Book Review Essay: “Growing Through the Erotic Transference: An Analysand’s Journey” by Frances H. Moore

Growing Through the Erotic Transference: An Analysand’s Journey is a brave and detailed account from the analysand’s perspective of parts of an analysis of a cis-gender heterosexual divorced woman in her 40s by her male analyst, with a special focus on the erotic transference within the treatment. The short but engaging book is divided into two parts. In part 1, Moore (a pseudonym) describes in chronological order some of the developments of erotic material within her treatment, some of which she shared with her analyst at the time as it was unfolding and some of which she did not, despite being aware she was holding back. She begins by describing the way she came to her analyst – through couples’ therapy. Her husband, the only man she had been with since she was 17 was having an affair and after some handful of sessions left her in the analyst’s office to continue the work alone as he exited the marriage to be with a younger woman, claiming that Moore was too masculine (castrating). She begins to feel the transference taking hold after a handful of individual sessions and notes that the analyst and the analytic situation was deeply evocative of Oedipal conflicts with their associated erotic and competitive feelings. “I became aware of my own discomfort at how powerful he seemed. He was an expert in a field of which I knew nothing. I had only the vaguest idea of what therapy involved and was completely unaware of psychoanalysis…..” (Moore, 2023 p. 11). The idea that knowing more about our field could be a way to address the discomfort associated with the asymmetry of the relationship was present early on. She began reading psychoanalytic literature, particularly articles and books about erotic transference and countertransference as she continued to withhold her erotic feelings in the treatment.  

She continues in part 1 to describe several experiences of the erotic transference that she did not share with her analyst as they arose including: Dreams, sensations, fantasies, associations, and her account of an enactment. This part of the book is delightful to read and leaves the reader wanting to know more. Because she selected particular moments of the treatment to illustrate in the book and her analyst’s thoughts are not featured, the reader has the feeling of being simultaneously let in and also kept out of the unfolding experience of the dyad in its fullness – a sort of tantalizing or teasing of sorts. We wonder what she did not share in the book but was aware of and what remained unconscious to her, perhaps available in the treatment in some form through unconscious communication to the analyst (Bass, 2019). She makes the excellent point in the introduction that there are thoughts and feelings that analysands are aware of and do not share in analysis and that in the case of the erotic transference for women analysands with male analysts, there may be real reasons for our discomfort in sharing freely that should be respected and skillfully handled, even at times supported, and definitely considered valuable resilient strategies, rather than simply understood as resistance to be overcome. She notes that, “…around 5 – 12% of heterosexual male therapists have acted out sexually with their female patients” (Celenza, 2007, as cited by Moore, 2023). The statistics about domestic violence, sexual abuse, and rape in the broader society in the US for women at the hands of men are even more grim with 90% of all victims of such attacks being women and 1 in 6 women experiencing an attempted or completed sexual assault in her lifetime (RAINN, 2022). This part of her agenda, helping male analysts in particular, to be more sensitive to the reality and impact of the fears female analysands may face while making themselves vulnerable to explore erotic and power dynamics with a male analyst is interesting and important. Her emphasis, however, on what is withheld in treatment from among what is consciously available suggests she may not be so appreciative of the process of unconscious communication (Bass, 2019) that is central to psychoanalytic listening and of our capacities as analysts to skillfully (hopefully) receive and tend to these even when analysands are withholding.

The stated goal of the text is to provide a case study from a female analysand’s perspective of an analysis with a male analyst with a specific focus on the erotic transference. This is undertaken, she notes, in order to center the voices of women analysands and to specifically address both fear-based erotic feelings as well as desire-based erotic feelings which she believes are not always both considered fully in the psychoanalytic literature and in practice and she aims to add her voice to our literature to fill this gap. She is an anthropologist and her desire to center her voice as analysand is consistent with the current trend in her field to move away from anthropologists writing reports detailing observations of the “exotic objectified other” and toward participant-observer methodologies that center the voices of those who are studied and that account for the impact the observer has on the observed. This is somewhat problematic as applied to our field, as the uniqueness of psychoanalysis requires that we look beyond what is available consciously to the analysand and this process simply requires the contribution of a psychoanalyst. There is a growing appreciation among psychoanalysts that there is no psychoanalyst without a psychoanalytic community of colleagues, so this same process applies to our need to seek consultation to make available more of what is unconscious to us as well!

