1. society
2. social institution
3. marriage

Why Is Sex Important? A Seminar on the Impediments to
Adult Love
Seminar Number: SM0336
Director: Stephen Levine, M.D.
Date: Monday, May 18, 2015
Time: 1:00:00 PM - 5:00:00 PM
Location: Chestnut East-West
Sheraton Centre Toronto Hotel
AMERICAN PSYCHIATRIC ASSOCIATION
th
168 ANNUAL MEETING
psychiatry.org/annualmeeting
Toronto, Canada ·May16-20,2015
AGENDA
AMERICAN PSYCHIATRIC ASSOCIATION
th
168 ANNUAL MEETING
psychiatry.org/annualmeeting
Toronto, Canada ·May16-20,2015
Schedule
First 75 minutes: What is love and how does it work?
Second 75 minutes: Why is Sex Important and Three
Compendia Of Love’s Impediments
15 minute break
Third 75 minutes: The iconic psychopathologies of love:
love/lust split, infidelity, jealousy, problematic sexual excess
(sexual addiction)
Last hour: Integrating concepts into practice—general
discussion
Adjourn
OUTLINE
AMERICAN PSYCHIATRIC ASSOCIATION
th
168 ANNUAL MEETING
psychiatry.org/annualmeeting
Toronto, Canada ·May16-20,2015
The entire seminar will be given by the director, Stephen B. Levine, MD
SLIDES
AMERICAN PSYCHIATRIC ASSOCIATION
th
168 ANNUAL MEETING
psychiatry.org/annualmeeting
Toronto, Canada ·May16-20,2015
5/26/2015
What is Love?
Stephen B. Levine, MD
Clinical Professor of Psychiatry
Case Western Reserve University
School of Medicine

The Two Nurturant Systems in
Adult Sexual Relationships
 Psychological Intimacy—the ability to create and recreate a
sense of emotional connection through conversation. It is
the pathway to love!
 Sexual Behaviors—largely a nonverbal process that reveals
the two individuals to aspects of the other—nakedness,
arousal, orgasm, power to give sensual pleasure, capacities
to tolerate sensual pleasure, after-sex affection.
 Facilitate emotional interconnection
 Establishes the other as special—provides a unique status
The Speaker’s Role
 To attempt to share his or her private
subjective experiences with the listener
 Three requirements
 1. Must know what one thinks and feels
 2. Must be willing to say it to another
 3. Must have language skills to express
thoughts and feelings with words
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What the speaker shares need
not be elegantly said, lofty in
content, or unusual in any way
It just needs to be from the inner
experiences of the self
The Listener’s Role
 To respond to the speaker with:
 1. An uncritical acceptance of what is being
said
 2. An awareness of the importance of the
moment to the speaker
 3. A grasp of what is being said
 4. The sense of the privilege of listening
Psychological Intimacy
 Creates a bond
 Provokes erotic interest
 Improves a person’s self regard
 Generates a sense of hope and optimism
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Love is Not One Thing!
 When new: It is a powerful preoccupying state of mind brought
about by an intensely hopeful investment in another person
 Once established, it consists of a shifting, nuanced private set
of feelings about diverse aspects of the other
 When all is said and done, love is a unique attitude towards the
selected another
 [Grammatically, love is an abstract or conceptual noun like
justice or equality that is typically used as a verb]
Five Recognizable Elements of
Adult Sexual Love
1.
Interest in the other
2.
Pleasure from other’s being
3.
Periodic sexual desire for the other
4.
Dedication (caring, devotion) to the other
5.
Faith that something good will come of this for us
The Five Elements
 Within a person, fluctuates over time both
 Predictably
 Unpredictably
 Between persons, the degrees of these five elements varies.
We do not all experience the same intensities of pleasure,
interest, desire, devotion and optimism
 Within a couple there are typically discrepancies between
how each person compares with the other
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Nine Meanings of the
Conceptual Noun Love
The nouns of love

1. Love is an Idealized
Ambition
 The cultural origins of the ambition are so strong and
widespread that few people can grow up without
privately longing to experience its highly advertised full
blown version
 Three alternative ways of explaining the ambition
The most succinct summary
I will have a partner who will
accompany, assist, emotionally
stabilize and enrich me as I
evolve, mature, and cope with
life’s expected and unexpected
demands
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Love is an Idealized Ambition
 The sense that the right partner has been found triggers
a great and lasting excitement
 As long as nothing major or repetitively adverse happens
over time, those who sense that they have realized the
ambition experience a sense of mental stability and say
that they are deeply satisfied
The Two Strong and Persistent Faces of
Love’s Ambition
 To experience positive feelings for the person
 To experience the behaviors based on positive feelings
from that other person
 The two sides of the same coin
So strong is the ambition, that when relationships fail,
people do not change the ambition; they may change the partner.
The
Ambition/Capacity/Potential to
Love is Hardwired
 Cultures modify its forms of expression, but
 In all cultures, love is the ambition to attain a
recurrent sense of unity, oneness, or
wholeness that ends separateness and
diminishes narcissism
Zeki, S. (2009)The splendors and miseries of the brain, Wiley-Blackwell, Oxford, UK
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2. Love is an Arrangement --a
Deal
 All adult sexual relationships are quid pro quo exchanges
of hopes, expectations, and assets

A social process arranges the deal




Dating or courtship
Parental arrangement
Religious authority arrangement
A clandestine relationship
 During courtship, the mind is preoccupied with “How will
this person enhance my life?”
Love is a Deal
Each Person Brings:
1.
Social assets and burdens
2.
Economic opportunities and
limitations
3.
Familial relationships
4.
Aesthetic pleasures or
disappointments in terms of

Beauty

Taste
Values compatibilities and
incompatibilities
5.



Politics
Religious
Moral
6.
Recreational interests and
capacities
7.
Sexual interests and
capacities
Physical and mental health
and their limitations
8.


