Moments of Meeting: The Relational Challenges of Sexuality in the Consulting Room

Abstract

In this paper, I explore the relational challenges of sexuality in the consulting room, as informed by developmental studies and 'moments' theory, and discuss the contentious issue of self-disclosure. I acknowledge that there has been a hiatus in recent decades in the discussion of psychosexuality in psychoanalysis, linked to a shift from Freud's drive theory to post-Freudian developmental theories, as well as to the change in the role of the therapist that this has entailed. While I also acknowledge that these changes have resulted in a certain de-eroticization and de-sexualization of psychoanalysis, I point to research showing that sexuality is, in fact, very much alive in the consulting room, but also to a gap in training on such issues, and to a concomitant lacuna in the literature discussing sexual attraction between therapist and patient. Before discussing the ethical and relational challenges of sexuality in the consulting room, I summarize the evolution of sexuality in psychoanalytic thinking and briefly discuss relevant developmental perspectives. I question the view that a developmental model is not suited to effectively working with sexual material. I illustrate theoretical points with a clinical case study, a development of previously published work (Renn, 2012).

Female therapists’ experiences of working with male clients who are sexually attracted to them—An exploratory study using a free association narrative interview method

“…The contemporary writing attempted to shift the thinking in three ways, which pertain to conceptualisations of sexual attraction in therapy. It highlighted the importance of 'mutuality' and 'cocreation' (Mitchell, 1988;Renn, 2013;Stolorow et al, 2002), it aimed at greater integration of bodily and affective responses to the understanding of the sexual aspects of the therapeutic relationship, and it considered both in potentially positive terms (e.g. Nuttall, 2014).…”

Love, Seduction, and Power in the Psychotherapeutic Relationship

“…Although in the current debate the topic of seduction is virtually absent, there is wide agreement among psychoanalysts and psychotherapists from different schools that the psychotherapeutic setting provides an optimal situation for patients to fall in love with their therapist (Celenza, 2007;Davies, 1994;Fletcher, 2007;Fosshage, 2007;Gabbard, 1996;Gabbard & Lester, 1995;Hoffman, 2009;Renn, 2013;Rodriguez, 2005;Slavin, 2007aSlavin, , 2007bSlavin, , 2007c.…”

Epilogue: Prevention and intervention.

“…In Renn's (2012Renn's ( , 2013 case, attachment issues were important to his 38-year-old patient, who, expecting abandonment and loss, experienced attachment as dangerous. Although the patient's history is relevant with respect to how the therapist chose to deal with her erotic transference, suffice it to say that she had an insecure attachment to her parents, a cumulative developmental trauma history, and an intergenerational transmission of fear.…”

“…Since Pope's observation, a good number of comprehensive and authoritative texts dealing with many facets of the issue have been published, although many of these do not contain detailed case examples. Yet some courageous mental health professionals have presented cases dealing with sexuality and the relational and ethical challenges they present (see, e.g., Celenza, 2014;Davies, 1994;Dimen, 2011;Gabbard, 1994;Jørstad, 2002;Pizer, 2017;Renn, 2012Renn, , 2013.…”