The Role of Love in Psychological Therapy

 

Love has been a bit of a four-letter word in clinical psychology. Perhaps it makes us think of therapists who have crossed boundaries, begun relationships with patients, even sexually abused them. Perhaps it all sounds a bit wishy-washy and not very scientific, shades of people who believe in religion rather than hard science1
 

However many psychologists have talked about love, although they might not always have used the word. For example the great Carl Rogers. Rogers was a humanist and a great believer in the ability of people to achieve their full potential. Apparently he wrote 16 books (thank you, Wikipedia) of which I’ve read, well, none. However I won’t let this stop me from expounding on his theories. As all psychologists know from their early lectures, Rogers describe three core conditions of psychological therapy: (1) empathy, (2) congruence and (3) unconditional positive regard. My understanding of this theory is that given the right environment (i.e. the therapist providing the core conditions) then people would blossom and grow (aka self-actualise).

I remember hearing about Rogers in a counselling course I did prior to my clinical psychology training. When I started my clinical psychology doctorate there was a tendency to consider the core conditions a bit basic. Perhaps the kind of thing therapists without psychological training might do because they don’t know any better approaches (like CBT! Because that works for everything!2). However as I got older (and hopefully wiser) I came to the realisation that the core conditions were incredibly powerful, and also really quite difficult to do.

Can you imagine sitting opposite someone doing something you consider to be abhorrent and not judging them? Can you find a way to be empathic and open to their emotional experience even if you are disgusted by their behaviour? Can you be congruent (genuine) about your own emotional response in this case without making the person feel ashamed? Can you sit in unconditional positive regard for them despite your response to what they are doing?

In everyday clinical practice the core conditions aren’t always thatdifficult, perhaps unless you are working with people who have committed terrible crimes. However I would argue that to truly embody the core conditions you need to make an intention to do so, and that you need to start with unconditional positive regard. Oh, and I would also call a spade a spade and name what I think we are really talking about here: love.

What is unconditional positive regard if it’s not love? It sounds like an over psychologising way to say love to me. Who do we have unconditional positive regard for naturally? Probably our children. With our children, it doesn’t seem too difficult to acknowledge that this is love.  I mean, I could say to my children at bedtime “night night, darling, I unconditionally positive regard you” but I think they would find this a little unusual3. It’s a common trait of psychologists (and academics generally) to take a phrase that everyone understands and make it so complicated so that normal people who have not been indoctrinated by 6 years of university haven’t got a clue what we’re on about4. When I think about people who unconditionally positive regard me, then I think about my parents and my children (it’s a bit more complex with partners, I think as we often have quite high expectations of them5.

Let’s get a bit more up-to-date now and think about another great clinical psychologist, Paul Gilbert. Paul (it feels weird calling him Gilbert) developed the fantastic compassion focused therapy (CFT). I was in some training for this a couple of years ago and the trainer asked us for some other words for compassion. When I said love he wrote it on the flipchart and proceeded to explain why this was entirely wrong. Compassion wasn’t love, he said terribly nicely, because love involves a wanting to be close to the object of the feeling. Well I don’t agree with this. I think love can involve a desire to be close to the object of it6 but sometimes it can be a different kind of thing altogether.

I am thinking of love in the religious or spiritual sense. For example when we hear “Jesus loves you”, most of us don’t immediately think this means that Jesus wants to take us out for dinner and try to smooch us the back row of the cinema. This kind of love is hard to explain in words (perhaps all love is). It’s a feeling rather than a set of rules. It’s an intention to be open; to stop judging and analysing. It’s a warmth, a colour, a light. It’s looking at someone sitting across from you and softening your heart.

In Acceptance and Commitment Therapy (ACT) there is a useful heuristic for the stance you take with your patients. Are you sitting with this person, seeing them as a maths problem that needs to be solved? Are you working out what’s wrong with them, what they could do better? Thinking that with a few tweaks perhaps they could be an okay person after all despite the mess they’re making of their life? Or are you looking at them as you might a beautiful sunrise? Appreciating them in all their individual glory, something to be marveled and wondered at rather than criticised or analysed. I would argue that taking the time to really appreciate each individual person, to see them as a sunrise, is an act of love.

Steven Hayes, the creator of ACT, talked beautifully about love in an interview with the British Psychological Society magazine7. He said “love isn’t everything, it’s the only thing”. He argued that we should make love the centre of everything we do with patients, with colleagues, in our home and with our families.

So for me love is the key feature of my psychological approach. When I sit down with someone in my therapy room I will make a deliberate effort to love them. I do this by mentally travelling down into my heart, which helps to avoid some of the many verbal judgments that my brain spews out at regular intervals. I try to generate a feeling of warmth and direct it towards them. I try to be open, to listen carefully, to not rush to offer suggestions and advice. Of course there is room for that, that is often what people come for, but I think all of this is so much more powerful if each technique is performed in the service of that person, from a place of love.

For me love doesn’t just have a place in psychological therapy. It’s the beginning, middle and end of it. It’s the basis of everything I do and unlike technique, it will never be replaced with a fancy new version. Perhaps the scientific community needs to use different terminology like compassion or unconditional positive regard. That’s okay, I know what they really mean: love.

Photo by Davide Cantelli on Unsplash

  1. I hate this false dichotomy. Surely you can believe in a wider meaning to the universe and still think that gravity is a pretty useful concept.
  2. It doesn’t work for everything.
  3. Maybe they would be so shocked they’d immediately go to sleep? In that case, it would definitely be worth it.
  4. It took me the whole first year of my clinical training to remember how to talk to normal people again.
  5. If my husband is reading this then I totally unconditionally positive regard you, darling.
  6. Or in the case of your children an hour after bedtime, perhaps not
  7. https://thepsychologist.bps.org.uk/volume-30/may-2017/why-cant-we-speak-deepest-issues-meaning-love-and-loss