Bruce Alan Kehr, M.D.Bruce Alan Kehr, M.D. is the Founder and President of Potomac Psychiatry, ranked “Best Psychiatry Care Provider in Maryland” in 2020 by Global Health & Pharma. He has been named a Washingtonian Magazine “Top Doctor” for each of the past eight years. Dr. Kehr is a best-selling author whose works have been read by over 800,000 people in 206 countries. In 2020, Dr. Bruce Kehr’s blog was ranked #2 in the nation among mental health-related blogs.  Dr. Kehr’s book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, is an Amazon Best Seller in the self-help categories: Happiness, Counseling, Healing, and Self-Esteem.

I’ve been lonely
I’ve been waiting for you
I’m pretending and that’s all I can do
The love I’m sending
Ain’t making it through to your heart
You’ve been hiding, never letting it show
Always trying to keep it under control
You got it down and you’re well
On the way to the top
But there’s something that you forgot

What about love
Don’t you want someone to care about you
What about love
Don’t let it slip away
What about love
I only want to share it with you
You might need it someday

I can’t tell you what you’re feeling inside
I can’t sell you what you don’t want to buy
Something’s missing and you got to
Look back on your life
You know something here just ain’t right

What about love
Don’t you want someone to care about you
What about love
Don’t let it slip away
What about love
I only want to share it with you
What about love
Don’t you want someone to care about you
What about love
Don’t let it slip away
What about love
I only want to share it with you

In listening to lead singer Ann Wilson belt out these lyrics from the rock band Heart’s famous song, “What About Love,” I was mindful of how music can capture the emotions we all feel when we are in love. Ann’s rendition of these lyrics poignantly expresses the challenges of establishing and maintaining intimacy. What makes it difficult to establish and maintain long-lasting feelings of love? What are the trials we go through that challenge our ability to sustain love over the course of a lifetime?

Our capacity for intimacy begins in childhood, as we establish the initial emotional bonds with our mother and father. Typically these are our first experiences with another human being, and they have a profound influence on our emotional development, and later capacities to form intimate relationships. For some, these child-parent bonds may be rock solid, trustworthy and secure; in which case our capacity for intimacy will be well developed and stable. For others, during the course of our childhood years our parents may be unavailable, inconsistent and self-absorbed, emotionally volatile, and/or physically or sexually abusive; and in these instances our capacity for later-life intimacy will be damaged. These emotional wounds may be expressed in a number of ways, as our yearnings for a stable love relationship encounter our fears of commitment, feelings of mistrust, and narcissistic injuries that form the residue of the damaging parental relations of childhood. “What About Love” captures the lingering effects of this trauma beautifully, as Ann sings:

I can’t tell you what you’re feeling inside
I can’t sell you what you don’t want to buy
Something’s missing and you got to
Look back on your life
You know something here just ain’t right

As we move into adulthood, love relationships that don’t work out may further wound the human heart. A series of disappointing love affairs, the breakup of a long-term committed relationship, or marital separation and divorce may leave lasting emotional traumas that play out to damage or destroy the possibility of later intimate relations. At times the breakups are the result of making poor choices, for example repeatedly engaging in relationships with people suffering from Narcissistic Personality Disorder. At other times we might select someone capable of providing us adult love, empathy and compassion, yet our own conflicts over intimacy may contribute to or cause a breakup.

As a result of these negative childhood, adolescent or adult experiences a “repetition compulsion” may develop, where one unconsciously repeats earlier traumas through patterns of self-sabotaging behavior carried out in existing or new relationships, time and time again. These unconscious behaviors may interfere with or destroy intimate bonds. Feelings of love and tenderness may develop toward one another, but difficulties in trusting and expressing these emotions directly, out of fear of further hurt, loss, or a lack of reciprocal feelings from one’s loved one, complicate the relationship. The number one hit song by Heart, entitled “Alone” poignantly captures aspects of these conflicts:

I hear the ticking of the clock
I’m lying here the room’s pitch dark
I wonder where you are tonight
No answer on the telephone
And the night goes by so very slow
Oh I hope that it won’t end though
Alone

Till now I always got by on my own

I never really cared until I met you
And now it chills me to the bone
How do I get you alone
How do I get you alone

You don’t know how long I have wanted
to touch your lips and hold you tight
You don’t know how long I have waited
and I was going to tell you tonight
But the secret is still my own
and my love for you is still unknown
Alone

Till now I always got by on my own
I never really cared until I met you
And now it chills me to the bone

How do I get you alone
How do I get you alone
How do I get you alone
How do I get you alone
Alone, alone

In these lyrics the singer describes someone who is deeply in love, who has previously tried to get by on their own without depending on another, and now she or he finds themself alone and feeling somewhat desperate. Perhaps it is because they have not expressed their tender feelings to the one they love, or their loved one is afraid to spend intimate time alone with just the two of them because it feels too close and threatening. Fears of further hurt, rejection, a lack of reciprocal feelings of love, dependency and vulnerability can all play a part in interfering with intimacy.

