Psychological Function, Relational Needs, and Transferential Resolution: Psychotherapy of an Obsession

Psychological Function, Relational Needs, and Transferential Resolution: Psychotherapy of an Obsession

Abstract

Hargaden's case study, "There Ain't No Cure for Love: The Psychotherapy of an Erotic Transference," provided the clinical material on which to base this discussion of erotic transference as an obsession. Obsessions, repetitive fantasies, rigid behavioral patterns, and habitualized feelings are all maintained because they provide significant psychological functions. Through a relational therapy and phenomenological inquiry the therapist facilitates the client in gaining an awareness of relational needs, appreciating the intrapsychic functions of an obsession, transferring those functions to the therapeutic relationship, and engaging significant others in interpersonal contact. Four examples of psychological function are provided: predictability, identity, continuity, and stability. Various forms of transference are described in terms of relational needs, and the way in which the therapeutic relationship can be useful in the treatment of an obsession is discussed.

Helena Hargaden's paper, "There Ain't No Cure For Love: The Psychotherapy of an Erotic Transference," is an example of a masterful psychotherapist's facilitation of an effective in-depth psychotherapy. In her article, Hargaden not only describes a client's emotional fixations, vivid fantasies, and ensuing transference, but she is also refreshingly forthcoming about her own countertransference. She, too, idealized the client's love object, found the client's stories erotically fascinating, and learned to make therapeutic use of both maternal and paternal countertransferential responses.

Although the contemporary psychoanalytic literature includes a number of case studies, written illustrations of clinical material usually rely on composite profiles that present a caricature of the personality or problem described. As a result, we are left to guess about what our colleagues actually do with their clients. Both gestalt therapy and integrative psychotherapy writings provide some examples of verbatim transcripts, but in the psychotherapy literature as a whole, thorough case studies or unedited transcripts of actual therapy sessions are seldom published. The transactional analysis literature also does not adequately reflect the therapeutic struggles, clinical methods, and resolution of therapeutic failures that are part of the daily work of clinical transactional analysts.

Therefore, Hargaden advances our understanding of the clinical process of transference, countertransference, and therapeutic resolution by exposing her work for critical review. This professional dialogue provides us with an opportunity to exchange theoretical concepts, engage in a meaningful discourse about therapeutic process, and arrive at new understandings of clinical involvement.

It is easy to criticize a therapist's approach when a psychotherapy is restricted by the therapist's narrow theoretical vision, or it leads to a reinforcement of the client's script beliefs, or it is handicapped by the therapist's failure to recognize and resolve therapeutic errors. However, it is difficult to criticize a psychotherapy that honors the client's natural vulnerabilities,

respectfully facilitates the client in dissolving defenses, and results in the client's transformation and integration of fragmented aspects of the self.

Of course, it is always possible to criticize any approach or method used by a therapist if the colleague or supervisor merely addresses the clinical work from a different theoretical orientation or personal perspective than that used by the therapist. In this article I will share my current professional perspectives in the hope that they will facilitate a lively discussion and expand our collective knowledge of psychotherapy theory and methods. I will emphasize the elaboration of specific psychotherapy concepts as I might in supervision with an experienced psychotherapist: "The aim of supervision with an advanced psychotherapist is the development within the therapist of the ability to integrate multiple theoretical frames of reference and select various treatment plans based on observations and hypotheses about a particular client."

In actual supervision, an exploration of the psychotherapist's perspective, discussion of concepts, and further teaching are interwoven in the dialogue. In addition, a responsible collegial critique explores the therapist's reasoning, validates and/or challenges the therapist's assumptions, and provides alternative perspectives that enhance professional dialogue and the direction of future clinical work.

Psychological Functions

It seems to me that Hargaden's case study is about the successful treatment of an obsession. There certainly is much material in this case study to facilitate discussion of erotic transference, narcissism, aspects of countertransference, and therapeutic methods. Each of these topics could lead to a fascinating and useful discussion. However, I will focus on the psychological functions and relational needs that underlie and are expressed in repetitive fantasizing and the use of the therapeutic relationship in curing obsession.

In this case, the client, Noel, was obsessed with Anna, a woman with whom he was peripherally involved. We can assume from Noel's consistent fantasizing that Anna served several psychological functions in his life. He described his Anna as a receptive spirit, as tender-hearted, bright, and wise. In fact, it was she who suggested the therapy.

Noel's Anna was, for him, a psychic entity—an internal image of another, a self-object that provided intelligence, creativity, and profound therapeutic understanding. Hargaden alluded to the psychological functions provided by the illusion of Anna when she described how Noel would bring Anna into the conversation if he ever felt threatened.

Noel's love and longing for Anna may have reflected a longing for a secure attachment. His attachment to his mother may have been disrupted by both "her betrayal" for using father's "violence as a way of keeping control of the children" and the implied depression in mother following the stillbirth of his sister just prior to his conception. Noel's longing for Anna and his recurring fantasies about her provided for him the functions of stability, continuity, identity, and predictability. In healthy development, these psychological functions are provided within the relationship when there is a secure attachment.

