Love in Psychotherapy

Updated: Mar 23, 2020

What is Love?

For centuries, we have largely regarded love as a core and essential human emotion for attachment and bonding. In ancient Greece, philosophers such as Plato, described different forms of love, each with a specific purpose:

Agape - Unconditional Love
Eros - Romantic Love
Philia - Affectionate Love
Philautia - Self Love
Storge - Familiar Love
Pragma - Enduring Love 

Novels, poems, essays, music, theatre, & cinema have told stories of enduring love as well as devastating heartbreak. Shame researcher, Brene Brown, reported that when people talk about love they often speak to their experiences of excruciating heartache. Much of our daily lives are organized around putting our best selves forward in the pursuit of social capital, or love and romance. Contemporary psychology and neuroscience describe love, like other emotions, as having an evolutionary function stemming from our developing social brains. 

The Triune Brain metaphor was developed by Paul MacLean to describe the evolutionary phases of brain development. 

Our emotions thus play a central role in our survival and biopsychosocial maturation, because they provide sense data that guide our attention and direct our behaviours. When we are within our Window of Tolerance, these three systems work in concert to help us attend to, process through, and act on our emotional sense data. Love, for example, is the emotion that is responsible for bonding and attachment in infancy, and sustains our capacity to form attachments across the life span. It is also the emotion that enables us to feel safe, soothed, and connected during times of distress. When we feel loved, safe, or contented, our brains stimulate the production of the neurotransmitter Serotonin (happiness and euphoria) and the hormone Oxytocin (love and arousal); our feel good agents.  Therefore, love is a somatic (i.e. neurobiological), psychological (i.e. attachment), social, and spiritual (i.e. philosophical/existential) phenomenon that drives us to achieve,  to desire intimacy, to strive for connection, and to practice compassion.  Love breathes life into our world. 

A Complicated Relationship: Love, Life, & Psychotherapy 

Nevertheless, love is hard to talk about openly, because it can renders us vulnerable and afraid. Cultural rules and expectations often limits how we can talk about, and or, express love.  For many people, love can be associated with betrayal, abandonment, and or trauma. People can use love to legitimize acts of violence and hatred. Similarly, people can use love as a reward when one conforms to dominant codes of conduct or behavioural standards rather than a resource that binds us together. We have all received messages, some of us more than others, that we are unlovable if we do not 'fit' the referential norms established by our societies dominant ideologies (e.g. heterosexism or ableism).

Paradoxically, we are also taught that love ought to be unconditional and endless; yet for many people love is scarce, or tenuous at best. No wonder we have a push-pull dynamic when it comes to our need for love (i.e. I need you, no I don't.). Couples' therapists call this the dance of intimacy. Calling the push-pull dynamic in interpersonal relationships the dance of intimacy assumes it's a choreography that is naturally occurring, not one born of our socialization in a western society that trains us to be insecure.

Bowlby, a British Psychiatrist and classically trained psychoanalyst, was disenchanted by how psychoanalysis conceptualized psychosexual and psychosocial development. He would go on to undertake important research that highlighted the role of emotional bonding and dependence on caregivers in early life as essential to successful physical and psychological development; a departure of from psychoanalysis' focus on individuation. Here is an attachment matrix organized around Bowlby's attachment styles

To add insult to injury, we are told when we are insecurely attached, we lack self-love therefore being unable to love others. I wish I could say that I cannot imagine how much fear that the prerequisite of self-love instills in people, but I know this feeling from my own experience. The notion of loving oneself may feel always out of reach due to the shame and stigma of surviving trauma or holding a marginal identity. People may feel condemned to a lifetime of loneliness as a result. I do not believe that the absence of self-love prohibits one from loving others, but it can diminish his/her/their capacity to believe he/she/them are worthy of love in return. One may sabotage his/her/their relationships; in so doing maintaining a cycle of loneliness. What if, however, we had the emotional intelligence to know this about ourselves and others? What if we were critical of 'accepted' truths about love and worthiness? Would we be more patient? Would we make efforts to shift social norms or reach out to others in suffering?

As a clinical social worker, I spend much of my day talking about love, directly or indirectly, with the people with whom I work. In my sessions when I name love as the problem in the room, I still get queasy and uncomfortable. I feel unsteady and nervous. What is it about love that I find so uncomfortable? I can talk about shame, fear, and sadness without much resistance at all. What I have come up with is this...I saw love as a tender and fragile emotion that is easily eroded by painful life experiences; a view that stems from my lived experience. My upbringing did not convey love is 'hardy,' 'gritty,' or 'enduring.'  I learned love is easily diminished or revoked. I became disillusioned with love. I did not trust in love, nor did I believe it was real beyond Disney. Despite my fear of love, I maintained a deep commitment to compassionately care for others. How did I manage this?

My social work education gave me a convenient excuse to treat practice as a theoretical exercise insofar as I respected the inherent worth of the people with whom I worked. I never wanted anyone to feel alone or to feel relegated to the Island of Misfit Toys. I some how convinced myself that compassion and love were not the same. Peter Smyth, a former social work course instructor, challenged my disbelief in the role of love in social work practice by asserting the concept of not having to like one’s “clients”, but having to love them in order to be effective. The kind of love that Mr. Smyth was referring to was Agape, a non-romantic and unconditional sense of affiliation and care for your clients.  

