Sex in Psychotherapy

Sexuality, Passion, Love, and Desire in the Therapeutic Encounter

Lawrence E. Hedges

• Publisher: Routledge
• Year: 2011
• ISBN:
  9781135192440
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychothérapie

Sex in Psychotherapy takes a psychodynamic approach to understanding recent technological and theoretical shifts in the field of psychotherapy. Lawrence Hedges provides an expert overview and analysis of a wide variety of new perspectives on sex, sexuality, gender, and identity; new theories about sex's role in therapy; and new discoveries about the human brain and how it works. Therapists will value Hedges's unique insights into the role of sexuality in therapy, which are grounded in the author's studies of neurology, the history of sexuality, transference, resistance, and countertransference. Clinicians will also appreciate his provocative analyses of influential perspectives on sex, gender, and identity, and his lucid, concrete advice on the practice of therapeutic listening.

PART 1
PERSPECTIVES
FOR
CONSIDERING
SEX, SEXUALITY,
GENDER, AND
GENDER IDENTITY

1
SEX, SEXUALITY, GENDER, AND IDENTITY

The Natural/Religious/Biological Perspective

Plato’s myth of the first humans with four legs, four arms, and two heads who were cleft in two by divine intervention, thus leaving male and female beings forever searching for their other halves, expresses the widespread belief that humans are naturally divided into two sexes with heterosexual motivation—although Plato did make room for some beings attracted to their own sex.

Despite tolerance for sexual variations in both antiquity and cross culturally throughout time, the hierarchical orders of the Greek city-states and later nation-states have generally supported a heterosexual orientation that ensures a distribution of wealth and inheritance rights according to what has been considered a natural principle of heterosexual patriarchal dominance.

We note, for example, that the orderly procession by twos into Noah’s Ark does not include any creatures sporting lavender fur collars, waving rainbow flags, or riding motorcycles—much less any creatures representing other minority community banners like those we now see flying in Internet chat rooms. The ark is decidedly heterosexual—dominated by male ordering. It is certainly fair to say that religious doctrines and governing powers around the world for at least 6,000 years have generally supported some form of natural or God-given heterosexual patriarchy based on male dominance and female submission, with other forms of sexual interest and curiosity generally repressed or subverted.

Biological science both before and after Darwin affirm the natural occurrence of male and female forms as essential for reproduction, with intersexed and other “queer” forms of sex and sexuality generally considered aberrant. The science patriarchy teaches that natural selection must involve exclusively male and female forms—and that other deviant tendencies quite naturally die off. But, such dogma at this point in the development of our knowledge simply makes no sense.

The year 2005 marked the centennial of the publication of Sigmund Freud’s Three Essays on Sexuality (1905/1975) and its iconoclastic shattering of historical innocence regarding human sexuality. While Freud sought to establish a biological basis for the sexual and aggressive drives, at all times he was mindful of the wide variety of biological, as well as culturally constructed, psychological sexual experiences. According to Steven Marcus (1975), in the forward to Freud’s three essays:

In its disclosure to the world of the universality and normality [emphasis added] of infantile and childhood sexuality in all its polymorphously perverse impulsiveness, Freud’s Three Essays was bringing to a close that epoch of cultural innocence in which infancy and childhood were regarded as themselves innocent, as special preserves of our lives untouched by desires, strivings after selfish pleasure, twinges of demonic perversity, [and] drives toward carnal satisfactions. … Some considerable measure of the odium that was attached for years to Freud’s name has to be understood in this light. In the name of truth and reality, he undertook to deprive Western culture of one of its sanctified myths. Cultures do not as a rule take kindly to such demythologizings, and it should come as no surprise that of all of Freud’s findings those that have to do with infantile and childhood sexuality were resisted with the most persistency. (pp. xx–xxi)

Freud’s seminal 1905 essays assume a universal and natural biological bisexuality (Freud, 1905/1975). His position holds that any and all of the many biological, cultural, and individual variations of sexual curiosity, interest, and activity are universal interests that all humans are capable of pursuing. In other words, we are much more complex sexual beings than had ever before been imagined.

Despite early feminist bashings of Freud, later reconsideration reveals that he, perhaps more than any other Victorian liberal, is to be credited for paving the road not only for equality between the sexes but also for a recognition of all forms of sexuality as essentially natural and universal. Said Freud (1905/1975): “Psychoanalytic research is most decidedly opposed to any attempt at separating off homosexuals from the rest of mankind as a group of special character” (p. 145). For example, in Adrienne Harris’s reading of Freud’s 1924 essay on a case of female homosexuality, we find that