Additional goals she alludes to within the text include her wanting to work through what she calls “powerful and bewildering emotions” (Moore, 2023, p. 81) and experiences of being so vulnerable with a male analyst. The text can be understood as her means to gain power in what was at times a frightening (erotically charged) and at times a playful (erotically charged) analytic relationship. She does this by withholding her thoughts and associations in real time, reading the psychoanalytic literature, and then she publicly produces a book, leveraging her considerable academic and intellectual gifts, designed to teach (male) analysts, including her analyst, about how to handle the erotic transference of women analysands. She notes in the beginning of the text that she will not conduct a literature review and points out that she is not an analyst and therefore likely lacks some insight into the meaning of what she writes, making herself humble so as to avoid a retaliatory attack, but then she produces something that reads very much like a literature review or a critique an analyst, may have written. She begins “The erotic transference was originally viewed as a form of resistance” (Freud 1915 as cited by Moore, p. 2).  “Texts of the last 35 years have presented a more enriching view of the erotic and its role in the consulting room. The most seminal include: Gorken (1985), Davies (1994), Wrye and Wells (1994), Mann (1997 and 1999), Maroda (1999), Orbach (2000), Schaverian (2006), Celenza (2014 7 2023) and Atlas (2016). The dyad’s willingness to explore the erotic within the proper frame can help a patient understand themselves and even transform” (Moore, 2023, p. 2). She goes on in part 1 to describe many of the ways that she and her analyst navigated skillfully and willingly the erotic dimensions of the treatment and by my estimation it seems like it has been a helpful transformative treatment (or at least her book suggests this is the case). Yet she puts this book outside of the analytic frame (Although she did share each chapter with her analyst right before breaks as part of the analysis and he interpreted the meaning of this gesture as a playful, teasing, flirty act leaving of something of her in his mind, tantalizing him, taking control of the breaks by making sure he yearns for more.). This text reads then in some ways as a demonstration of her (sexual) power through thinking, an attempt to top all of us analysts by ignoring the need for an analyst to co-create meanings with her, and as a way to insert some (defensive/resilient) control over the moment-to-moment real-time vulnerable engagement with the erotic that can be, and seems to have been for her, so dizzyingly intense at times. It can also be seen as a way to present her analyst a final and enduring gift of gratitude as her portrayal of him in the text can only be described as skillful, attuned, and loving and her portrayal of the treatment as transformative and life-affirming.

At the same time, she makes use of the analysis and the text to work through her erotic material including dimensions of the treatment related to femininity and power. In parallel she raises real concerns about the historical and systemic unequal power of women in these dynamics with male analysts. She suggests that perhaps new theories or additional voices may be warranted to further and deepen our ways of working with the erotic and with power dynamics. I couldn’t agree more and yet I believe that perhaps female analysts (who have also been analysands, many of whom are cis-gendered, heterosexual women who have been analyzed by male training analysts and worked through issues of power and erotic transference) might be better positioned to theorize these dynamics or take up a self-analysis as our training would provide us a more nuanced view (one hopes) of the unconscious communications or technical points that Moore may not readily have access to. There are stellar women analysts who have theorized relevant ideas. Davies & Frawley (1992), Gherovici (2017) and Elise (2019) come to mind as some who have considered women’s sexuality and sexual abuse as part of the dynamics of working with erotic material in male analyst/female analysand dyads as well as other pairings. Perhaps even more voices, including not only those of female analysts or analysands but also male and trans* or queer analysts (and analysands) who may have contemporary views of the erotic against the backdrop of the #metoo movement (Mann, 2021) as well as LGBTQAI analysands, and analysts and their relationships to erotic dynamics in differently configured but equally erotically charged with significant power differences are also warranted. 

She provides not only her own account of parts of her treatment in part 1 but also several short chapters in part 2 that address aspects of erotic transference that she believes are under theorized in our seminal papers on the topic. These areas or chapters within part 2 are titled: Women’s power: Suffering, gratitude and turn-on; Erotic transference: Fear and desire; resistance or transformation?; Working with sexual abuse survivors; Transference love or ‘real love’?; and Revoicing the patient.  

