A Book Review

Is Love All You Need? A Review of Joseph Natterson’s “The Loving Self” by Arsalan Malik, MD

Psychotherapy is a labor of love. This is a trope as old as psychoanalysis itself. Freud himself famously wrote in a letter to Jung that psychoanalysis is “essentially a cure through love.” So, what do these analysts from Freud to Natterson mean when they use the word “love” in the context of psychotherapy? They don’t mean an erotic or physical love. Nor do they mean verbal flirtation. It’s not the kind of selfish, mean, grasping, egotistical thing that people often mistake for love but which only uses love for self importance. Nor does it take the form of romantic interchanges, no matter how much either party may so desire.

Dr. Natterson, in his protean way, draws on Jurgen Habermas’ and Axel Honneth’s analysis of love as a “struggle for recognition.” It is in the search for this recognition that human beings relate to each other. Mentally ill or not, we are all primarily motivated by a yearning to be recognized and understood, to “see ourselves in another.” In the intimate transaction of psychotherapy there is a reciprocal searching, in the course of which a mutual and transformative identification occurs for both the therapist and the patient. Seeing oneself in another and the other in oneself is the core of love out of which emerges not only self respect but a respect for others, and their rights. The unfolding of the loving self is thus essentially an intersubjective and eventually a communal phenomenon. This is the scaffolding upon which Dr. Natterson builds his concept of love in the therapeutic situation.

What makes the psychotherapeutic situation especially suitable for this unfolding is the searching and “subordinated subjectivity” of the therapist. There is an asymmetery in the patient-therapist relationship that does not exist in a person’s relationships outside therapy. The patient is seeking help and must be able to express his neediness candidly, urgently and clamorously. The therapists subjectivity must be active to the extent that she should be able to identify with the patient’s dependence and vulnerability, his guilt, his shame and his fears, but in a mellow, controlled fashion. The therapists “subordinated subjectivity” in this sense is the gift he brings to the therapy, because he has been there and done that. This subordinated subjectivity, is actively and empathically attuned to the patient’s pain and suffering. The therapist feels with and for the patient but in a way that she can analyse it and use it for the benefit of the patient without being swamped by her own emotions in her identification with the patient.

Dr. Natterson gives some powerful examples of vividly reliving his own childhood relational themes, emotions and images evoked contrapuntally in therapy with certain patients. With the skill of a master composer he is able to momentarily subdue his own pain, long enough to use this relational music to make poignant, intense and  “loving” interpretations about his patient’s emotional experiences, making them aware of hidden, neurotically suppressed, and loving aspects of themselves. The psychotherapist's offering of this love to the patient is what encourages, stimulates and enables the patient to gradually reciprocate in kind. To open up to love. To tolerate love's anxiety and ambiguity. To risk letting love happen, to experience it, to allow the vulnerability of intimacy. To relinquish control and be more receptive to love.

Dr. Natterson also gives clinical examples to emphasize how it is that a person’s immature aggression and inability to reconcile the angry and destructive parts of themselves with their loving self, blocks their willingness to open their hearts, and commit to and care deeply for another. The notion of love as something pure, as a given in social terms, is a sentimental fallacy. We can only love or be kind by an exhaustive, honest, endeavor to acknowledge understand and embrace our aggression. Without that we don’t achieve the synthesis called kindness or love that is the cornerstone of a mature relational life. There is no way to have a “purified love”, or a love free from ambivalence. The trick it is to recognize the ambivalence and achieve a synthesis.

In the end, Dr. Natterson has done a stellar job of articulating in easy, accessible language what we already do intuitively as therapists, whether we are psychiatrists, psychologists, social workers, mental health counselors, neophyte or experienced therapists. No matter what one’s theoretical orientation, we should all aspire to this way of being with our patients.