Anticipated time to significant
illness
Anticipated time to death
Love is a Deal:
Making the Arrangement
 The crucial issue is how well a person is able to do his or
her analysis of the assets and limitations of this partner
 Four heterosexual outcomes
 No deal
 Short term deal
 Longer term deal
 Marriage (and increasingly, homosexual)
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Love is an Arrangement/a Deal
 Inexperienced young people tend to dislike
acknowledging the due diligence of the deal
 With more experience--after a breakup, divorce, death, or
an extramarital affair, people are more able to admit that
they, of course, think about these matters
Love is an Arrangement
 Each person perceives at least some aspects
of the deal that is being offered
 Perceptions vary in accuracy and in breadth
 Clear thinking is made difficult by the excitement
stimulated when a deal seems to be good on
several fronts
 Clear thinking is also made difficult by the
awareness that one may not have another chance
3. Love is an Attachment (A Bond)
 As the deal is worked out, people become
attached
 Weave their psyches together
 Begin to feel a hunger to be with one another more
 Establish a “we” identity as belonging to the other
 Sex is highly desired
 The bond—the internal sense of couplehood—
begins early in the relationship though not
necessarily at the same rate or to the same
extent
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3. Love is an Attachment (A Bond)
 Having sex and orgasm together facilitates the bond
 The early attachment is expected to induce strong
motivation—dedication--to attain love’s ambitions
 A newly established bond rearranges the self
4. Love is a Moral Commitment
 The clergy teach the couple that love is a
commitment to try to realize love’s grand ambitions
 The marriage or commitment ceremony, a public
promise to honor and cherish each other through all
of life’s vicissitudes, emphasizes love as a moral
commitment
 Ceremonies instantly restructure life and generate a
new strong set of obligations for a lifetime
Guilt and Moral Commitment
 Guilt is a powerful force that maintains marriage
 Those who are serious about their vows will feel
painful and persistent guilt when they don’t behave
well and when contemplate extramarital affairs and
divorce
 Agony is felt when the unhappily married grapple
with the dilemma between their commitment to
provide their children with two live-in parents and
the wish to be free of unhappiness with their partner
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5. Love is a Management Process
 Where does a couple’s love reside?
 In the mind of community—family, friends, others
 In the privacy of each partner’s mind
 In between the two attached adults as they relate
publicly and privately in ways unique to couples
Love is a Management Process
 We protect our partner from many of our positive and the
negative mental processes
 Under ordinary circumstances, we wisely, diplomatically,
do not share too much of our anger, disappointment or
joy
Love is a Management Process
 A person needs the illusion that it is not a
struggle to love him or her
 The irony—we struggle to love although we
perceive it is not a struggle to love us!
 If our partners knew how much we struggled to
contain our anger, disappointment, and regret
over the deal we made, they would worry too
much and fear the devastating impact of
abandonment
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The Day-to-Day Management
Process
The management goals are to:
1.
remain prudent about what one says
2.
remain diplomatic about how one says it
3.
maintain perspective about the bigger things in
one’s life
4.
prevent the partner from realizing what is actually
transpiring within one’s mind
What is Managed?
 Every marriage contains two separate subjective states
 his marriage
 her marriage
 Every coupled person has an internal sense of self and an
internal sense of the partner. They are not the same.
 Honesty sounds good as a rule, but sharing how one
experiences the other can be dangerous
6. Love is a Force of Nature
 It creates a unity out of two individuals
 It casts our fates together, organizes reproduction,
and remains vital to our adult growth and
development and to the maturation of our children
 It is the skeleton that supports the sexual and
nonsexual processes of our lives
 We have a sense that we are part of a grand
biological plan with special human options
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Love is a Force of Nature
 We are unaware that it is acting upon us most of the
time
 It is most pleasingly discussed at the beginning of
relationships when people are happily amazed at the
transformations in their lives
 It can be seen at the end of the lifecycle when
people stay together because they have always been
together even though all the forces that brought
them together have long since vanished and there is
no pleasure, interest, sexual motivation or optimism
Love is a Force of Nature
 After a number of years, a person may
recognize that he or she can never be
psychologically free of the partner
 Nature—the underlying force that socially
brought them together, gave them
culturally approved tasks that kept them
together, and now having slowly
attenuated their capacities--has had its
way with them
7. Love is a Transient
Emotional State
 Love is not a feeling!
 It is, at least, a combination of variable degrees of
pleasure, interest and sexual desire/arousal.
 Investment in a partner and identity as part of a couple
are more processes than feeling
 I love that book and I love that person share processes and
feelings.
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An Array of Feelings
 When a woman learns that her newly beloved
thinks about her in the same terms and declares
his wish to marry her, her feelings might consist
of






Pleasure to the point of joy
Interest to the point of fascination
Pride in being highly valued
Gratitude
Sexual arousal
Awe
 “She is happy” fails to capture her separate
feelings, changing intensities, and time courses
Feelings about Feelings
 Two children are taught about envy

#1 has a simple feeling called envy

#2 has an emotion called envy-guilt-anxiety
Love is a Transient Emotional
State
 A religious man averts his gaze when he sees an
attractive woman, feels guilty and anxious, and
tries to redirect his thoughts to his wife. He
explains that this is the proper way of handling
his sinful response to another woman. His mere
aesthetic appreciation of another woman—a
simple feeling of pleasure from someone who is
visually pleasing--has become a complex
emotional process.
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Love is a Transient Emotional
State
 People may spend years anxiously
waiting to experience the feeling of
love. They privately are uncertain what
love is, yet they assume others
experience it. They may be tempted to
fake love and mislead their partners
about their degree of pleasure and
interest in them.
Love is a Transient Emotional
State
 It is liberating to understand the
ordinary complexity of love as a
changing array of emotions
 Love is the label we give to a range of
transient emotional experiences.
 Love is always complicated by past,
present, and future considerations.
8. Love is an Illusion
 We want to think positively about love
 We want to believe in it
 We want to assume that we are loved by our partner
 We want to believe it is ONE THING
 We want to think that we love our partners
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Love is an Illusion
 In order to maintain these beliefs, at times we need
to create certain distortions or illusions for ourselves
and our partners
 Love as an illusion refers to:




The fact that we create love by internal private processes
Maintain it by prudent diplomatic dishonesties
Can lose it for our partner without the partner knowing it
Self-perceptions as loving and as beloved can prove to be
transient and inaccurate
Love is an Illusion
 We need courage to face the fact that the
processes of love require defensive distortions
of a person’s feelings, thoughts, and
perceptions in order to remain in an intimate
relationship
 Love is at least part illusion, although there are
some that believe it is simply illusion
Love is an Illusion
 It means that society, though its
educational and religious institutions,
through its celebrations of love in song,
and though its academic discourses on
the topics, fosters simplistic notions
about love that encourage us to
behave as though we all know what it
is
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9. Love is a Stop Sign
 Many people are baffled, tongue-tied, or
stumped to explain themselves when asked why
they love their partner
 ? A simple unwillingness to answer the question
 ? An unwillingness to think about the question
 The stop sign is a defense against self discovery.
“I don’t want to pursue the subject further!”
protects the person from confronting the illusory
aspects of his or her love.
Love is a Stop Sign
 Love is the word we invoke when we don’t want to
examine our motives for our interpersonal behavior in a
sexual relationship
 Love, the stop sign, ends the inquiry
Love is a Stop Sign
 Doctor: Why do you put up with that behavior from your
spouse?
 Patient: Because I love him!
 Doctor: What does that mean?
 Patient: I don’t know.
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Love is Not One Thing
 It is a force in
 It is an ambition
 It is a deal
 It is a bond
 It is a moral
commitment
nature
 It is a transient
emotion
 It is an illusion
 It is a stop sign
 It is intrapsychic work
Love is Not One Thing!
 When new: A powerful preoccupying state of
mind brought about by an intensely hopeful
investment in another person
 Once established, it consists of a shifting,
nuanced private set of feelings about diverse
aspects of the other
 Love over the life cycle is a unique, in the
details, evolving attitude towards the another
Adult Love is Conditional
 Appraisal is the assessment of the
partner's behaviors, particularly their
recurrent patterns
 Partners do not simply and constantly
feel positively about us
 Partners notice our behaviors, give
them meanings, and depending on what
they perceive, feel pleasure, admiration,
disappointment, or anger
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Adult Love is Conditional
Appraisal vs. Bestowal
 Bestowal is the granting of cooperation
 When our behaviors create positive feelings, our
partners are more cooperative, affectionate, and
enjoy us. These behaviors shore up their
idealized internal image of us as loved.
 Money in a bank
 As positive experiences accumulate under diverse
conditions over time, our partners treat us as
though we possess a good character.
Continuing Negative
Appraisals
 Interfere with our partners’ pleasure
from and interest in us
 They rob our partners of their sexual
interest in us and attenuate their
commitment to love us by eroding their
internal image of us as respect-worthy
Continuing Negative
Appraisals
 Our partners then find it difficult to bestow affection and
cooperation.
 At a certain point, these negative appraisals come to
dominate all thinking about the partner. This may then
trigger new mysterious anxiety, panic, guilt, or depression
as the person confronts the question,“Now, what am I to
do?”
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Continuing Negative
Appraisals
 For a while, people prefer to think of their new
symptoms as a mystery. They may take some
psychotropic medication.
 Eventually they come to realize that it is only in
their best interests to keep the source of their
feelings from their spouse
 Some temporarily wait for a better day with the partner
and seek a calmer acceptance of their partner’s
capacities and style
 Others, however, privately decide to terminate the
relationship.
Five Vital Considerations for
Staying in Love
1. Competence--a consistent pattern of absence of
hostility, the presence of warmth, respect, support, and
a willingness to engage with the partner to solve
mundane problems. The sense of friendship prevails
even in the face of disagreement.