Examples of self-sabotaging repetition compulsions include the young adult woman who acts out sexually with a series of young (or older) men, in a futile attempt to find emotional intimacy, love and affection. Or the young man who engages in a series of meaningless hookups to prove his prowess, and gain narcissistic gratification, because of underlying self-esteem problems that began as a child, perhaps resulting from repeated disappointments in his relationship with his mother or father where he felt powerless. Some of these young adult relationship themes are captured in the song by Pat Benatar entitled, “Love is a Battlefield

We are young, heartache to heartache we stand
No promises, no demands
Love Is A Battlefield
We are strong, no one can tell us we’re wrong
Searchin’ our hearts for so long, both of us knowing
Love Is A Battlefield

You’re beggin’ me to go, you’re makin’ me stay
Why do you hurt me so bad?
It would help me to know
Do I stand in your way, or am I the best thing you’ve had?
Believe me, believe me, I can’t tell you why
But I’m trapped by your love, and I’m chained to your side

We are young, heartache to heartache we stand
No promises, no demands
Love Is A Battlefield

We are strong, no one can tell us we’re wrong
Searchin’ our hearts for so long, both of us knowing
Love Is A Battlefield

We’re losing control
Will you turn me away or touch me deep inside?
And before this gets old, will it still feel the same?
There’s no way this will die
But if we get much closer, I could lose control
And if your heart surrenders, you’ll need me to hold

We are young, heartache to heartache we stand
No promises, no demands
Love Is A Battlefield

We are strong, no one can tell us we’re wrong
Searchin’ our hearts for so long, both of us knowing
Love Is A Battlefield

We are young, heartache to heartache we stand
No promises, no demands
Love Is A Battlefield

We are strong, no one can tell us we’re wrong
Searchin’ our hearts for so long, both of us knowing
Love Is A Battlefield

Another example is when one repeatedly and unconsciously picks a fight following intense closeness and feelings of happiness (for example, following highly passionate sex), as a way of creating emotional distance because of feeling vulnerable, a loss of control, and the fear of dependency that is engendered by intimacy. And not uncommon is the adult who has lived through a painful divorce, who dreads what he or she believes may become another conflict-ridden relationship. Consciously or unconsciously they avoid falling in love again, or sabotage the development of intimacy in a new love relationship, because of the unresolved emotional trauma resulting from the prior marital separation and divorce.

And then there are the life stage crises that test the bonds of love and marital fidelity. Our life cycle brings different challenges to the human heart at each phase. These trials may include: a fear of commitment during courtship and early marriage; the demands of child rearing that make intimate moments difficult to establish, with longings to return to a simpler time with fewer responsibilities and more romance and freedom; conflicts over how to raise children; a mid-life crisis where one may have intense doubts about choices they have made, or feel highly dissatisfied with their level of professional or financial accomplishment; periods of financial distress; the death of one’s parents; and the realization of one’s own mortality, and the issues surrounding growing old and dying (such as a loss of power, chronic health problems, and major life regrets).

Sometimes a couple may grow apart as they evolve in different directions, or one member may outgrow the other emotionally or intellectually. This can place significant strains on the relationship, as compellingly characterized in the movie, “The Blue Valentine.”

The human heart is complicated, isn’t it?

Psychotherapy can be very helpful in uncovering the unconscious causes of repetitive failed relationships, and the difficulties in establishing or maintaining intimacy. The therapist engages the patient in a caring and trusting relationship, encourages the patient to free associate about their thoughts, feelings, fantasies and memories related to the current and earlier love relationships, and over time the unconscious conflicts emerge. Both the therapist and the patient need to commit to a longer-term therapy to work through the emerging issues that interfere with intimacy. This takes courage. At times it involves emotionally painful sessions, as the patient intensely relives earlier traumatic relations in what is called “abreaction.” The therapeutic process uncovers prior experiences of conflicted relationships that damaged feelings of closeness and intimacy, and the development of trust. The patient grieves the loss of what had been yearned for yet remained unfulfilled, and reaches an understanding that puts into perspective the reasons for the earlier disappointments and heartbreaks. This process enables one to let go of the traumatic experiences, bringing with it a freedom to experience healthier adult love. It is very gratifying for the therapist to see the patient emerge from this process happily engaged in a more mature love, with their heart finally released from the emotional bonds created by the past traumas. What is learned in therapy will hopefully be applied time and again over the course of one’s lifetime; because intimacy, once achieved, is fragile.

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