I found his proclamation of love for your clients provocative and radical in a profession aiming to legitimize itself by adopting evidence-based practice and other model-driven approaches to practice. I momentarily considered what integrating love into my work would mean in a system that reduces the therapeutic relationship to a factor in successful treatment outcomes. I also reflected on what loving clients would mean for a profession increasingly concerned about liability and risk management. In western culture, we often frame love as naive or reckless unless it reaches maturation through marriage. This idea also relates to another pivotal learning moment for me was when another of my favorite instructors, Rick Owens, pointed out that almost all human relationships are governed through legal statues (i.e. tenet-landlord, consumer-industry, civilian-state, and so on). The notion of love in a risk adverse world frightened me.

Finding Love When You Least Expect It

It wasn't until soon after my master's whilst practicing in California at youth service organization that I came face-to-face with loving your client in a way that I hadn't before. I was working with a teen mother who had been staying at our emergency shelter.  I was her Youth Counsellor/Case-Manager. I was struck by her tenacity, intelligence, and emotional depth. She was so strong. She wasn't a stranger to our shelter, because her mother would often fail the mandatory drug testing to maintain social housing. Each time they lost their housing, she and her brother would come stay at our shelter. 

What struck me about her, and many of the other youth that lived there was their openness, compassion, and understanding. As a queer male, I often fear sharing my sexual identity with clients. I try, often unsuccessfully, to conceal my sexual identity. In the fall of 2010, there was a state-wide gay-straight alliance conference happening in San Fransisco. I decided to take a risk and asked my supervisor if I could use the company SUV and take a group of youth to SF to attend the conference. I wanted to convey to the youth at the shelter that sexual and gender diversity is not only okay, but something to celebrated. Further, I wondered how many of the youth at our shelter had ever been to SF? 

To my surprise, many of the youth wanted to go. Some of them came-out to me whilst others identified as questioning, or 'simply' allies. I also had permission from my supervisor, and the youth attending, to bring my then partner as an additional chaperone. I was moved by how much the youth with whom I worked lit-up when they arrived at the conference. Some of the youth who were questioning, came-out, or at least, had a clearer sense of where they needed to explore themselves further. In that moment, I felt an overwhelming sense of love and connectedness with the youth who attended, my client included. 

The true test of love did not come until much later in my tenure at the shelter when my client made several disclosures that required that I make a mandatory to Children's Protective Services. It was one of the hardest things I had to do because she pleated to me not to call CPS. I had no choice. She did not talk to me for weeks. I did not realize how emotionally impacted I was until she started talking to me again.

I felt a profound sense of relief even though things were not the same. Retrospectively, I rationalized away my feelings by hanging on to my ethical commitments. Knowing what I know now, being confident you did the right thing is insufficient, you also have to make room for the grief you feel when you think you've lost a relationship. The ending phase of the social work process with a client is just as much for the practitioner as it is for the client. Grief is a natural outcome of the loss of a relationship wherein you both invest so much of yourselves.

Brene Brown says compassion and empathy demands of us to connect to something within ourselves that knows a similar kind of pain to the person before us. Thus, psychotherapy, and indeed social work, is not an arms length relationship where we stand at the opening of the an existential or emotional chasm offering words of affirmation, but a willingness to go into the chasm to hold space from another's suffering.

I thought the worst of my love hangover was behind me until my client told me they had to go into foster care, and that she wanted me to be her foster parent. She feared foster care as a racialized teen mother. She also worried about being separated from her child.  I knew that foster care is a fraught system that has caused unspeakable harm to racialized youth. I also had my own experience of abuse at the hands of those tasked with protecting you. Somewhere deep inside me, I felt an intense pull to say yes. 

...Notwithstanding that I still felt like a youth myself in the throes of trying to get adulting right. I knew I loved this person, because the heartache that I felt in the wake of a profound sense of powerlessness to rescue her from going into care. I wish I could have shared my inner dialogue, but what she needed more now than ever was an 'adult' who conveyed confidence and wisdom. What I said was

I can't be your foster parent, because it would be a dual role, a boundary violation. I know more about you, then you do me. You get the perfectly put together version of me who is required to care for you by attending solely on your needs without bias or prejudice.  Your desire to live with me is based on an incomplete picture. You may not like the person I am outside of work, the messy version of me. That puts you at risk because you stand lose another caring figure in your life. I can't let that happen.

I was devastated. Looking back on this, if I had acknowledged sooner that I loved my client then maybe I would have been more emotionally prepared to deal with the profound sense of failure I felt. Moreover, I would not have minimized her experience of our relationship or challenged the truth of her feelings. Whilst some of her feelings might be the displacement of unmet emotional needs onto the professional relationship, our relationship was still authentic and sincere. 

Ms. Lynn Burns, my future clinical supervisor and mentor, would tell me it's my heart, not my mind, that makes me a good clinician. She went on to say that people are less likely to remember the interventions I used, but they will surely remember how they felt in your presence. I eventually learned that love is an essential component of social work practice. Love is the thing we all want most in life. Psychotherapy, and indeed general social work practice, plays an important role in helping people feel unconditional positive regard (a.k.a love) which enables them to feel validated, seen, and worthwhile.

Love helps mend and heal attachment ruptures, which provides the scaffolding for people to seek meaningful and sustainable relationships outside of therapy. Thus, bringing love into the therapy room isn't an impediment to nurturing client autonomy based on the misguided notion that love fosters relational dependence, rather it offers the secure base for people to risks in the wider world. We saw in Bowlby's work that securely attached infants were less afraid and more equipped to explore their environments.

Interesting Reads

Here are some interesting articles on psychotherapy and love from Psychology Today.

Happy reading!

Love & Psychotherapy

When a Therapist Falls in Love

The Gift of Being Loved by your Therapist

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