Freud traces out the view that sexuality and identity can never be simply some hard-wired, constitutionally driven forms but, rather, that the formation of sex and identity operates like the rules of grammar. … [Following Chomsky, she states that] any human experience of sexuality and identity is built on a unique and particular sexual sentence in which elements of subjectivity, action, and object are never inherent or inevitable. … The play of sexual forms and symbolic meanings for bodies, selves, and acts are the radical core of Freud’s theory of desire and gender. (Harris, 1991, in Mitchell and Aron, 1999, p. 310)

Harris (1991, in Mitchell and Aron, 1999) points out the “golden possibilities” in Freud’s unsettled, wondering, open register and speculated on how little we know of whom and why we love. “It would seem that the information received by our consciousness about our erotic life is especially liable to be incomplete, full of gaps, or falsified” (Freud, 1924, pp. 166–167). Harris adds that, “Freud makes a pitch for a hermeneutic method for psychoanalysis as opposed to prescriptive and predictive scientism” (p. 313), and that Freud maintains that “sexual object choice is achieved, not given. Any individual contains and, in some forms, retains multiple sexual needs and objectives. Only a reflective, psychoanalytically-based study of an individual’s history yields some understanding of the relative potency of homosexual and heterosexual libido” (pp. 312–313). Following Freud, Harris argues for reading gender identity as a complex, multiply figured, and fluid experience. …

Gender may in some contexts be as thick and reified, as plausibly real as anything in our character. At other moments, gender may seem porous and insubstantial. …

For some individuals gendered experiences may feel integrated, ego-syntonic. For others, the gender contradictions and alternatives seem dangerous and frightening and so are maintained as splits in the self, dissociated part-objects. Any view of sex, object choice, or gender that grounds these phenomena as categories of biology or “the real” misses the heart of Freud’s radical intervention in our understanding of personality. Gender, then, and the relation of gender to love object can be understood only by acts of interpretation. (pp. 302–321, emphasis added)

Thus, Freud’s clinical interest in sex and sexuality lies in analyzing, breaking down, or deconstructing relationally based psychological complexes that develop in early childhood. Psychological complexes arise from internalized conflicts in infantile sexual desires and engagements. Later, he formulated patriarchal culture as in perpetual conflict with polymorphic sexual drives and implicitly endorsed heterosexual development as the ideal cultural norm (Freud, 1938). Subsequent psychological studies have generally followed Freud’s lead in being open to a plurality of naturally occurring variations of sex, sexual identity, and sexual orientation (Jung, Hillman, & Kettner, as cited in Downing, 1991, pp. 111–130)—so much so that we now have another potential problem on our hands: Psychotherapists today, in their eagerness to be open-minded regarding their clients’ sexual interests, desires, and orientations, can easily forget that, while biologically based, all sexual curiosities and interests are also a product of cultural, familial, and individual constructions that need to be carefully scrutinized in therapy for their personal meanings. As such, all psychodynamic constructions of sex, sexuality, gender, and gender identity—all just-so stories—are a potential focus for therapeutic study, and none can be considered as necessarily permanently fixed.

To summarize, while the natural/religious/biological perspective historically has been characterized by doctrines that have privileged the heterosexual patriarchal order, psychologists since Freud have continued to expand this perspective toward naturalizing and universalizing (although not necessarily condoning) all expressions of human sexual interest and desire. The sex life of any particular person coming to our consulting rooms may be intertwined with any and all of the themes developed in the listening perspectives under discussion.

The Infant–Caregiver/Erotic Interaction Perspective

The past three decades have seen the emergence of a community of baby watchers, ingeniously researching every possible aspect of infant life that they can define and observe. Summarizing recent infant research from a dyadic systems point of view with an eye to shedding light on intimate adult interactions, and therefore adult sexuality, Beebe and Lachmann (2003) developed three principles of salience for considering infant-caregiver interactions and lifelong attachment issues:

1. Moment-by-moment ongoing self and interactive regulations
2. Disruption and repair of interactive connections
3. The special impact of interactive moments of heightened affect

Beebe and Lachmann propose that affectively charged expectancies based on these three principles of self and other mutual regulatory interaction are stored in infancy as prototypical or foundational presymbolic representations that later evolve into relational interactive possibilities that form the foundation of adult relationships and sexual engagements. This point of view is consistent with 50 years of somewhat differently formulated attachment research (Fonagy, 2001) as well as relational psychotherapy research (Benjamin, 1988, 1995).

Of special interest in considering the origins of mutual sexual regulations are the infant studies that involve both mimicry and affect mirroring—that is, the parent’s use of facial and vocal expression to represent to the child the feelings the parent either mimetically reflects or assumes in interactions with the infant. Research indicates that the image of the caregiver mirroring the internal experience of the infant comes to organize the child’s emotional experience. Thus, the self not only is open to environmental influence, but also is constituted through its interactions with the mirroring social environment. The caregiver’s mirroring display is internalized and comes to represent an internal state, but it can do so only in certain conditions, which include sufficient emotional attunement, together with signaling to the infant that the affect the caregiver is expressing is not the caregiver’s but the child’s.

