkin (1985) that
female patients with powerful masochistic traits induce a sadistic kind of
perverse countertransference in a male analyst. In response, he may either
compensate by an attitude of kindness, or act out the sadism by becoming
provocative and sarcastic (as in the case of my enactment with Teresa);
259
alternatively, he may assume a cold, off-putting front or intrusively force

interpretations on the patient. Such enactments, which are at first to some
extent inevitable, can more readily be overcome if the analyst is capable of
tolerating(Carpy, 1989) his perverse fantasy and of bringing it back into
circulation in his communication with the patient.
Conclusions
I have postulated the following:
that the disappearance of concrete sexuality from psychoanalytic scenarios is

attributable, among other things, to the dearth of theories of the sexual
countertransference and its consequent insufficient use;
that this dearth may be connected (a) with the temptation to act out and, in
particular, but not only, with the incest taboo, and (b) with the understandable
difficulty of communicating these matters to colleagues;
that it is important to distinguish three main varieties of the sexual

countertransference: namely the erotic, the erotised and the perverse types;
that such countertransferences, if correctly used, may be extremely valuable to

patient and analyst alike in terms of their capacity for transformation and
integration.
It is clear from the foregoing that my conception of the countertransference

agrees with that of those authors who regard it as a mixed production, created
partly by the patient and partly by the analyst—in effect, as a Winnicottian
transitional object. From this point of view, to borrow Nissim Momigliano's
(1984) apt metaphor of the psychoanalytic session as a musical composition for
four hands, the countertransference reactions could be seen as vibrations of
notes issuing from the keys of the analyst's piano, made to resonate by the
patient's hands (free associations and paralinguistic communications).
But what do we mean by the ‘correct use of such countertransferences’?
In noting that nowadays the analyst's emotional response is generally seen as

the result of projective identification, which inherently impels one to action,
Carpy (1989) shows that the prime task of the therapist is to tolerate the
projected emotions and feelings, while at the same time distinguishing what
belongs more to the patient from personal aspects of his own. For Carpy,
‘toleration’ means not remaining aloof but allowing oneself fully to experience
the projected feelings without acting them out. Similarly, in the specific case of
sexual responses, it is in my view appropriate to overcome the
countertransference resistances associated with the various superego-type
agencies mentioned earlier. In other words the analyst must ‘sink into’ the erotic
fantasy without “‘drowning” in it’ (Gorkin, 1985, p. 423); that is to say, he must
allow all the details to unfold while resisting the impulsive urge to interpret. The
problem is ultimately of how the analyst can allow himself to have the ‘sexual’
experience, to digest it, to formulate it and then to communicate it as an
interpretation (Brenman Pick, 1985).
A number of aspects of my subject call for further investigation:
This paper was written by a male analyst, but what form does the musical
composition take when the analyst is a woman? Lester (1985) acknowledges the
difficulty of presenting herself to her male patients as an object of sexual
cathexis; she feels more at ease in the role of the feeding analyst-mother. Could
it be that, for a female analyst, the mother-child model also serves the purpose
of defending against the emergence of sexuality in the session? I am of course
unable to answer this question directly.
What are the specific problems met with by an analyst with same-sex patients?
Is his or her gender identity solid enough to enable him or her also to ‘play’ the
part of the opposite sex?
The analyst's piano is not an instrument that is given once and for all, but
undergoes constant tuning because it is subject to the ravages of time, the
inevitable vicissitudes of existence
260
and the effects of the life cycle. Moreover, all these factors are likely to impart
particular timbres, calling for further study, to the notes of the sexual
countertransference.
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(2001). Int. J. Psychoanal.

Erotic, Erotised and Perverse1

The author begins by drawing attention to the dearth of psychoanalytic theory

Humani nil a me alienum puto (Terence).

1Translated by Philip Slotkin, MA (Cantab.), MITI.

Alternatively, had sexuality vanished because new—in particular, relational—

While struggling with these questions and wondering how to make my

My anxiety was partly allayed by the discovery, in the course of my

Some Notes on the Origins of the Concept of

As pointed out by Barron & Hoffer (1994), whereas Freud succeeded in

But how is he to overcome it? I shall return to this point later.

This ideal of ‘analytic normality’ has momentous consequences, some of which

I shall not recapitulate here the well-known development of the concept of

Despite the eventual corrective of the personal analysis, the comprehensive

In this connection, it is apparent that, by and large, the psychoanalytic

Rather than moralise about our institutions, I should like to preserve a

Disappearance of Sexuality from Psychoanalytic Scenarios

(1) Theoretical reasons

The questioning of the traditional psychosexual model, the shift of emphasis on

Furthermore, relational theories tend to underestimate the intense and

(2) Normative reasons

Closely related to this agency is the fear of judgement and diagnosis by

acting out; and acting out is indeed always a token of psychopathology.

Gabbard (1989) reports that, in a survey covering a big sample of

In my view, the criterion for distinguishing between pathology and normality is

(3) The wish for sexual contact with patients

The way psychoanalytic societies have hitherto managed the manifestations of

Whereas the manifest structure of the dream suggests a latent oedipal

The Erotic, Erotised and Perverse Countertransference

So far I have deliberately referred to ‘the sexual countertransference’ without

By erotism I mean ‘normal sexuality’. Here I share the position of Kernberg

By erotisation, sexualisation or libidinisation—leaving aside the various senses in

Whereas we can recognise and accept the presence in ourselves of ‘normal’

Notwithstanding the difficulty of making clear-cut distinctions as mentioned

1) The oedipal variety (Bolognini, 1994) may be manifested in phobic avoidance

par excellence and from the fantasy of transgression. It is usually accompanied

2) The post-oedipal variant seems to me to be typical of the final stages of an

My erotic countertransference served as a kind of radar in drawing attention to

As a result of the working through of the oedipal erotic transference together

P: It is also painful to talk to you about my desires, partly because I am

A: [Registering a stiffening of the body] Where do you feel this difficulty?

P: It is a stiffening of the muscles as if I had to keep the whole of my body

As stated above, I am using the word ‘erotisation’ in the limited sense of a

The erotised transference, which is so frenzied and intense, usually appears at

If there is a symmetrical countertransference response to the initial erotised

Listening to him more attentively, I became aware of a seductive element in his

In perversion, as already mentioned, sexuality and the wish to do harm to the

of myself, appropriately but not too deeply buried in my unconscious?

The use of a complementary countertransference relationship in which I had

alternatively, he may assume a cold, off-putting front or intrusively force

I have postulated the following:

that the disappearance of concrete sexuality from psychoanalytic scenarios is

that it is important to distinguish three main varieties of the sexual

that such countertransferences, if correctly used, may be extremely valuable to

It is clear from the foregoing that my conception of the countertransference

But what do we mean by the ‘correct use of such countertransferences’?

In noting that nowadays the analyst's emotional response is generally seen as

A number of aspects of my subject call for further investigation:

Barron, J. & Hoffer, A. ( 1994). Historical events reinforcing Freud's emphasis

Brenman Pick, I. ( 1985). Working through in the countertransference. Int. J.

Carloni, G. ( 1982). Sofferenza psichica e vocazione terapeutica. In Itinerari

Carpy, D. ( 1989). Tolerating the countertransference: a mutative process. Int. J.

De Masi, F. ( 1988). Idealization and erotization in the analytic relationship.