Questions in the therapy room

Most of the men and women who come to sit in the armchair of my consulting room join me after having been down similar paths: For a number of years, they have usually been attending Sex and Love Addicts Anonymous (SLAA) fellowship meetings, often having been through the famous H.O.W. programmeme. They have received cognitive behavioural counselling and frequently started their journey dealing with substance and alcohol addictions.

They express, in their own different form of language, the same queries: “I feel there is something I miss when it comes to love”, “Can you help me to understand it?”, “I want answers”, “why is it that despite all the work I put into my recovery, I still feel so un-at-ease?” And then, lastly, comes the usual erroneous egoistic assumption-question: “what is wrong with me?” Nothing is “wrong” when it comes to love, but everything is hugely complex and, often, painful experiences happen which we are hasty to label as “wrong”.

In addition, hypothesising it as a possible addiction is to be handled cautiously. Surely love, as something that can obsessively preoccupy individuals, presents itself with fixation characteristics and mood altering associated experiences making it first an addiction in disguise and then potentially an addiction in action. As a clinician, I believe our duty is to understand one’s profound experience of love before any pathologisation or therapeutic planning can take place.

To these questions posed by my clients, I usually answer that struggles around the meaning of love – eventually named as addiction - its internal experience and external deployment, can hardly be “treated” only from a normative procedural perspective. However, it can be explored together, with a curiosity, an open-mind, with a true aim to find things, learn things, accept and change them, using this unparalleled human wisdom and ability to find and know their differences and re-design intimate ways out.

The rainforest

I like to imagine and propose to my patients an exploration of love as the exploration of a deep, intimate, personally unknown and unchartered (but with its existence never in doubt,) Amazonian Rainforest. The reason I like this metaphor, is primarily because the Rainforest is like a piece of folklore, a myth to most of us. We’ve all heard about it at some point in our individual life and in our deep past of collective shared subconscious, it is a powerful archetype.

My invitation is sensory and visual: our intimate “Rainforest of Love” is mysterious, full of scent and noise, tweets and roars, paradise birds and jaguars, colourful flowers and poisonous plants, sunlight and storms, shadows and plain light, peace and fear, flushing rapids and calm waters, threats and shelter. It has been growing forever and re-creates itself daily, whilst nothing is permanent, everything is intrinsic. It is unchartered land and a big part of our personal planet, our local self-universe, an emotional breathing space as much as a suffocating climate. If we want to know who we are, we have to go there and experience our own individual meaning of love.

All this may seem very esoteric and unrigorous from the perspective of a clinician. I am a man of science and philosophy, I try to respect knowledge and epistemology well enough to avoid falling into the trap of hasty formalisation and structural conceptualisation at first sight.

How do Psychology, Science and Philosophy all play a part?

When it comes to love as a global notion, knowledge provided by science is actually rather scarce. Even though psychology and neuroscience have, over the last 3 decades, provided insightful theories, models and characterisation of mechanisms, they are very entrenched in the attachment, developmental and evolutionary psychological fields, or brain functioning neuroscience. Maybe it is because love vastly exceeds the limited horizon of the science of psychology.

The best attempt to characterise love still lies with philosophical propositions. As a psychologist, I believe we cannot exonerate ourselves from our philosopher colleagues’ contribution to comprehensively capture the concept of love. From Plato, Kant, Hegel, the monumental Germans, Nietzsche and the post-modern, to eventually the existentialists and Emmanuel Levinas, who audaciously proposed the dual asymmetrical process of love in a relationship, all of whom tried to understand and formalise love. However, I am not going to embark on an essay in that direction. For those interested, I would suggest you look at Irving Singer, Philosophy of Love: A partial summing-up, MIT Press, 2009.

Back to our approach as clinicians, we all agreed rather quickly, but only recently, that the core of love addiction is about romantic love. It manifests in adulthood, or more precisely in post-pubescent phases of the life span. Romantic love has been globally conceptualised as a “dynamic structure of experience that must be continually reanimated to continue” (Salomon, 1988). It is experienced and expressed by one individual on a spectrum from “mature” to “immature” in form, but with individual variances in plasticity, in connection with another individual (both ways inside-out and outside-in).

