While some people take it for granted that patients fall in love with their therapists, the fact that patients do so with some regularity is astonishing. Of course, therapists call these feelings transference, but the patient often experiences them as genuine feelings of love and longing. Furthermore, therapists besotted with love for a patient often think their own reactions are far more than mere countertransference.
Sigmund Freud was the first to describe the phenomenon of the erotic transference, theorize its origins, and make a connection between transference and romantic love. But an understanding of the erotic transference did not spring full-blown, even to Freud. His introduction to the phenomenon began with a strange series of events that he learned about through his mentor and collaborator Josef Breuer.
The talking cure was an early precursor of psychoanalysis and developed in the course of Breuer's therapy with "Anna O," a woman with many hysterical symptoms. She initiated a free association, in which speaking of the origins of each symptom caused it to disappear. She called this process "chimney sweeping." Breuer, who was fascinated with Anna O's treatment, was thought to have ignored his wife and thereby provoked her jealousy. Chagrined, he terminated Anna O's treatment. Shortly afterward, he was called back to find her in the throes of a hysterical childbirth. He calmed her down, but the next day he left to take his wife on a second honeymoon.
Freud reported these events in a letter to his wife, Martha. In The Life and Work of Sigmund Freud (1953-1957, Basic Books) Ernest Jones, M.D., noted that Martha identified with Breuer's wife and hoped the same thing would not happen to her. Freud reproved her vanity in supposing that other women would fall in love with her husband; for that to happen, he would have had to be Breuer. Only later did Freud come to see Anna O's reaction as the rule, rather than the exception.
It was not easy for Freud to arrive at insight into the erotic transference. Simply being a close colleague seems to have brought him too close to the phenomenon for comfort. Freud's reluctance in recognizing the phenomena may be some measure of the power and threat that erotic transference exerts even to this day.
Ultimately, Freud's understanding of the phenomenon of transference love deepened in response to his growing knowledge of other such transferences. He was privy to several instances of enacted patient-doctor affairs. For example, at a time when Carl Jung was still a disciple of Freud, Jung fell in love and began a relationship with one of his patients, Sabina Spielrein. This was well-known to Freud because Spielrein fled Jung to go into treatment with Freud.
Freud formulated the dynamics of the erotic transference as re-enactments of a patient's early life impulses and fantasies that emerge during the process of analysis and that replace a protagonist from the patient's past life with the person of the therapist. At first, he placed more emphasis on the repetition inherent in transference and not on its subjective reality for the patient, having not yet distinguished the dramatic difference between the way the patient experienced transference and the way the psychoanalyst viewed it.