4.3 Forming Relationship
4.3.1 Affect Needs Relationship
Therapists said they experience affect regulation as a dyadic, shared and co-created process that, particularly for women, is embedded in relationship, whether in therapy with the
* Therapists’ gender will be unstipulated unless relevant and then identified using gender specific pronouns i.e., he/she, him/her.
So it is actually all about the relationship – it always comes back to that. (P3/34)
While affect needs to be communicated, understood and expressed in the context of relationship, analysis also revealed therapists as seeing the initial contact in therapy to paradoxically represent a source of over-activation, anxiety, arousal and dissociation. While this relational contact was indeed mentioned as stimulating and heightening levels of affective and erotic arousal, it was also mentioned as key to establishing and sustaining crucial and mutually coordinated processes involved in the therapeutic alliance. The co-ordination of this affective encounter was described for one participant as the ‘guts of it ’.
The shared emotional soup, that two people get into from the start in the therapeutic relationship; I believe that my emotions and my clients’ emotions constituted about 80% of the therapeutic relationship whether it was good, excellent, fabulous, and bad or a nightmare. I think our shared affect and difficulty regulating affect from the beginning determined how the relationship went. (P1/98)
While therapists mentioned their female sex addicts’ affect as being persistently dysregulated, they also understood their sexually addictive behaviour to manage hypo-aroused and hyper- aroused states perpetuated by the absence of a ‘good enough’ internalized experience of a regulating self/other. Therapists understood this to be a strategy in which regulation is sexualized and saw relational experience emotional excitation for the female sex addict to be embedded in and indivisible from their sexual arousal templates.
Everything is sexual, even how she relates is sexual. She doesn’t know how not to be. When she sits with me she will flirt with me, there is a type of sexual tension and we have talked about that. (P4/9)
‘Erotic is a space where this relational creativity can occur’. (P11/45)
4.3.2. ‘Any Bond Will Do’
Analysis revealed that therapists expect the initial stages of forming the relationship with the female sex addict to be challenging and difficult. They experience the female sex addict as resisting close contact and understood this to be rooted in anxious/avoidant and disorganized adult attachment patterns created by early relational experiences. They said this often meant attendance in therapy for these clients felt frightening and temporary. While the female sex addicts’ avoidant pattern was mentioned as shaping the early therapeutic relationship, analysis showed this to be overlaid with a narcissistic personality style, which also created a
distancing in relational proximity. Therapists do experience the female sex addict as not seeking closeness, describing interpersonal connection as extremely difficult.
Almost all of them have significant early relationship disruption and attachment disorder. I have never found an addict wanting to climb up with me for years and years. They have a very hard time attaching in the work and the true female sex addict does not want to stay around for years and years to do the work. (P1/55)
For this reason, therapists reported forming a bond as quickly as possible and said they looked for whatever connection might be available to work with. They mentioned the unconscious organizations of historical affective and relational experience for the female sex addict are particularly triggered by the interpersonal contact in therapy and, very quickly, transference and archetypal projections emerged. These established superficial and surface-level connections creating a lens through which the client can perceive the therapist as a familiar relationship figure, past object or archetype. Therapists made the point that while this maintains a psychological distance, it also allows for a connection and that while not ideal this bond is better than none at all, and gets the therapy work started. They commented that this opportunity appears immediately in the therapy and remarked on the fast speed and apparent spontaneity with which these configurations can emerge.
One of the things working with the female sex addict is that it is important for them to make the therapist into an archetype or projection quickly in order for them to begin to do the work. (P1/55)
Therapists reported how, in the early sessions of therapy, they often become a past relationship figure for their clients and described various archetypal configurations on which they can begin to build a bond. One participant recalled that her clients ‘very early on are
going to label me something whether it is hag, a mum or the guy who is not there for her’
(P3/30). Another encapsulated the tensions for the client involved in managing closeness and distance in these early projections and mentions that, in most of her clients, whatever configuration the projected object takes, it is usually designed to maintain interpersonal distance.
It is going to be very superficial and an ‘at arm’s length keeping’ projection that is just going to come out right away, you see it immediately and it (the transference relationship/alliance) does not take long to form. (P10/35)
Other female therapists described the early bonding as involving processes of twin-ship (Kohut, 1971), with one therapist in particular describing how she identified similarities of gender with her female client in order to establish rapport. This she saw as emphasizing an equality and alignment as ‘two women’ in the work together and as immediately establishing an ethos of connection, openness and honesty:
I said, you are the client and I am the therapist but we are also two women in this room, so we are going to work together and we will be as honest as we can with each other. (P4/28)
Male therapists mentioned being perceived by the female sex addict in the immediacy of the transference as her possible partner figure and as an object of erotic fantasy. Therapists talked about the tension between immediately challenging clients’ inappropriate sexualized/eroticized projections and transferences, expressed as being ‘coy and coquettish’ (P11/35) and arriving seductively dressed, ‘ready for sex’ (P5/15), and using the erotic transferences to create a working bond. While male and female therapists certainly confronted sexualized transference as it appeared in the first sessions, male therapists noted that some female clients did not return. Bonding with the female sex addict in the context of the erotic transference was mentioned more often, with clients presenting with a ‘higher level of
romance’ (P1/55) in their arousal and attachment templates. This subtype is said to engage in
the therapeutic relationship more eagerly from the beginning and to have a more preoccupied attachment style as well as borderline personality features. While therapists said these clients are more ambivalent, they did seem to form an attachment bond earlier in the therapy in a dependent way, with the complex transference tensions emerging later in the therapy.