What's Love Got to Do With it? The Role of Love in Therapy, From a Client's Perspective

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I've been in therapy for over 25 years, seeing two therapists – the first for 17 years, and the second for just over seven. Alexis, my first therapist, retired at unexpectedly short notice in November 2017 due to a family illness, though she had already told me that she was planning to retire the following year.   

Alexis was (is) what I would describe as a very traditional psychoanalytic/psychodynamic therapist. We had no contact outside of sessions, our appointment days and times were rigidly adhered to, and she did not actively disclose any personal information about herself. Despite my lack of knowledge about her life outside of her consulting room, I was very clear on one thing about Alexis: she saved my life. I am as sure of that now as I was all those years ago. 

In a way, a relationship with a therapist can be seen as a model of how any relationship develops, though almost in a vacuum – away from shared experiences and friends, contextual information, home environment and personal history (at least on one side). Alexis and I never went to the cinema together, or to an exhibition; she never met any of my friends or family – although I imagine that by the end of our time together she felt that she had; she never came to my house, nor spent a day in my company. Despite all of that, we built a meaningful and profound relationship and knew a great deal about each other. I loved her, and in some ways still do. 

In 1906, Freud wrote a letter to Jung in which he asserted that “Psychoanalysis is, in essence, a cure through love”. When I came across this letter, it struck a chord since it chimed with my feelings towards Alexis, albeit I was aware that Freud’s sense of the therapeutic relationship was very different to my own, and to my own experience. 

I wanted to explore Freud’s views on the nature and role of love in therapy, and also to consider how the sense of the relationship, or love, between the therapist and client has evolved over time, not least in light of our broader understanding of the different shapes that relationship may take. 

Curing through love 

Freud reiterated his view on love’s role in therapy in a 1909 letter to fellow analyst Max Eitingon, stating that ‘the secret of therapy is to cure through love’. He explored this idea in greater detail in his 1915 paper, Observations on Transference-Love. For Freud, as the paper's title suggests, this love primarily referred to the patient’s love for the analyst, which is aroused in transference.

In psychotherapy, transference is when the patient redirects unconscious feelings – often from childhood – onto the analyst. Freud saw it as the main way in which unconscious conflicts and repressed feelings could be accessed in therapy, which was necessary to achieve a cure. The paper focuses on the love of a female patient for a male therapist and thus primarily on love that is predicated on sexual desire – though it is worth noting that Freud believed that the principles of transference-love and its sexual basis were broadly applicable to all patients, regardless of their or the analyst's gender. Freud offers articulate and persuasive guidance to the analyst, whom he urges neither to gratify nor to suppress the patient’s wishes. Instead, the analyst should pursue a middle course, enabling him to use the patient’s love as a tool to inform the therapy. 

Freud saw the transference-love the patient might experience for their analyst as a repetition of earlier, often infantile patterns of loving and relating. Freud’s approach to a ‘cure’ for neuroses through psychoanalysis was aimed at bringing the repressed into consciousness. As such, an exploration of the patient’s expression of love in therapy might cast a valuable light on some of the origins of her psychological challenges. Freud also observed that a declaration of love was largely the work of resistance, i.e. the patient’s reluctance to engage with psychological material. He believed that love limited the patient’s insight and diminished the analyst’s authority in that he was ‘demoted’ to the role of lover. He suggested that the patient’s psyche might emphasise feelings of love and desire for the analyst to illustrate the dangers of such feelings, which again would serve the patient’s resistance to the analysis and her repression, which was precisely what the analyst was trying to overcome and explore. 

Freud’s paper raised a question that is still debated today: is transference love the same as love in ‘real life’? Freud’s position is unclear. On one hand he highlights three features of transference love that seem to differentiate it from other expressions of love: it is uniquely provoked by the analysis; it is intensified by the impact of resistance; it has less regard for reality. However, he then notes that ‘these departures from the norm constitute precisely what is essential about being in love’, and thus appears to undermine any clear distinction between love within and without the analytic setting. 

Modern interpretations: Healing through authentic relationship

While transference remains a core concept in many forms of therapy, a key, emerging focus of many modalities is the relationship between the therapist and their client. The psychotherapist Petrushka Clarkson developed a model in which she outlined five different kinds of relationships that can be constructively used in psychotherapy. 

While each of these modalities envisages the therapist – client relationship in a slightly different way, research has shown that the very fact of the relationship is far more important to the success of the therapy than the particular method the therapist employs. Freud recommended that the analyst’s personality should not intrude on the treatment, and positioned the analyst as a mirror for his patient. By contrast, most modern therapies see the relationship they create as essential, not least given that the reasons for choosing therapy are most commonly rooted in relational issues. Within the therapeutic setting, the therapist and client can co-create a safe and healing relationship, within which both parties need each other and are likely to be changed by the relationship.  

The therapist’s ‘love’ in relational therapy 

Whereas Freud was primarily focused on helping the therapist navigate the challenges posed by the patient’s expression of love, modern theory encompasses a broader consideration of the role that the therapist plays in the therapeutic relationship. This consideration includes an awareness of the deep care and positive regard that the therapist may have towards the client. This care is rooted in the therapist’s desire to help the client to develop a stronger sense of self. The American psychologist Carl Rogers, a pioneer of humanistic therapy, emphasised the need for unconditional positive regard, and that the therapist should acknowledge and value the client's emotions, thoughts, and experiences. Within the safe, therapeutic relationship, the therapist can act as a "loving witness", allowing the client to explore their inner world and challenges without judgment.  

