Altruistic Love in Psychoanalysis: Opportunities and Resistances
Michael J. Bader, D.M.H.
Dr. Bader is in private practice in San Francisco . He can be reached at (415) 752-0351.
All patients wish to help their therapists in some way. This desire may be described as altruistic to the extent that it has, as its primary irreducible aim, a concern for the improvement of the welfare of the other. While for some patients, this wish operates silently and in the background of the therapy, for others it is prominent. Psychoanalysis has traditionally viewed these wishes as derivative of some other aim or purpose or as defensive. In my view, this bias tends to lead the therapist to fail to recognize and pass certain crucial tests. In contrast, an appreciation of the healthy developmental role of altruism enables the therapist to normalize the patient's wish to help and facilitate the patient's ability to integrate these warded off feelings. As a result, the patient is helped to consolidate a new confidence in his or her ability to love and be loved.
Clinically, the patient's altruistic wishes and gestures take a variety of forms. The patient implicitly or explicitly critiques our dress, appearance, health , approval, style, character, or theory. The patient tries to cheer us up, or help us feel smart, or otherwise contribute to making us healthier or happier. In my view, these interactions often constitute rejection tests. By inviting the therapist to decline or rebuff the help, the patient is seeking reassurance that his/her altruistic love is good, valuable, and worthy. Therapists most commonly fail these tests through interpreting the patient's wish to give to the therapist as a reparation, reaction formation, an attempt to "buy" love or safety, pre-oedipal efforts at control, or an expression of oedipal love. The patient often feels rejected when the therapist implies hat the patient's altruism is "really" something else. The patient then often complies with this perceived rebuff, blames him or herself, and experiences the altruistic gesture as bad and unworthy. Thus, therapists may unwittingly traumatize their patients in much the same way that the parents did by their unwillingness or inability to register and appreciate the child's positive influence.
Control-Mastery therapists can also tend to overlook the progressive dimension of the patient's altruism by misunderstanding the patient's testing strategy in a very particular way. Patients often attempt to help or restore us in response to real and transference perceptions of our weakness and fragility. Particularly when this kind of object relationship was prominent in their families, patients often test the therapist to see if the latter needs the patient's help in the same way that a parent did. In these cases, the therapist passes the test by providing evidence that the therapist is self-sufficient and can take care of him or herself. However, if the patient's altruistic gesture is really a rejection test, i.e., if it really represents the leading edge of a warded-off but healthy aim, then the therapist's self-sufficiency fails the test and the patient feels rebuffed and confirmed in the pathogenic belief that her/his altruistic love is worthless.
In these cases, the therapist needs to provide a tangible corrective emotional experience to the patient which counteracts the latter's pathogenic beliefs about his/her altruism. For instance, a patient of mine-a talented artist-who had been severely rejected by her father and made to be a silent audience to her narcissistic mother began hinting that she was uncomfortable about some thoughts she was having about my appearance, particularly my manner of dress. I first helped her articulate and disconfirm her feeling that she wasn't supposed to have opinions about me and that I would resent or ignore them. I told her she incorrectly assumed that I wouldn't welcome or enjoy her clearly accomplished aesthetic "eye" and pointed to the origins of this pathogenic belief in her familial dynamics. She then offered me a detailed critique of my color schemes, choice of ties, and the generally conventional bent of my fashion. I recognized the validity of these comments which echoed my own growing dissatisfaction with various conservative identifications and inhibitions that shaped aspects of my personal style. I took her advice and made no bones about my pleasure in the results. She felt not only extremely gratified by my willingness to take her advice, but began to assert herself more confidently in groups, something that she had been afraid to do because of a pathogenic belief that she wouldn't be welcomed.
Altruism is a normal and healthy aspect of object love. In his 1985 essay, "A Reconceptualization of the Concept of Guilt," Michael Friedman reviewed the literature on the normative appearance and meanings of pro-social behavior in children. Current developmental research supports the existence of an independent altruistic motive system that is not explicable as a compromise formation. In their recent book The Adaptive Design of the Human Psyche, Slavin and Kriegman (1992) persuasively argue for the adaptive value of altruism in human evolution and the likelihood that altruistic motivations are "hard-wired" in our brains and psyches.
Various factors contribute to the tendency of therapists to misunderstand the role of altruism in the clinical process. First we have a theoretical bias that reduces "nobler" motivations to their darker roots. Second, therapists have a principled commitment to subordinate their own activity and gratification's to the patient's welfare. This ethical commitment cuts across different psychoanalytic orientations. To the extent that this commitment is overly rigid and abstract, the case-specific altruistic needs of the kinds of patients I am describing are misunderstood. In these instances, then, the therapist paradoxically rebuffs a patient's altruistic interests under the banner of placing the patient's interests first.
Finally, I believe that therapists tend to have particular personality traits that make them uncomfortable about taking too much help from a patient. Therapists often use their "helper" role to deal with their own unconscious guilt, maintain a covert form of control, regulate boundaries, etc., and a patient's altruistic gestures can evoke various kinds of anxiety. Sometimes, the therapist deals with these anxieties by subtly interpreting the patients "underlying" motives or otherwise "turning it around" to focus on the patient's aims, tests, plans or worries. This re-establishes the therapist's role, but unfortunately can be perceived as a subtle rejection by the patient.
Friedman, M. (1985). Toward a reconceptualization of guilt. Contemporary Psychoanalysis. 21(4): 501-547.
Slavin, M. & Kriegman, D. (1992). The Adaptive Design of the Human Psyche. New York: Guilford Press..
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