(Gottman, 1998)
2. Staying Balanced—Not Losing
Perspective
 Staying in love is in large part the result of what happens
in the privacy of one’s conscious mind
 Struggles within the privacy of one’s mind are frequent
 We have values, ambitions, and a sense of what is
realistic that is kept largely private from the partner.
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3. Emotional Genuineness

Staying in love requires the re-meeting of two
people at their emotional genuineness

The important differences among us may be
our abilities to face our individual and joint
challenges together as a supportive
sympathetic team.

Genuineness means sharing with our partners
our thinking, emotions, and the pleasure or
pain from the consequences of our decisions
4. Overcoming Narcissism
1.
It is important that each person develop the ability to put him
or herself second at times.
2.
Overcoming narcissism means increasing devotion to the
partner, couple, and family—putting the needs of the partner,
the couple, or the children ahead of one’s own.
3.
Partners notice the degree to which this is accomplished; we
can more easily bestow cooperation when our partner’s selfinterest is put aside.
4.
It also adds to the loving internal image of the partner—i.e., it
puts that psychic money in one’s private mental bank.
5. Negotiation Skills
1.
2.
More matters are negotiated than meet the
eye
Some people are autocratic and feel entitled to
make the decisions for the couple.


Even this seeming unbalanced“pathological”
circumstance is the result of some form of prior
negotiation
The partner who does not like confrontation,
disagreement, or directly representing personal
interests decides to go along and often find spheres
of activity that the other person is not interested in
controlling
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How To Behave Poorly In Established Love
Relationships
1. Routinely escalate angrily or withdraw in the face of
interpersonal conflict
2. Avoid genuineness—lie frequently and don’t share too much
about yourself
3. Put yourself first in choices with your spouse and children
4. Assume you have a right to decided all matters important to
you
5. Practice outrage when others find a way to protest your
decisions
Part Two
 LOOKING AT THE PATHOLOGIES OF LOVE
Ways Of Viewing The Pathologies
Of Love
• By WHEN THE IMPEDIMENTS MANIFEST
• Before courtship, during courtship, after relationship is established
• IMPEDIMENTS THAT IMPAIR A PERSON’S LOVABILITY
• Longstanding or new physical, mental, behavioral, sexual limitations
• IMPEDIMENTS WITHIN THE SELF THAT LIMIT INVESTMENT IN
THE PARTNER
• Distrust, narcissism, self-hatred, inability to have respect and desire for the
same person
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COURTSHIP IMPEDIMENTS PREVENT
OR LIMIT LOVE FROM DEVELOPING
 Major physical disabilities
 Major cognitive disabilities

unaware, unreachable, or
unavailable
 Major mental illness
 Gender Identity Disorders
 Character pathology
Rejection
 Falling in love with the
 Refusal to commit to
marriage
 Loss of sexual interest in
increasingly committed
relationships
 Select paraphilias
 Lifelong sexual
dysfunctions
An Important Distinction In The
Impediments To Loving
Partner’s view of the index
person

Loving a person is made difficult
by any number of the index
person’s traits, behaviors,
thinking, reactions to others, and
capacities
Index person’s own
characteristics

Investing and maintaining kind
supportive behavior towards
one’s chosen partner can be
limited by character traits, values,
decisions, internal and
interpersonal conflicts and
ambitions
Impediments that Diminish a
Person’s Lovability

Incompatible Sexual Identity
Variations

Acquired Sexual Dysfunctions

Sexual Excess Patterns

Paraphilias

Character traits that alienate

Aggressive Behaviors

New Major Mental or Physical
Illness

Violation of fundamental
assumptions—infidelity, harming
children, criminality
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Impediments That Limit the Person’s Ability
to Express Love

Discovery of One’s Alternative
Gender Identity/Orientation

Acquired Sexual Dysfunctions

Sexual Excess Patterns

Alcoholism and other forms of
drug addiction

Paraphilias

Problematic character traits

Aggressive behaviors

New Physical or Emotional
Illness

Loss of respect for partner

Partner loss

Sexual adventuring
Understanding Character Traits
Character traits that
alienate

Recurrent inability to problem-solve
together

Unacceptable differences in honesty,
religiosity, political sensibilities

Fatigue over differing cultural interests
and pleasures

Differing concepts of what are
acceptable boundaries for the
relationship—e.g., friendship patterns,
flirtation, extra-dyadic sex
Realization of the limits of a
partner’s capacities

Partner’s endowment of:
 Emotional expressiveness;
 Intelligence
 Vocational effort
 Sexual capacity
 Athleticism
 Sociability/interest in others

Gradual realization of divergent
life goals
Traditional Ways of Looking at
Relationship Problems
1. Power struggles
2.
Gender roles
3.
Unrealistic expectations
4.
Intimacy barriers
5.
In-law relationships
6.
Money
 However one looks at
the processes that
bedevil intimate adult
relationships, we can
agree that our
understanding of it is
incomplete
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The Partners Of Those Who Love
Poorly
 The partners for a while think that they love you but no longer
am in love with you = Love As A Moral Commitment and Love
As A Management Process.
 There is very little pleasure, personal interest or sexual
desire for you.
 The MHP will be told love has become a bad deal and
will endorse love as an illusion
 They will complain of feeling empty and may claim to
not understand their fantasies of having a fresh start.
They are even given to infatuations
 They will spend money surreptitiously on consultations
with divorce attorneys
15-MinuteBreak
Barriers to Loving: A Clinician’s Perspective is
available for purchase during the break