A safe, professional relationship between the client and therapist can lead to corrective emotional experiences that enable the client to develop their confidence in seeking to establish and develop positive relationships outside of therapy. While safe, the therapeutic relationship can nonetheless be challenging; the therapist may often question a client’s beliefs or emotions where they feel these are inhibiting the client’s potential for self-actualisation. In contrast to Freud’s sense of the analyst as a mirror, the modern therapist is an authentic and active participant in the therapeutic relationship. The therapist’s care for the client incorporates the need to take ownership of their own experience, and to acknowledge that the client may disagree with them not due to resistance, but simply because the therapist’s suggestions do not resonate with them. The therapist also needs to monitor their own emotional responses to the client - often referred to as countertransference. As was the case in Freud’s original understanding of transference, these responses are not obstacles to the therapy, but instead a valuable source of information that can be explored and understood in the context of the therapeutic relationship.

My experience of therapy 

As I have said, I loved Alexis, and while I no longer see her, I still do. I loved her because of the sense of safety I felt within our relationship, which was reparative at a time when I needed help to trust in my relationships with others, to understand that I could build new relationships, and that not everyone’s view of me was the same as my own. I loved her because of the security of my routine of seeing her once or twice a week for most of a 17 year period. I also loved her personality, and the ways in which she challenged me. With hindsight and to a degree even at the time, I was aware that my feelings of affection towards Alexis were potentially problematic within our therapeutic relationship. I definitely put her on something of a psychotherapist pedestal. I found it hard to admit when I did not agree with her, although she would often push me to express that disagreement, or even my anger. Since working with a new therapist, I am also aware that I perhaps unconsciously modified the kind of language I used in therapy with Alexis in an attempt to accommodate her preferences, such as her dislike of generalised labels for emotional states. 

When Alexis told me that she was retiring, I was devastated, and didn’t know how I would cope without the one person in the world who knew more about me than anyone else. Each holiday break from then on became a distressing rehearsal for our impending, definitive ending. We discussed my sense of loss at having to accept that our relationship would be coming to an end. However, despite the level of emotional honesty I felt I had achieved in therapy with Alexis, I felt the need to couch my sadness in almost apologetic terms, I suppose for fear of exposing intense emotions that she might consider misplaced. I explained that I understood that a great deal of my sense of attachment to Alexis was due to the psychological processes of displacement and projection that had been present in the therapy room. I found it hard to own my feelings, which I told her were perhaps confused due to the psychological support with which she had provided me over the years, and my over dependence on it. 

Alexis’ response to my attempted rationalisation of my feelings was to tell me it was bulls**t (she occasionally used swearwords for emphasis in our sessions, which was a highly effective strategy and also often made me laugh, since she was very much not a ‘bulls**t’ kind of person). She told me that I was allowed to be sad, and should not be ashamed of what I ought to acknowledge as genuine feelings. Her response directly challenged the theoretical idea that such feelings are merely ‘unreal’ or ‘displaced’, instead affirming their validity within the therapeutic context. Of course, as it nearly always the case with therapists, she didn’t tell me how she was feeling, though she seemed genuinely touched by the gifts and letter I gave her in our final session. Instead she did that therapist thing of using the sense of our own feelings as a way of further interrogating my own: ‘Well, you have been seeing me for a long time now. You may think that I have my own feelings about our relationship coming to an end after such a long period of time.’ Frustrating in a way, but still kind of comforting in the sense that I had had seventeen years to get used to it! 

Prior to our last session,  Alexis also told me that the end of our twice-weekly appointments didn’t necessarily mean a definitive end to any contact between us, and said I could be in touch with her if I wanted to, or needed to. Were this any other kind of relationship, professional or personal, I would have assumed that this offer was just a way of softening the impending blow of its ending, but Alexis was always punctiliously honest and upfront in our relationship, as far as I knew. I found it really moving that she would make this offer; it gave me some sense that our professional relationship had seeped into the personal sphere – though as she frequently  told me, it was a personal relationship, and it was both valuable and important to consider how it worked and how I operated within it, since in no sense did it exist in perfect isolation from the other relationships in my life.

The enduring impact of therapy 

While I no longer see Alexis and have been working with a new therapist for seven years now, the impact of my relationship with her lives on, both in therapy and in my day-to-day life. She has had a greater impact on me than anyone else in my life. My progress in and feelings about therapy have varied over time, and I have continued to struggle with anxiety and depression despite the self-awareness and sense of self-compassion (albeit periodic) that it has given me. Nonetheless, alongside giving me the space and the challenging questions to unravel some of my most significant challenges, therapy has also given me two really meaningful relationships, within which genuine emotional connection, care and mutual trust have been paramount. I believe that within the safe boundaries of the therapeutic relationship, ‘love’, or ‘kinship’ or  perhaps ‘mutual understanding’ can develop, a lived and vital force that has a significant impact on the process of healing.