Infant researcher Ed Tronick (cited in Beebe & Lachmann, 2003) has suggested that, in the process of mutual regulation, each partner (mother and infant or therapist and patient) affects the other’s “state of consciousness” (state of brain organization). As each affects the other’s self-regulation, each partner’s inner organization is expanded into a more coherent, as well as a more complex, state. In this process, each partner’s state of consciousness expands to incorporate elements of consciousness of the other in new and more coherent forms. While these processes of mimicry and affect mirroring have been defined and studied in infancy in a variety of ways, they have also been demonstrated to be lifelong processes characteristic of intimate intersubjective relating. (The effects of mimetics as such are discussed more fully in a further perspective.)

Further studying the psychological impact of early interactive formations, Jessica Benjamin, in her studies of the erotic in psychotherapy (1988, 1995), uses a metaphor of a “space” in which two subjects negotiate relatedness. She formulates this relational space as an emblem for the feminine, in counterpoint to phallic penetration as an emblem for the masculine. Benjamin (1988) linked presymbolic representations of movement in space, transitional and reciprocal experiencing, and being alone in the nonintrusive presence of the other to the unfolding of woman’s desire, to an intersubjective space that allows the self to come alive, to become absorbed with internal rhythms rather than reacting to or being excited by penetrations and impingements. This quality of internal preoccupation that can emerge in the space of intersubjective relatedness contrasts with the image of phallic penetration in the erotic experience of becoming recognized and known. For Benjamin, the feminine/maternal relational dimension includes interpersonal space that allows for “a mutual awareness of affect, a reciprocal impact on each other, interacting contours of intensity and kinetic timing, and a complex and idiosyncratic choreography of turning toward and away, all of which become internalized interaction schemas that affect later intimate relationships” (1988, pp. 160 ff.).

In considering the implications of infant research for understanding the establishment of erotics in adult relationships, Benjamin (1988) said: “These internalized schemas lead to expectations of closeness vs. distance in relating, of matched and met vs. violated and impinged upon experiences, and of an erotic dance [each schema being] fundamental to mutual attunement and pleasure in adult sexuality as well as to movements and mutual empathy in the analytic relationship” (p. 160). Benjamin views these early sensual experiences of mutual attunement as becoming internalized as interactional or intersubjective schemas. When they reappear in later intimate relationships, including the therapeutic relationship, she refers to them as erotics of transference.

Benjamin (1988) wrote extensively on the importance of mutual recognition in intimate relationships, moments when mutual attunement between separate minds and bodies is achieved. “In erotic union this attunement can be so intense that the separation between self and other feels momentarily suspended [and] a choreography emerges that is not reducible to the idea of reacting to the outside. In erotic union the point is to contact and be contacted by the other—apprehended as such” (p. 184, emphasis added). Benjamin also said:

In erotic union we can experience that form of mutual recognition in which both partners lose themselves in each other without loss of self; they lose self-consciousness without loss of awareness. … This description of the intersubjective foundation of erotic life offers a different perspective than the Freudian construction of psycho-sexual drive phases, for it emphasizes the tension between interacting individuals rather than that within the individual. (pp. 27–29, emphasis added)

The Origins of Human Sexuality: Two Just-So Stories

While infant research, as well as current attachment and inter-subjective theory, are now able to draw clear connections between internalized infant–caregiver interaction schemas and later erotic interactions in intimate adult relationships, these connections have long been a topic for study by psychoanalysts. Almost as an aside, let us review briefly the theoretical work of Freud and Laplanche on the topic of early established interpersonal dynamics that make their appearance in later erotic life.

In addressing the topic of the development of sexuality, Freud attempted a distinction between the biological and the psychological aspects of sex. He took the position that parental responsiveness sets up a series of interactions (now studied as attunement/misattunement, rupture/repair, mutual empathy [or lack of it], and mutual affect regulation [or failure of such]). In “Instincts and Their Vicissitudes” (1915), Freud formulated the first infantile instinctive position as “primary sadism”—activity that is indifferent to the outcome, to whether the other is being hurt. Next comes a perception of the other’s pain through primary identification or mimicry (A. Balint, 1943) and an understanding of that pain. Once the infant internalizes the pain of the other (establishes an internal position that Freud called “primary masochism”), the infant can willfully inflict pain on the (m)other. This intentional sexual position Freud labeled ...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Dedication
• Acknowledgments
• Introduction: “Boy Meets Girl”
• Part 1: Perspectives for Considering Sex, Sexuality, Gender, and Gender Identity
• Part 2: Published Accounts of Sex In Psychotherapy
• Part 3: Three Extended Case Studies Illustrating Sex and Sexuality In the Transference, Resistance, and Counter-Transference of Psychotherapy
• References
• About the Author
• About Lawrence Hedges' Other Books