Falling in love and remaining in love, while sustaining tenderness and sexual desire for the same person, can be a challenging experience both for our patients and for ourselves.
This capacity has its own developmental history. The ways in which love and sexuality become integrated—or remain separate—can help the psychotherapist understand the nature of a patient’s difficulties and their potential for further change.
In his book Internal World and External Reality: Object Relations Theory Applied (1980), Otto Kernberg, M.D., writes:
“ In order to fall and remain in love two developmental tasks must have been achieved.
First, the capacity for establishing a total object relation must have been integrated with a previously established capacity for experiencing sensuous stimulation of erotogenic zones.
Second, full genital enjoyment can incorporate early body-surface erotism in the context of a total object relation, including a complementary sexual identification.
The first task requires, in essence, that primitive dissociation of the self- and object representations be overcome so that ego identity and the capacity for total- in contrast to part-object relations are established.
The second task requires the successful overcoming of oedipal conflicts and the related unconscious prohibitions against a full sexual relation.
I also traced a continuum of character constellations on the basis of the capacity—or rather, the incapacity—to fall and remain in love:
1) narcissistic personalities who are socially isolated and who express their sexual urges only in polymorphous perverse masturbatory fantasies;
2) narcissistic personalities who are sexually promiscuous;
3) the ordinary borderline patient who engages in chaotic, polymorphous perverse activity.
Paradoxically, disturbed, inappropriate, and immature as the ordinary borderline patients’ falling in love, primitive idealization, and sexual promiscuity may appear, these patients do have a much better prognosis for further development than the descriptive pathology of their love relations would initially suggest. In contrast to narcissistic patients, they have a better capacity for investment in others, or a less active deterioration of their object relations.
These three configurations represent the pathology of “stage one,” that is, before the achievement of an integrated self-concept and an integrated conceptualization of others and the concomitant capacity for relations in depth with significant others, in short, the achievement of libidinal object constancy.
4) Next along the continuum is the neurotic patient and those with less severe character pathology. With these patients we find present various sexual inhibitions, masochistic love relations, a greater capacity for romantic idealization and tenderness coupled with sexual inhibition. Here the chief etiological conflicts are in the triadic, oedipal realm.
5) Finally we have the normal person who has the capacity to integrate genitality with tenderness and a stable, mature object relation”.
For psychotherapists, this perspective provides a basis for exploring a patient’s sexual difficulties in relation to their capacity for deep attachment and their internal conflicts. Understanding these connections helps define the focus of therapeutic work and assess the potential for further development.
We invite you to continue exploring these themes in our NEW Clinical Seminar Series:
Love, Sex and Aggression
Faculty — Otto Kernberg, M.D.
(c) Yuliia Holopiorova,
Ukrainian Association of Transference-Focused Psychotherapy