Iconic Situations that Destroy
Love
 Jealousy
 Sexual addiction-problematic sexual excess
 Love-lust splits or Madonna-whore complex
 Infidelity
Levine, SB. Barriers to Loving: A clinician’s perspective, Routledge, 2013
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Jealousy
 Mate guarding
 Attachment anxiety—separation anxiety
 Low self-esteem
 Ranges from ordinary forms to psychosis
Problematic Sexual Excess—
Sexual Addiction
 Involves infidelity but is dominated by the commercial
aspects, multiplicity of episodes, the sense that the man
lacks control of his behavior and continues after he realizes
that it is self-destructive
 Up to 30% of these men are paraphilic
Madonna-Whore Complex
 Inability to love affectionately and desire the same person.
 Presents shortly after engagement or marriage
 Patient (can be a woman) is averse to intimate contact and unable
to have intercourse or orgasm with partner but is fine with others
 Freud thought it due to a oedipal fixation to mother or sister but
today it is known to have a diversity of remote causes in both
males and females, heterosexuals and homosexuals
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Infidelity: Monogamy Promises to
Preserve
1.
2.
3.
4.
The
couple’s mental, physical, social and
economic health over time
The structure of family in order to facilitate
children’s emotional development
The continuity of parents’, siblings’, extended
family’s and friends’ lives
The belief in the possibility of marital
happiness among the children
5/26/2015
Monogamy Does Not Always
Deliver on Its Promises
of the individual/couple’s
mental, physical, social or economic health
2. Limits some children’s emotional
development
3. Alienates family and friends
4. Leads to children’s cynicism about
possibility of marital happiness
1.
Deterioration
Expectations—Love’s ambitions
 Then there is reality
①
Happiness
②
Monogamy
③
Sexual fulfillment
④
Psychological intimacy
⑤
Caring support
⑥
Respectful understanding
⑦
Happy capable children
⑧
Financial stability
⑨
Agreement on important issues
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There Is No Single Motivation For
Infidelity
A search for
1.
2.
3.
4.
5.
6.
7.
Coping With
Love
Conventional sexual
pleasure
Paraphilic sexual pleasure
Homosexual experience
Defiance
Adventure
Distraction from personal
pain
8 Low self esteem
9. Sense of Entitlement
10. Gender identity
confusion
11. Uncertainty whether to
divorce
12. Separation, war, prison
13 Disabled spouse
There Is No Single Definition of Infidelity
Where is a Partner
1.
Masturbation
2.
Pornography
to Draw a Line ?
6.
Flirtation
7.
Friendship lacking evidence of
sexual contact
Sending pictures of breasts and
genitals to another
3.
Strip club attendance
8.
4.
Lap dances at strip clubs
9.
Commercial partner sex
5.
Chatting with others about
10.
Casual situational sex
marital dissatisfactions
11.
Love affair
Do You Think Infidelity Can Be
Normal?
Adaptive?
Morally acceptable?
Reasonable?
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Difficult to be Nonjudgmental about Infidelity

Verbs are negative






Cheating
Betraying
Deceiving
Sexual
adventuring
Swinging
Swapping
 Nouns are negative
 Cheater
 Philanderer
 Womanizer
 Slut
 Tart
 Whore
 Floozie
Lexicon: Wide Range of
Infidelities
 Affair vs. affair of the heart or love affair
 Fling, dalliance, indiscretion, one-night stand
 Adultery
 Casual sex
 Acting out
 Sex addiction
People Have to Decide about
Fidelity
Negotiated Nonmonogamy

Polyamory

An arrangement
Open marriage

Swinging

Menage a trios

Troilism
A night out
Swapping
Polygamy
Non-negotiated Nonmonogamy

The unilateral decision to have
another sex partner
 Would my partner ever agree to
what I desire?
 Would knowledge of my desire
harm my partner and our
marriage?
 Would an agreement to allow it
victimize me?
 What are my risks of disgrace,
humiliation and divorce?
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Dichotomous American View on
Infidelity
Public
Monolithic
opposition
Any contrary view = moral
depravity, psychobabble, or
rationalization
Almost everything
that is ever said about
it conveys social
opprobrium
Tarnishes reputations
Arts
Nuanced views in Comedy, Fiction,
Theater, Music, Poetry, Film, Biography,
Essays
Accepted as common
Not invariably negative
Cross cultural and class
aspects
Historic aspects
Dangers are not ignored
*Laura Kipnis, Against Love: A polemic, Vintage, New York, 2003 and Susan Squire,
I Don’t! A contrarian history of marriage, Random House, New York, 2008.
Six Meanings of Acting Out
1.
Disapproved of behavior
2.
Behavior which expresses a fantasy
3.
Behavior which has negative consequences
4.
Behaviors that are created by individual psychopathology
5.
Behaviors that are motivated by unconscious fantasies
6.
Behaviors that arise from the person’s incapacity to put into
words what he or she is actually experiencing
Countertransference
 When we hear infidelity stories, our shock
and emotional stirrings threaten our ability to
remain nonjudgmental, calm, nondirective,
and clear thinking
28
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What Will We Feel If
 We have never known this in our family of origin
 We are currently having an affair
 We already have had several
 Our spouse has been unfaithful
 Our parent’s marriage was characterized by infidelity
Infidelity can be exhausting for the therapist!
Seven Conceptual Tools
Distinctions between
1.
2.
3.
4.
5.
Privacy and secrecy
Guilt, shame, humiliation
Problem, dilemma, conundrum
Values, meanings, feelings
Apology, remorse
6.
Crisis= Danger + Opportunity
7.
Judgment changes over time
Values---> Meanings--->Feelings
 Values organize meanings
 Meanings generate emotional responses
 Patients usually share their feelings directly but not their
implied meanings and values
 Therapists assist in the articulation of meanings and
values
29
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Meaning Makers In a Discovered Affair
Unfaithful one
Aggrieved partner
Paramour
Therapist in the room
Adolescent and older
children
Parents and in-laws
Sibs and friends
Maturation Changes Values
 It is difficult to remain faithful to
any value system for a lifetime






Political
Professional
Religious
Child rearing
Honesty
Sexual
Three Values Positions on
Fidelity
1.
2.
An inflexible basic requirement for love to grow
An ideal that cannot ever mentally, or, often
behaviorally attained for a lifetime
–
–
3.
To be understood in a nuanced and flexible matter
Compatible with loving and sometimes enables it
Stifling to pleasure, against biological tendencies, an
invitation to boredom, and the social source of
many woes
80% of American and British: it is morally wrong!
Thorton, Young-Demarco.Four decades of trends in attitudes…J Mar.& Fam 63:1009.2001
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Third Position
 Many people who hold this value position used to have position
#1 or #2
 Rarely shared except with intimates
 Typically not volunteered to the therapist unless
nonjudgmentally asked
 Male fidelity



was not expected until 17c
is not expected in many cultures today
May be far more common that women appreciate
Therapist’s Role with Newly
Discovered Infidelity
 To maintain our personal balance, to think clearly, to clarify
what the patient is experiencing
 To prevent a rush to a decision about the marriage—that
is, to separate the reactions to infidelity from the matter of
divorce
 To be a force of stability
.
Expectations of the MHP

To understand that extramarital sexual behavior benefits men and
women in ways that cannot be easily spoken about in public

To know that some people highly value their extramarital experiences
and do not experience major regret over time

To recognize that many unfaithful males report that they know of no
married peers who abstain from all forms of extramarital sex