Mature romantic love aims to create an environment sustaining mutual growth amongst the lovers. Conversely, immature romantic love creates a maladaptive environment within the couple and the self-experience of love. Immature love involves obsession, insecurity, uncertainty, and resulting over-control, related anxiety, compulsion and negative life consequences - meeting the typical characterisations of an “addiction” within the lines of the DSM-V. In addition “love addiction” implies profound irrational beliefs that romantic love is omnipotent, magical, life-saving, something which soothes everything, in summary all the attributes of a true Higher-Power concept.

It is therefore not surprising that when an individual starts to rigidly obsess over love-type feelings, they will experience a decreased adaptive functioning in their life which accordingly shape their brain functioning and neural organisation. On the other hand, love-type feelings are absolutely central to human condition, and have been a great promoter of our species.

Have you ever asked yourself how many generations were backing you (and me) since we have been hominies? About 40’000. And since we have been Homo Sapiens? About 7’500 generations. Which surely totals hundreds of millions of romantic love stories which had to happen in order for us to be together on the earth today! From paleo-anthropological research, there is good, direct and inferential evidence that romantic love started to replace the mammal-mating process alongside the development of tribal communities more than 150’000 years ago. Of course it evolved into further complexity with the development of social rules and a more sedentary life-style some 15’000 years ago.

I find it very powerful to imagine that romantic love is so central to the human-specific success of our species and its development. I believe it played an important role in our unique adaptive skills, mature romantic love creating a collaborative growth in strength. Thus, maybe, the “magical belief” about love, as an old cognitive reverberation from our deep collective past experience of love.

Why are we not equipped with a solid normative capacity to experience love in a mature way?

A pertinent question indeed, assuming romantic love is so central to our human condition and successful propagation as a species. Findings support that, even though the capacity to love is innate and stable in its potential at a meta-level, from a genetic predisposition perspective, its individual development, experience and expression depends on one’s local-level learning mechanism. In simple words we all have a primal capacity to love, a blue print, but it has to grow into an individual romantic love map. This map can be vandalised at different stages, level and domains of our own self-development and experience of love (probably at epigenetic, emotional and cognitive levels at the same time). And this is when the seeds are planted and will sprout at some stage of one’s life, growing into love addiction.

The first environment of love for every human being is its family of origin and the infant-care giver’s primal instinctive and then socially constructed experience of love. Bowlby and Ainsworth first conceptualised the variances in attachment styles. They seldom used the word love, I always wondered why. Maybe, they needed some more objectified terminology to make it more scientific, maybe they needed to neutralise the emotional charge associated to the word love, or maybe they were biased by some obscure English uneasiness with feelings… Nevertheless, beyond the concept of attachment, what they were really exploring was the early form of love, the birth of it in a human process of becoming. Their findings were mind blowing, showing how innate longing for secure attachment, to experience love and self-develop harmoniously could become easily vandalised by inadequate parenting leading to various distressed attachment styles in infancy.

However, Bowlby did not evidence the longitudinal reverberation of his early attachment theory into adulthood. When he claimed it to be integral to human behaviour from “the cradle to the grave” in 1979, it was more of a hypothesis than a documented fact. He left us with this immense legacy of the “Internal Working Model” and a duty to test it and possibly turn it into a theory, rather than blindly believe in it because it is such an exciting answer to this major question of how romantic love works, succeeds or fails its purpose for a given individual.

Thanks to Shaver, Hazan and many others who dedicated important research to test Bowlby’s hypothesis, we can assert that their findings significantly supported the hypothesis: when attachment in childhood has been vandalised through immature, abusive or neglectful parenting, romantic love in adulthood is much more likely to be experienced and expressed in an immature way.

So is that all? Is it simple as that? A blue print (the internal working model) is established in early life to determine, decades after, what framework an individual will use to deploy their absolute legitimate need for romantic love, predicting their degree of maturity or immaturity. It seems simplistic, not necessarily wrong, merely reductionist.

Can we change the blue print?