In the first chapter in part 2, Moore discusses how women (and men) are socialized and notes that we have been taught to prop up men’s egos by diminishing our power in order to seem sexually compelling and this likely is at play in analytic relationships and may be unconsciously supported rather than analyzed by male analysts. It is important for male analysts to be aware of this dynamic and to facilitate and support, as her analyst did, women’s power even if powerful women might compete with and threaten men, including the analyst, and even if these dynamics are related to men’s castration fears and women’s fears of not being feminine if we are powerful. She asserts that the fear of asserting our power and being unfeminine is actually more significant than any fear of lacking power (a penis) in the first place, “…women are punished for having an inner power not for envying a power they lack” (Moore, 2023 p. 64). This suggests a beginning understanding of Lacan’s views of lack and feminist critiques of colonial perspectives embedded in psychoanalysis (Campbell, 2000). Within this chapter she then uses cases of boundary violations to describe how our studies of those who transgress have demonstrated that these male analysts get turned on when their female patients cry or act helpless, citing these as the reasons for their transgressions (Gabbard, 1996). She goes on to cite Field (Field, 2007 as cited by Moore) noting that seeing a woman in need gratifies men as it signifies capitulation and triumph. This is problematic, however, in that using cases of transgressions to illustrate this dynamic leaves out the vast majority of cases with analysts who are not engaging in violations and who may be more turned on by very different (healthy) dynamics and who have sufficient professional and ethical capacities to not act out the wide range of feelings and impulses that occur in the analytic situation including erotic feelings. She ends the chapter with a call to analysts to break the taboo of talking about desire for our clients (and I would argue also to break the taboo about talking about lacking desire or having disgust in response to our clients’ erotic material too). What she doesn’t seem to appreciate is that we do tend more and more to speak of these issues but generally these topics are dealt with most frequently in case conferences and consultation sessions and groups. Fewer of us publish raw accounts of our desires or lack thereof for the public (including her) to read for good reason. There are a wide range of countertransference sensations, feelings and thoughts we have with each of our patients, some of which we have to work hard to sort out before using them ethically and usefully in the treatment with the patient and much of this is done in consultation or case conference so as to protect the analysand and have a protected space to speak more freely with colleagues who are bound by the ethics of the profession to protect confidentiality and to hold the best interests of the patient in mind. There are a great number of accounts of brave analysts discussing and analyzing their desires and she has cited some of these (Searles, 1959; Davies, 1994) but she seems to want more, perhaps to know if her analyst desires her and also if he is safe with his desires.  

She continues in the second chapter of part 2 with a discussion of the distinction between fear based erotic transference and desire based erotic transference suggesting that both types of erotic transferences can be seen as a gateway to growth rather than as resistance and that we should aim to decouple the pleasantness or unpleasantness of the feelings in the transference/countertransference from any valuing of the experience as resistance and instead aim to explore the material regardless as a vehicle for growth, an argument that Mann (1997 & 1999) has cogently made. She notes that if erotic transference is understood as a resistance it is seen as something to be overcome. “It is hard to escape the erotic implications of male analysts persistently trying to penetrate their female analysands by ‘overcoming their resistance’” (Moore, 2023, p. 69). I agree with this stance in that all material can be useful to explore and the dynamic function of any particular response is best understood in the context of the analytic situation. Interestingly, she ends the chapter by using the first person plural, “…which side of the coin do we prefer to ‘see’ in the analytic setting?; and are we fully trained to cope with both?” (Moore, 2023, p. 70). By this point in the text she has included herself in the group of trained analysts interestingly, and perhaps this is a castrating defensive maneuver, or a sadistic grab for power, or a way to remain close to her analyst after termination or it could be supported and explored. Perhaps she would like to join us and begin analytic training? Freud was the first to note that people’s wishes and fears were apparent in slips and dreams and so on. Perhaps this particular use of we indicates just such a wish that if we strip away any gendered stereotypes about power and creativity and sexuality allows us to see that she may very well be the next gifted analyst in waiting. 