To recognize that many married women have been unfaithful
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Four Recurring Swirling Cognitions in
Newly Discovered Infidelity
1.
What is the meaning of the infidelity to me?
2.
What is the best way I can respond to it?
3.
Will I be abandoned?
4.
Why did this happen?
Affective Processes
1.
Storms of separate feelings making eating, sleeping,
concentration, and usual activities difficult
2.
Feelings are: Sadness, anxiety, fear, anger, guilt, doubt
3.
Indecision about sharing the situation with others
Modifiers of the CognitiveAffective Experiences
 Age + maturity + values = sensibilities
 Character structure
 What one knows about the topic
 Partner’s past infidelity
 Prior experience in family of origin
 Personal experience as an unfaithful person
 The degree of infidelity
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Two-Person Crisis
1.
Anxiety about restructuring of the family
a.
b.
c.
d.
e.
Separation anxiety, panic about being alone, return of old
anxieties
The intensity of the spouse’s reaction is often surprising
to the unfaithful one
Everything is more difficult to transact
Spouses no longer feel in control of their destiny
Each feels like a personal failure
Beyond Two-Person Crisis
 Children react to the changes in parents
 When family members get involved, bonds are suddenly
changed
 Friends can take sides and pass harsh judgments
How to be Helpful
1. Do not personally panic—remain calm and in
good control of your personal reactions
2. Resist being a friend; watch your boundaries
3. Explain the patient’s affective storms in
terms of reactions to the four issues
4. When another storm occurs, clarify which of
questions was its source
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How to be Helpful
5. Articulate that while the storms are occurring is not the time
to make decisions about the future of the relationship
6. Be supportive and empathic about the patient’s plight
7. Do not condemn the partner as a supportive tactic
8. Remain interested and curious about the patient’s evolving
meanings of the infidelity
How to Help the Unfaithful
Person