If the internal working model is a valid prediction of future attachment processes, then come two subsequent questions: what is the plasticity (robustness) of this model within a given individual and what is the impact of the sum of the several romantic love experiences which previously happened in one’s life. Can’t we, as individuals, learn from a trial-and-error process, or is it that this very first experience of love is so written in stone that it operates with huge gravitational power over our romantic love formation?

This central question has huge implications when it comes to therapy. If the internal working model resulting from infancy is prevalent in informing love addiction, then any love addiction therapy model will mostly have to be derived from relational childhood trauma and PTSD therapy, dealing with pre-cognitive stages, as priority over any cognitive behavioural therapy and model approaches which unfortunately have poor outcomes on healing childhood relational trauma.

Research has attempted to provide a conceptualisation of attachment from infancy to adulthood stability using two axis: the prototypal perspective (blue print remains) and the revisionist perspective (self-actualisation prevails). Mathematical models and testing have flourished (Fraley, 2002) providing directions of conceptualisation but few systemic answers applicable to local-levels of romantic love addiction experiences.

In other words, yes a prototype of romantic love is formed in infancy and plays a continuous role and yes, every other romantic love experience in adulthood interferes with the prototype’s initial model with possible negative or positive re-enforcement. The underlying forms of one’s experience of love are hugely individual, and it is deployed in a dyadic environment (the lovers), making it almost impossible to achieve normative conceptualisation and therefore a normative therapeutic approach.

What are the best models to help treat love addiction?

One of the best attempt to structure a therapeutic system to one’s individual experience and expression of love immaturity is probably Pia Mellody’s work on Love Addiction and Love Avoidance cycles. Her therapeutic systems links the childhood adverse experiences that vandalise the internal working model, together with the distorted cycles of attachment to the Other, in its dyadic form – presented as a possible “toxic tango”. Stemming from this model, there are a great deal of opportunities for the therapist and the patient to find meaning and healing, if and only if, it is not seen as a static model (“you are of that kind” – prototypal perspective), but as a dynamic grid applied to look at from the revisionist perspective at one’s potential homeostasis of the experience of love. The therapy will aim to look at the two axis, internal and external, and learn the wisdom to navigate on from them by accepting the past (internal vandalised working model) and changing the local possibility for immediate and future experiences inside the existing or future relationship.

Additionally, Love Addiction rarely comes as an isolated planet to one’s life. In unpublished research that I complied in 2015, I surveyed patients in residential treatment for addiction: 57% of them scored high within the top deciles for love addiction. In several converging pieces of research, love addiction was strongly associated with personality disorders of various forms and OCD. I believe that it is necessary to carry out a comprehensive clinical case formulation for any patient seeking help around love addiction. The tree could well be hiding a forest there.

However, there are always some personality characteristics associated with the experience of romantic love, whether it is in a mature or immature addictive form, implying an existential and psychodynamic approach in therapy. At some point, I am always driven by and with my patients to unveil the meaning of mortality and death associated one way or another with romantic love.

This is why, firstly, as I illustrated in the opening of this essay, I always propose that my patients co-explore their historical experience of love – what I call the Rain Forest. Exploration is about experiencing, re-experiencing, not only map drawing – as in cognitively measuring – what (as in why + how) happened to the individual which makes them identify now as a love addict?

I could carry on reflecting and surfing on the waves of romantic love, its power and its addictive nature because I feel like I have only just described the crests of these waves - there is an abyssal ocean beneath.

I would like to conclude by drawing attention to one thing that was profoundly important to me more than a decade ago and still resonates in my present life: The 12 step fellowship of Sex and Love Addicts Anonymous and its H.O.W. programmeme.

I have to say that SLAA would not have been sufficient to help me understand myself and grow enough to have the possibility of mature relationships. I needed childhood trauma therapy, I needed experiential therapy, I needed cognitive and behavioural reframing (CBT…) to reshape my relationship working models and ability to start enjoy life with acceptance and constructivism (construction + optimism).

But I am adamant that without the warmth of the fellows and the compassionate structure of SLAA, all my therapeutic attempts would have fallen short, or would never have reached long-range productivity. For that I am most grateful to SLAA, which hosted the path of my personal voyage into the realm and meaning of love as I came to understand it.

By Christophe Sauerwein