Obsessions, recurring fantasies, rigid behavioral patterns, and habitualized feelings are all maintained by an individual because they provide significant psychological functions. In an effective psychotherapy, the functions of the repetitive behavior, feeling, or fantasy must first be identified and appreciated by the client prior to any lasting growth or even change. For change to be lasting, it is essential that the psychological functions imbedded in the obsession, fantasy, or habitualized feeling be transferred into an actual relationship. In the life of a young child, these psychological functions were originally relational in nature.

As a result of relationship failure and the disruption of interpersonal contact, the functions became internalized, defensive, and attached to something intrapsychic, such as obsessive thoughts or feelings, the urge for compulsive behavior, or repetitive fantasy.

Predictability: As an elaboration of a biological imperative, humans have an internal urge to seek structure and predictability. When the urge for relationship is not satisfied, the failure of the relationship is often compensated for by the individual's increased attempts to structure experience, that is, to make meaning and predictability. Hence, repetition, compulsion, obsession, script beliefs, habitualized feelings or behavior patterns, and transference can all be seen as repetitive attempts to structuralize relationship failures.

As described in Hargaden's case study, Noel's obsessive fantasizing about Anna provided the psychological function of predictability. With Anna he could long for the secure attachment of a loving relationship with a receptive spirit who was tender hearted, bright, wise, and understanding. Simultaneously, he retained an anticipation of no relationship or perhaps even rejection-a repeat with Anna of the disturbed attachment with mother through fantasizing about Anna. Noel spoke about Anna in therapy, but it seems from the case presentation that he did not speak to her directly. He did not court her or profess his love to her, although he reported in therapy that it was his desire to do so. By not talking with Anna and sharing his feelings with her, he passively created a nonrelationship or, perhaps, in the fantasy, even rejection. But he was, through the fantasy, active and in charge of the prediction of rejection or of the nonrelationship.

Identity: Noel expressed his unique identity in his fantasies about Anna. This identity was of someone who longed for a tender-hearted partner and yet unconsciously knew that he would be scorned-hence the conflict between longing for Anna's love and not communicating with her. "This is who I am!" is a felt sense that may be more affective and physiological than cognitive, one that often lacks words since the origin of this identity may be lost to awareness. Each fantasy of Anna was a further expression of Noel's unconscious identity-his life script. This archaic identity is maintained through fantasy rather than the ever-changing identity that occurs in active, spontaneous, authentic relationships. By maintaining a fantasy of Anna, Noel did not risk a new way of being in the world-the continually emerging "who I am" and the ongoing discovering of the other.

Continuity: By fantasizing about Anna, Noel maintained a psychological continuity with the past. If he had actually courted Anna and professed his love, most likely something dramatic would have happened. She might have responded in a loving way, thereby creating a juxtaposition between his current experience and his emotional memories of longing for an unrequited love. He would probably be filled with fantasies about the love he did not receive as a child. He would hurt again. Conversely, if Noel had developed a real relationship with Anna, she might not have wanted a loving involvement with him, and that might also have stimulated the emotional memories of the inherent rejection in mother's use of father's violence and or her depression.

Stability: Obsessively fantasizing about what might occur is an attempt to remain psychologically stable and grounded. It is a false sense of living life today, a contact disruption from both the full remembering of the earlier emotional experiences and the pull to a therapeutic, healing regression. The unresolved early emotional experiences are unconsciously expressed in the fantasy. The hurt, rejection, neglect, or abuse may, through fantasy, be projected onto current or future relationships, thereby avoiding a full regression-a kind of being half in and half out.

Regression within a sensitive, caring therapeutic relationship is healing and growth producing. It is an opportunity for a reparative experience. Yet people fear the overwhelming flood of emotions often present in regression and therefore use obsessing and other psychological defenses as a desperate attempt to stabilize themselves. However, even in the presence of such defensive, stabilizing maneuvers there is always a pull to healing. Hence, transference and obsessing are expressions of both the repetitive and needed relationship and a defense against a full, vulnerable regression.

It is essential in an in-depth treatment of obsession to assess the origins and intrapsychic functions of the repetitive fantasizing and to validate how those multiple functions help the client to maintain psychological homeostasis. The psychological functions described in this article-predictability, identity, continuity, and stability-are only four of a number of such functions. Many clients who are locked into a life script and use repetitive fantasizing as a means of maintaining homeostasis may use other psychological functions as well. Compensation, reparation, efficacy, integrity, and triumph are examples of other psychological functions used to maintain obsessions. The psychotherapy of obsessions is complex because of the compounded and continually reinforcing multiple intrapsychic functions. A respectful and patient inquiry into the client's phenomenological experience is required to learn the unique combination of intrapsychic functions.