Ask about what is being felt and considered

Remain interested in motives for the affair and return periodically to the issue

Promote truth telling within limits of partner’s pain

Empathize with the complexity of the situation

Urge delay of major decisions until more affect/meaning is worked through

Equal attention to

Fully explaining the partner’s experience

Understanding the unfaithful person’s post discovery experiences
Forgiveness Is Not……
 Forgetting
 Condoning
 Excusing
 Trusting that it can never happen again
 Forgoing
 Reparation
 Insuring health/safety of the aggrieved
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Two People Seek Forgiveness
The Supplicant
Fruits of Forgiveness
Ends the righteous sense
of superiority
1.
What I did was wrong
1.
2.
I chose to do for my own
reasons—which I can now or
later try to tell you
2.
Dissipation of anger and
vengeance
3.
I now realize that I hurt you
in these ways
3.
End to picturing the
spouse in sex acts with
another
4.
I now regret what I did and
apologize
4.
Beginning of judging the
partner on some other
basis than the infidelity
5.
I evidence continuing
remorse
5.
Seen of being merciful
Four Steps for the Forgiving
Person
1.
Hearing the whole story of what was done
2.
Grieving for what happened
3.
Turning away from interactions that amplify or
needlessly replay the story
4.
Acknowledging that the partner has some good traits—
is more than his or her poor behavior
Post, Neimark. (2007)Why Good Things Happen to Good People. .Broadway Books, New York
Motives for a Second Chance
1.
Infidelity was not the most important consideration: $,
children, family, stability, career more important
2.
Partner has reinvested in us and seeks a higher level love
than we previously had
3.
I, too, have made mistakes
4.
We have exhausted the subject and are exhausted by it
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Why Some Divorce After
Infidelity
1.
Possess a conviction about the first values position
2.
They have a sense of the partner’s character from the story
of the infidelity. “You are not a good enough person for
me.”
3.
The infidelity was an opportunity to have a socially
acceptable reason to leave
Discussion
36
BACKGROUND
AMERICAN PSYCHIATRIC ASSOCIATION
th
168 ANNUAL MEETING
psychiatry.org/annualmeeting
Toronto, Canada ·May16-20,2015
SB Levine, (2006) Demystifying Love: Plan Talk for the Mental Health
Professional, New York, Routledge.
Chapter 1
The Nouns of Love
Love is a noun and a verb, a thing and an action, a concept and an organized set of behaviors, and a subject
that clinicians generally avoid. This avoidance is strange to me because love seems to be vital to us at every
stage of our lives. I find it impossible to think about human developmental psychology, mental health, and
psychopathology without making reference to maternal love, paternal love, friendship, sibling love, love of
God, and love of recreation, vocation, learning, food, or music. The range of love is vast and its processes
inherent in our fundamental essence as human beings (Lewis, 1960).
This chapter and the rest of the book are about love relationships that aspire to a lasting sexual
relationship, an arena in which I have spent all of my professional life. If anything that derives from my
consideration of this confined topic proves applicable to the other forms and processes of love, it will be an
unintended bonus.
Romantic love has been carefully studied in behavioral science for several decades (Hatfield & Rapson,
1993; Regan, 2000). Its neurophysiology has more recently begun to be examined with imaging
techniques(Aron et al., 2005; Bartels & Zeki, 2000), neuroendocrine measurements, and speculations about
pathway activations (Esch & Stefano, 2005). Despite these and other impressive modern works (Gilligan,
2003) and enthusiastic journalistic interpretations of them (Gottlieb, 2006; Slater, 2006), sexual love,
perhaps because it is supposed to last most of a lifetime, is too complicated for the current reach of science.
Science is a bit weak kneed before love because of its intrinsic subjectivity and because so many variables
seem to shape its outcomes(Lee, 1988). What follows is not the product of a scientific process of
hypothesis generation and testing. It is merely the synthesis of one person’s obsession informed by reading,
clinical work, and personal experiences.
What is This Thing Called Love? The Nine Nouns of Love
I can provide at least eight answers, perhaps nine, to this fundamental question, none of which is the right
or most important answer. Taken together, however, the dark mystery of this elusive thing called love
begins to be illuminated. Like those academics who have tried and failed, I have no hope of defining love
in a succinct sentence (Watts & Stenner, 2005). Each of these meanings of love can be periodically sensed
during all stages of adult life.
LOVE IS AN IDEALIZED AMBITION
Love is so intensely celebrated in culture (Jankowiak & Fisher, 1992) that few people can grow up without
longing to experience its highly advertised, full-blown version. Along with this aspiration to fall in love
comes the ambition to reap love’s many promised long-term rewards. Here are several alternate ways to
articulate the specific ambitions inherent in love (Levine, 1998).
1. Love is an ambition to attain a lasting state of interpersonal harmony that will insure enough
contentment that the person will be able to focus on other important matters such as raising
healthy children, having a good job or successful career, or enjoying life.
9
2. Love is the ambition to live a life characterized by mutual respect, behavioral reliability, enjoyment of
one another, sexual pleasure and fidelity, psychological intimacy, and a comfortable balance of
individuality and couplehood.
3. Love is the ambition to find a partner who will accompany, assist, emotionally stabilize, and enrich us
as we evolve, mature, and cope with life’s demands.
When individuals sense they have found the right partner to attain their ambition, they experience a
great and lasting excitement. They are often eager to begin a new phase of life as a couple. When they have
lived for a long time with someone and feel their lives are close to ideal, they experience a sense of mental
stability and say that they are deeply satisfied. What they feel about their partner and about life in general
derives from these private meanings. Despite their enviable situation, most people know their situation can
change.
The ambition of love has two faces: to be loved and to be able to love another. The strength of these
ambitions should not be underestimated. They can persist for a very long time after a partner continues to
disappoint. Optimism that tomorrow will be a better day sustains the ambition. Even when the love
relationship has been declared a failure, the twin faces of the ambition often continue to operate. The
ambition to love and to be loved is not readily exchanged for a lesser set of expectations — although
sometimes the partner is exchanged.
LOVE IS AN ARRANGEMENT — A DEAL
All adult sexual relationships are deals — quid pro quo exchanges of hopes, expectations, and assets. The
social process for arranging such a deal is called dating or courtship. During courtship, the minds of the
two people are often privately preoccupied with the answers to the question, “What will this person bring to
my life?” The question can be asked about many dimensions: social, economic, aesthetic, recreational,
sexual, medical, time-to-death, and more.
Young people in their first relationships generally do not prefer to think in these terms. They think
more romantically and are often too embarrassed to admit that they thought about the specific assets of the
partner. Their embarrassment dissipates with age and the accumulation of experiences in subsequent
relationships. Love as a deal can be clearly perceived after a relationship is ended by breakup, divorce, or
death and the person begins with someone new. During the second (or third or fourth) time around people
are often able to weigh the factors that will determine their involvement. Not only do they carefully
consider potential partners’ assets, they are able to discuss their analysis of the potential arrangement with
friends.
When we refer to love as a deal, we mean that the person accepts the arrangement — the exchange of
assets. Each person perceives what has been offered by the partner. Of course, perceptions vary in
accuracy. While there can be a lot of excitement in anticipation of making a deal, once the deal is formally
accepted, people often feel a celebratory degree of pleasure, interest, sexual desire, and think that life is
good. In some cultures, parents make the deal. The adolescent or adult children only court after they know
who their spouse is to be. They then hope to fall in love through courtship and the early processes of
marriage.
LOVE IS AN ATTACHMENT
Once the deal has begun to be worked out, love comes to mean a bond or attachment. People weave their
psyches together and begin to feel a hunger to be with the other person more. They think of themselves as
belonging with and to the other. Mental couplehood begins in the minds of two individuals early in the
relationship though not necessarily at the same rate or to the same extent. Sexual activities, particularly
those that involve orgasm, facilitate the private sense of attachment, and the attachment induces strong
motivation to attain love’s ambitions.
LOVE IS A MORAL COMMITMENT
Society has a great interest in love. After the deal is made, most people seriously think about marriage and
a marriage ceremony. The rituals which sanctify marriage emphasize love as a moral commitment. While
the clergy may be uncertain that the ambitions of love can actually be attained on earth, they teach the
couple that love is a commitment to try to realize love’s grand ambitions. The charming emotions that
occur in the bride and groom and their families during the ceremony are only the internal music that
10
accompanies the public promise of two people to honor and cherish each other through all of life’s
vicissitudes. The ceremony officially raises the bar of expectations; the new spouses are expected to honor
their vows. Whether religious or secular, the ceremony instantly restructures life and generates a new set of
obligations. Love as a moral commitment begins as a strong set of obligations for a lifetime.
People vary in how seriously they take their vows. Those who are very serious will feel painful and
persistent guilt when they contemplate extramarital affairs and divorce, even many years after the marriage
ceremony. The moral nature of the commitment is more excruciatingly felt when unhappily married
parents grapple with the agonizing dilemma between their commitment to provide their children with two