In the 3rd chapter in part 2, Moore takes up the issue of working with sexual abuse survivors and in particular, emphasizes aspects of the treatment and power dynamics that may be unique in these cases. One such moment for her is the moment one moves from sitting face to face to the couch. She discusses mutual seduction and what this means for abuse survivors. In her case this moment in her treatment followed her bringing a sexual dream to session. As she told the dream she could not look her analyst in the eye. He notices this and responds in that moment to suggest the use of the couch. The dimming of the lights, the seductive voice he uses at that moment and his penetrating gaze is both compelling and frightening to her. When she decides to try the couch, an intensity of feelings and deepening of the transference occurs. In her case, she felt seduced, trapped, forced. This is an important moment, Moore notes, for male analysts to understand. How many women have actually been seduced, trapped and forced into unwanted sexual situations? And how many of us have not felt fully free to say yes or no in some of these moments? The moment of laying on the couch for the first time as a cis-gendered heterosexual woman with the gaze of a powerful male analyst behind us, is indeed evocative and vulnerable in ways that it may not be for other gendered or sexually-oriented people or configurations. The roles of anxiety, compliance or trauma responses in that position cannot be overlooked. It seems that the analyst couple handled this moment skillfully, as Moore has nothing but praise and gratitude for her analyst’s skills in navigating these issues, but I could imagine situations where sexual abuse is not recalled consciously, or unexpected trauma reactions occur at the moment of discussion of the couch or its initial use if consent to proceed isn’t held skillfully. Moore’s point is that she withheld all of these reactions and he couldn’t see her to gauge how she was feeling so she felt frightened and alone in this part of the process. Not all patients know that they can sit up if needed or that there can be a dialogue about the use of the couch or that they might wish to use it sometimes and other times not. They also may not know that we train to receive unconscious communications (Bass, 2019) and do not require looking into their faces to orient ourselves – in fact often this is distracting from catching the drift (Ogden, 1997). The point that Moore makes about the use of the couch and technical sensitivity being needed is important but what Moore may not understand is how analysts have honed our use of countertransference and technical skills to guide us in these moments and perhaps it is precisely this that she could not discern that helped her analyst to know just when and how to invite her onto the couch skillfully even if it is frightening and perhaps in order to bravely confront this fear in service of the development of a new sense of her power.  

She spends the next chapter asking the classic question Freud (1915) originally posed, “is transference love real love?”  She notes she imagined him fucking her, assaulting her, making love to her but not necessarily being her lover in a more full and complete sense. She goes on to discuss her feelings of love for him but also how the lack of reciprocity (not knowing him and not having to take care of him) limited her feelings of love in some important ways. She understands how powerful psychoanalytic treatment is and begins to appreciate the skills that are needed as an analyst to manage the intensity of loving feelings (and I would add a range of passionate feelings that we experience in the countertransference) skillfully and ethically. Moore comes to her own conclusion that that analytic love is real love, but that it is a form of love that is not the same as a real reciprocal love relationship, which she eventually comes to have in her outside life in the form of a conventional and satisfying romantic partnership with a man.  

The final chapter focuses on her decision to write and her conviction that the patient’s voice and women patients’ voices in particular are important. This stems from her anthropology background as discussed above and her belief that men may not be as sensitive to women’s relationship to power and sexuality as discussed above. She acknowledges that there are needs for confidentiality on the part of our patients and that while there are patient accounts of an analysis that are published and interesting (Mohavedi & Wagner, 2005; Mahalal, 2020; Anastasopoulos, 2017) more often than not analysands are hesitant to publish such intimate details of their lives. What Moore may not appreciate fully is that psychoanalysis is not the same as self-analysis and self-analysis is usually done by someone who has been analyzed previously for the reason that it takes skills to learn to think analytically and to render the unconscious material more available. Reading a patient account such as hers, which is filtered through her writing and editing process and thus is not raw like process notes and does not include the analysts’ countertransference reactions may not fully capture for the analyst reader the drift of the material (Ogden, 1997) to help orient us to what is communicated unconsciously and this is the essence of psychoanalysis. It is, however, likely very useful in stimulating analysts to think more about our impact on our patients and the phenomenological experience of important aspects of treatment. It also may help lay persons to gain insight into psychoanalysis, a type of treatment that is often mysterious to those unacquainted with its format and power.

In the end, Moore’s text is a moving exploration of some selected erotic dimensions of what appears to have been a very transformative treatment with a skillful analyst. Her points about women having real fears rooted in socialization and experiences of sexual violence that should not be dismissed as merely resistance, are warranted. Her refreshing idea that there might be room for powerful women who are more classically feminine is also important and her call for (male) analysts to consider exploring the erotic fears and desires as well as fears and desires for power rather than trying to get off on their own power as a function of the asymmetry is reasonable. I would add that this text suggests a call for women analysts to perhaps write more on these topics and for any analytic pair, regardless of the gender or sexual orientation of the analysand or the analyst to be subject to consideration about how the erotic material and power dynamics are being held. It is high time that we expand original binary notions of male/female, masculinity/femininity and gay/straight (even as these may be very useful in particular treatments) and come to see the issues of power, competition and erotic feelings infusing all relationships in some fashion and analyze these fully with fluidity and bravery as gateways to transformation.