Love as a Clinical Variable

Every case of psychotherapy, to a greater or lesser extent, is a problem of the failure to love.  Sometimes the problem is in focus; sometimes
it is a covert contributor to other problems, but at core, it is always
.  Those who can plant and tend
love may have pain in life, but not the
kind of pain that draws a person towards psychotherapy…

Failure to love is always a religious problem.  It always has roots in the answer to
the question: What is the nature of the universe in which I dwell?

Paul R. Fleishman, The Spirit Within

            I like Paul Fleishman as a modern philosopher.  In fact, more of my fodder for writing has come from the above book than from any
other modern work.  The central idea in this quote, however, gave me pause.  Is it not bad enough that suffering people must seek the assistance of others to help them navigate the “white waters” of difficulty without the selfishness label being added to their struggles?  “Every case of psychotherapy is a consequence of failing to love?”  Perhaps it is often true, or much of the time, but in every

            It could just as erroneously be argued that every case of psychotherapy is, to a greater or lesser extent, a problem of the failure to be loved.  Some personality disorders can have their root in a perception of being unloved and failing to receive the kind of nurturing necessary to developing a healthy sense of self, but that is certainly not the only cause.

The subject of perception is important when it comes to looking at love and its many implications on mental health.  Perception is everything when it comes to feeling loved.  Parents can love their children more than life itself, but if the child does not believe it, the love of the parent has little psychological benefit to the child.

            In the regimented, clinical and (sometimes) sterile environment of a psychiatric hospital or mental health clinic, cultivating love sounds a tad sentimental.  The perception could exist that it’s not even on the radar.  We are accustomed to treating symptoms and managing behavior, and often clinicians find little time to do much else.  Fiscal pressures, patient resistance, and the sheer enormity of the problems we often encounter make it difficult to be as client-centered in our praxis as we desire to be in our ideals.  If an optimum methodology for interacting with patients exists, it probably lies somewhere between “Patch Adams” and “Dr. Gregory House.”  Yes, we are treating human beings, and yes, we are treating diseases and disorders.  And yes, it is probably necessary at times that treatment lean more heavily toward the disease than the person, as traditional allopathic methodology has suggested.  But should that be the ideal in a mental health setting?

            Clearly, both failure to sense love and failure to communicate love are clinical variables.  Human well-being could be conditional upon this quality above all others, as poets and philosophers have
long asserted.  A person’s capacity to receive and express love is likely the single best predictor of resiliency, and resiliency is likely the single greatest predictor of recovery.  How do we then, as health care professionals, make it an appropriate ingredient in client and patient assessment and care?

            It perhaps begins with taking sentimentality out of the equation. The early Greeks had a word for the kind of love that makes good process in a health care setting.  While Classical Greek had a
variety of words to describe the various aspects of love, it is the agape definition that could prove helpful for our work.  Agape has little
to do with affection or passion, or how we feel about another person.  It is more about volition.  Agape affirms the significance of the other and the value we place on others’ needs and desires.  As a counselor and therapist for over twenty years, I have learned that a sense of being valued is critical to the therapeutic process.  Unless
positive transference is developed, people do not develop the kind of trust essential to their recovery.  Inherent in positive transference are such qualities as respect, honesty, appropriate boundaries, and clear communication.  It is not about others getting that “warm, fuzzy” feeling; it is about their believing that we “get” them, and that they matter.

            When we care for others with agape, we listen with our eyes as well as our ears; we provide what is needed rather than what we believe is deserved; and we use power only as a last resort, when it the ethical and only therapeutic approach remaining.  In the process, our patients get the message that they are seen, and that the outcome of their treatment makes a difference to us.

There are no formulas available that make the application of agape an easy thing, but its outcome is dependent on taking our patients need to be valued seriously.  Some who receive this kind of care actually feel affection.  But whether or not they do, a good first step toward the kind of emotional health that leads to meaningful relationships is a belief we can be worth something to someone.  Our manner of relating either contributes or detracts from that belief.

Cultivating worth is a clinical matter and looks an awful lot like loving.  Kumbaya!

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