live-in parents and the wish to be free of unhappiness with their partner.
LOVE IS A MANAGEMENT PROCESS
While a couple’s love exists in the mind of community (“They are a couple”) and between the two attached
adults as they relate publicly and privately in ways unique to couples, the most important place that love
exists is in the privacy of each partner’s mind.
Many of the positive and, particularly, the negative mental processes involved in loving another person
must remain private from the partner. Under ordinary circumstances, we wisely do not share too much of
our anger and disappointment about our partner. We intuitively realize that our partner needs the illusion
that we do not struggle to love them. It is ironic that both partners tend to believe that it is not a trying
struggle to love them, even though each is quite aware how often he or she struggles to love the partner. If
our partners knew how much we struggled to contain our anger, disappointment, and regret over the deal
we made, they would worry too much and fear the devastating impact of abandonment. We protect them.
Love as a management process is the practical day-to-day work of love. The usual immediate goals of
this work are to remain prudent about what one says, to remain diplomatic about how one says it, to
maintain perspective about the bigger things in one’s life, and to prevent the partner from realizing what is
actually transpiring within one’s mind. Absolute honesty sounds good as a rule, but its interpretation has to
be refined in order to not create interpersonal chaos. A husband’s and a wife’s marriage are two separate
subjective states — his marriage and her marriage, each of which exists in the privacy of the person’s own
mental world.
Love is good self-management in relationship to the beloved. Much of adult life is spent with an
awareness of the gap between our private sense of ideal love and our actual experience of our self and our
partner in a relationship. The gap is a source of existential distress and, like all subjective distress, is
buffered by an array of competing life demands (“I have children to raise”), defense mechanisms (“I keep
telling myself that no partner is ideal”), and self-management techniques (“Take a deep breath and focus on
your work!”). When the buffering system works, one's love relationship, while not continuously or
completely harmonious, is good enough. The private mental struggle to maintain cooperative, kind
behaviors exists in all people, even the happily married.
LOVE IS A FORCE OF NATURE
Love is a force in nature that creates a unity out of two individuals. At a certain time in life it casts our fates
together, organizes reproduction, and remains vital to our adult growth and development and to the
maturation of our children. This love is a skeleton that supports the sexual and nonsexual processes of our
lives (Lear, 1990). It is not unlike the forces that organize reproduction in other animals. It can be studied
both in terms of an individual’s biologic processes and in terms of how collections of individuals behave
(Crews, 1998). We humans, after all, have a great deal in common with each other. This force of nature
acts upon us without a constant awareness of its presence. It is most pleasingly discussed at the beginning
of relationships when people are happily amazed at the transformations in their lives that their new
arrangement has brought about. But it can also be seen at the other end of the life cycle when people stay
together because they have always been together, even though all the forces that brought them together
have long since vanished. Older people often recognize that their partner is now an inextricable part of
themselves and that they can never be psychologically free of the partner. Nature — the underlying
biological force that brought them together socially — gave them culturally approved tasks that kept them
together, and now having slowly attenuated their capacities, has had its way with them.
11
LOVE IS A TRANSIENT EMOTIONAL STATE
Love is not a feeling but a combination of two, and sometimes three or more feelings. The basic two are
pleasure and interest. The third more variable feeling is sexual arousal. When I declare that I love the book
I am reading, you can assume I feel pleasure and interest in it. When I sincerely state that I feel love for a
person I may mean that I sometimes have sexual inclinations as well.
In order to understand love as a transient emotional state rather than a feeling, we must understand that
the words feeling and emotion are not synonyms. A feeling is a simple experience of sadness, anger,
disappointment, aversion, pleasure, or interest. An emotion is built from feelings but is more complex and
consists of two or more simultaneous feelings. Feelings and emotions alert us to the meanings of events and
processes within our relationships. They are our first warning system for the changes in our external and
interpersonal environment.
Two separate patterns explain emotions. First, emotions exist because events typically create more than
one feeling. Anything important to us typically creates an array of feelings. When a woman, for instance,
learns that her newly beloved thinks about her in the same terms and declares his wish to marry her, her
feelings might consist of pleasure to the point of joy, interest to the point of fascination, pride in being
highly valued, gratitude, sexual arousal, and awe. Yes, she may be described as having the feeling of
happiness, but this simple summary does not capture the separate feelings that she is experiencing, their
fluctuating intensities, or their individual time courses.
Second, emotion is created because we humans have feelings about our feelings. Consider this
example: A child of a certain age can experience envy. But, when a child is taught that it is wrong to feel
envy, the subsequent experience of envy may evoke anxiety from the guilt of feeling something of which
parent disapproves. If the parent is watching while envy occurs, the child may experience shame as well. In
this child, an initial simple feeling of envy has become an emotion comprised of envy, anxiety, guilt, and
possibly shame. All of us can experience the simple feeling of envy. The emotion of envy, however, varies
among us based on our attitude toward envy. Your envy may be an unencumbered feeling while mine can
be a complex guilt and anxiety-provoking array.
Here is a second example of how family and culture create emotion out of simple feeling. A religious
middle-aged man averts his gaze when he sees an attractive woman, feels guilty and anxious, and tries to
redirect his thoughts to his wife. He explains that this is the proper way of handling his sinful response to
another woman. His mere aesthetic appreciation of another woman — a simple feeling of pleasure from
someone who is visually pleasing — has become a complex emotional process.
The emotions of love are particularly complicated. Feeling intense pleasure and interest in a potential
new partner quickly stimulates some internal reaction to this incipient love. It may stimulate apprehension,
eagerness, or guilt, for instance, depending on the circumstances of the person’s past or current life. When
one person contemplates saying “I love you” to another, anxiety appears. The speaker often feels danger
because he or she realizes it will have an important meaning to the listener. Sincere first declarations of
love are very anxious moments. They inform the listener that important transformations have already
occurred in the speaker. How will the listener respond? Pleasure and interest in the partner at that moment
are often overshadowed by trembling fear.
Sexual interest and arousal are often associated with the intense pleasure and interest in a new partner.
The sexual arousal continuum varies from slight genital tumescence to profound, preoccupying bodywide
sexual arousal (Levine, 2003). Since “I love you” can create sexual arousal in the listener, the phrase can be
used when the primary pleasure and interest in the person is the anticipation of sex. The meanings and
motives for expressing love change all the time. When a person says to us, “I love you,” we have to discern
both its meaning and motive. Sometimes it means only, “I want to have sex.” A genuinely felt “I love you”
expressed immediately after sex may reflect an intense psychological pleasure experienced during the
previous moments. But such statements may be made out of politeness rather than being genuine.
Most people do not understand the difference between a feeling and an emotion. As a result, they may
spend years anxiously waiting to experience the feeling of love. Privately, they are uncertain what love is,
yet they assume others experience it. They may be tempted to fake love and mislead their partners about
their degree of pleasure and interest in them. Although it may initially be shocking to learn that love is not a
feeling, it can be liberating to understand the ordinary complexity of love. Love is the label we give to a
range of transient emotional experiences. Love is always complicated by past, present, and future
considerations.
12
LOVE IS AN ILLUSION
We want to think positively about love. We want to believe in it as a concept. We want to assume that we
are loved by our partner. We want to think that we love our partners. In order to maintain these beliefs, at
times we need to create certain distortions or illusions for both ourselves and for our partners. Love as an
illusion refers to the fact that we create love by internal private processes, maintain it by prudent diplomatic
dishonesties, and can lose it for our partner without the partner knowing it. We can courageously face the
fact that the processes of love require defensive distortions of a person’s feelings, thoughts, and perceptions
in order to remain in an intimate relationship. Defense is the psychiatric term for an illusion. As individuals
gain experience, many can look back and see that many of their assumptions about love were self-serving
illusions. Some dismiss their entire relationship with “What was I thinking?” They usually don’t literally
mean that they never experienced any transient emotions of love for the partner, they mean that now they
can perceive that they created illusions so as not to admit to themselves the depth of their disappointment
with their partner or themselves during the relationship.
Love as an illusion does not mean that there is no such thing as love or that all felt love is an illusion. It
only means that self-perceptions as loving and as beloved can prove to be inaccurate. It also means that
society, through its educational and religious institutions, through its celebrations of love in song, and
though its academic discourses on the topics, fosters simplistic notions about love that encourage us to
behave as though we all know what it is.
LOVE AS A STOP SIGN
This ninth meaning of love is a first cousin to love as an illusion. The stop sign is visible to clinicians and
others as well. While many people state that they love their partners, they are baffled, tongue-tied, or
stumped to explain themselves if asked “Why?” While this can be simply an unwillingness to answer the
question, the motive for the stop sign is often an unwillingness to think about the question: The stop sign is
a defense against self-discovery. The statement, “I don’t want to pursue the subject further!” protects the
person from confronting the illusory aspects of his or her love. The word we use when we don’t want to
examine this arena of ourselves is love. Love, the stop sign, ends the inquiry.
Example 1
Lover A: I love you.
Lover B: Why do you love me?
Lover A: I don’t know, I just do!
Example 2
Doctor: Why do you put up with that behavior from your spouse?
Patient: Because I love him!
Doctor: What does that mean?
Patient: I don’t know.
Example 3
Patient (crying): She’s using crack again, she ignores our children, she got pregnant last year during
her long visit with her parents and had an abortion without telling me, and now she is running
around with her drug dealer. She simply cries every time I mention how long it has been since we
were together sexually. Everyone says I should divorce her.
Doctor: And why do you not?
Patient: I still love her. (Sobbing increases)
Doctor: What does that mean?
Patient: I have no idea…. I feel we could be so good together… I still vividly remember the day
when I was 11 and my father left us with his suitcase in hand. He saw me crying and said he
would be back soon. I did not hear from him for three years.
Our motives for entering a particular love relationship and staying in it are intensely private matters.
Much of what clinicians assume to be unconscious in this regard may be a mixture of unconscious and
13
quite conscious but private awareness. The patient may think of these motives as the darker side of love —
that is, the social, material, future economic, or psychological considerations. In any particular
conversation, the person may see fit to hide these motives because the clinician is not yet trusted with such
personal information. Thus, “I love my partner” is a stop sign, a functional part, conscious or unconscious,
of the eighth meaning of love. It says, “Allow me to maintain my illusions please.”
Lurking behind the stop sign may be the belief that the person’s love for his or her partner is not
genuine. The person may not understand that love is ordinarily part illusion. The stop sign may be a
reflection that he or she does not understand the nature of love.
Final Thoughts
I have a suggestion for how to use this chapter: eavesdrop. The next few times you hear or read the word
love, professionally or privately, see if you can discern which of the following noun meanings of love is
being invoked. Is it love: the ambition; the deal; the attachment; the commitment; the management process;
the force of nature; the emotions; the illusion; the stop sign, or something else? Then consider whether you
think the speaker or writer demonstrates any awareness of the range of possibilities of meanings of this
word.
Finally, I want to acknowledge a limitation of the metaphor of love as a noun. While the noun title
headings are static sounding, my descriptions of each of the nine nouns is quite dynamic. The nouns have
an ongoing, ever changing impact on our mental lives. The nouns of love create the verbs of love. After we
have considered the processes or the verbs of love in chapter 2, I hope we will agree that love is a series of
things and behaviors across the life cycle. Love is not a set of nouns or verbs, it is both, and each needs the
other to be understood.
References
Aron, A., Fisher, H., Mashek, D. J., Strong, G., Haifang, L., & Brown, L. L. (2005).
Reward, motivation, and emotion systems associated with early stage intense
romantic love. J. Neurophysiology, 94, 327-337.
Bartels, A., & Zeki, S. (2000). The neural correlates of maternal and romantic love.
Neuroreport, 11, 3829-3824.
Crews, D. (1998). The evolutionary antecedents to love. Psychoneuroendocrinology, 23,
751-764.
Esch, T., & Stefano, G. B. (2005). The neurobiology of love. Neuroendocrinology
Letters, 26(3), 175-192.
Gilligan, C. (2003). The birth of pleasure: A new map of love. New York: Vintage Books.
Gottlieb, L. (2006, March 2006). How do I love thee? Atlantic Monthly, 297, 58-71.
Hatfield, E., & Rapson, R. L. (1993). Love, Sex, and Intimacy: Their psychology, biology,
and history. New York: HarperCollins College Publishers.
Jankowiak, W. R., & Fisher, E. F. (1992). A cross-cultural perspective on romantic love.
Ethnology, 31, 149-155.
Lear, J. (1990). Love and Its Place in Nature: A philosophical interpretation of Freudian
psychoanalysis. New York: Farrar, Straus&Giroux.
Lee, J. A. (1988). Love-styles. In M. L. Barnes (Ed.), The Psychology of Love (pp. 3867). New Haven, Ct.: Yale University Press.
Levine, S. B. (1998). Sexuality in Mid-Life. New York: Plenum.
14
Levine, S. B. (2003). The nature of sexual desire: A clinician's perspective. Archives of
Sexual Behavior, 32(3), 279-285.
Lewis, C. S. (1960). The Four Loves. New York: Harcourt Brace.
Regan, P. C. (2000). Love Relationships. In F. Muscarella (Ed.), Psychological
Perspectives on Human Sexuality (1st ed., pp. 232-282). New York: John Wiley
& Sons.
Slater, L. (2006, February, 2006). True Love: The chemical reaction. National
Geographic, 209, 32-49.
Watts, S., & Stenner, P. (2005). The subjective experience of partnership love: A Q
methodology. British Journal of Social Psychology, 44, 85-107.
15
REFERENCES
AMERICAN PSYCHIATRIC ASSOCIATION
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References
1. Levine SB. (2013) Barriers to Loving: A Clinician’s
Perspective. Routledge, New York,
2. Kernberg OF. (2012) Love and Aggression., American
Psychiatric Press, D.C.
3. Sternberg R, Weis K. (2007) The New Psychology of Love,
New Haven, Yale University Press
4. Fisher H, Aron A, Brown LL. Romantic Love: An Fmri Study
Of A Neural Mechanism For Mate Choice. J Comp Neurol.
2005 Dec 5;493(1):58-62.
5. Freud, S. (1912). On The Universal Tendency To
Debasement In The Sphere Of Love. In J. Strachey (Ed.), The
Complete Psychological Works of Sigmund Freud (Vol. XI, pp.
178-190). London: Hogarth Press.
6. Hatfield E. & Rapson R. L. (2009). The Neuropsychology Of
Passionate Love And Sexual Desire. In E. Cuyler and M.
Ackhart (Eds.). Psychology Of Social Relationships.
Hauppauge, NY: Nova Science.
7. Levine SB. (2006) Demystifying Love: Plain Talk For the
Mental Health Professional. Routledge, New York.
SELF
ASSESSMENT
AMERICAN PSYCHIATRIC ASSOCIATION
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Self Assessment Questions
1. Love as a stop sign refers to
A. The bonding function of courtship stops people from being interested in
others
B. The commitment to love in keeping with culture’s deep grasp of love’s
expectations over the lifecycle stops aggression from being directed at
the spouse
C. The tendency to employ the term love as an explanation for behavior
when a person does not want to discuss deeper motivations
D. Love’s capacity to enable one to conquer one’s narcissism in relationship
to one’s spouse or mate
E. The implicit warning to go slow when one is considering a partner as a
potential life mate
2. It is reasonable to be wary of flowery speeches about love for a partner
because
A. Love is primarily felt by the partner as a kind action taken to cooperate,
to help, to make life easier or nicer; words without these caring behaviors
become disingenuous
B. The term love has no specific meaning so a listener can interpret in
numerous ways
C. The term love has four meanings; which one is being referred to in a
speech?
D. Love is primarily a grand cultural illusion
E. The motives behind declarations of love are always hidden
3. Falling in love
A. Begins as a two-person behavioral phenomena with enormous sexual
energy
B. Begins as subjective one-person phenomena
C. Predicts at least five years of marital happiness
D. Is provoked by sexual intercourse
E. May begin because of a perception of shared understanding and apparent
compatibility
4. Staying in love is facilitated by
A. Overcoming narcissistic entitlement in relationship to the partner
B. Good negotiation skills
C. Emotional competence to dampen one’s hostile impulses in face of
disagreement
D. Emotional genuineness
E. All of the above
5. The nurturance systems in a long term relationship are
A. Functional conversation and sex
B. Shared intense emotional experiences and sex
C. Recurrent psychological intimacies and mutual sexual pleasure
D. Money and sex
E. Common childhood traumas and shared environmental pleasures
6.
A.
B.
C.
Infidelity
Has many neutral sounding synonyms
Is a hallmark of those who call themselves Polyamory
Has a prevalence that varies broadly from study to study such as 3 to
85% depending on specific definitions used for the term
D. Occurs ~once a year in 35% of educated American couples less than 50
years of age
E. Is a reliable sign of significant individual psychopathology
7. When a spouse discovers that her husband is having sex with another
woman she typically experiences all of these affect laden questions within
the first two weeks except
A. How much money can I get in a divorce settlement?
B. Am I to blame for this?
C. How shall I respond to this?
D. Will I be abandoned?
E. Am I losing my mind?
8. Compendium of love’s problems
A. Replaces the need for a DSM-5
B. is one theorist’s attempt to demonstrate the relevance of love to
psychotherapists
C. has four major divisions
D. emphasizes the apprehension of partner’s deficiencies above all other
factors in love
E. does not include changes in sexual identity over the life cycle
9. Love/lust split (All are correct but one)
A. is likely to be a normal transient developmental phenomenon of
adolescence
B. is a deathblow to continuing sexual activity within marriage
C. occurs among heterosexual and homosexual individuals
D. was described a century ago by Freud
E. is always due to incestuous fixation on opposite sex parent
10. The benefits of forgiveness are all of the following except
A. Forgetting the extramarital affair entirely within several years
B. Ending the righteous sense of superiority
C. No longer imagining the partner having sex with another person
D. Begin to judge partner on a different basis than the affair
E. Gaining the respect of the forgiven for one’s compassion and mercy
Answers
1. C
2. A
3. B
4. E
5. C
6. C
7. A
8. B
9. E
10. A
8/7/2014 9:10:00 PM
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