Status of sexuality in contemporary psychoanalytic psychotherapy as reported by therapists.

Abstract

Contemporary psychoanalytic literature places less emphasis than its classical counterpart on sexuality in explaining human motivation. However, up until now no methodical research has been done on the status of sexuality in clinical work. We report on a qualitative interview study that examined the status of sexuality in psychoanalytically oriented psychotherapy (n ϭ 10). We studied the extent to which therapists used sexual factors to explain patient behavior: To what extent were sexual themes dominant in the treatment, what importance did therapists attach to them, and what factors affected their place in therapy? The data gathered from the investigation were related to theoretical thinking on the marginalization of sexuality in psychoanalytic theory and practice. On the basis of the investigation, we describe four factors that affect the status of sexual themes in therapy: the extent of the belief in the centrality of sexuality in human motivation, the level of expressiveness of therapy, the narrowing of the concept of sexuality and the separation between sexuality and intimacy, and the tendency to avoid sexual issues because of the discomfort their discussion causes to patient or therapist.

Inside the Revolution: Power, Sex, and Technique in Freud’s “‘Wild’ Analysis”

“…This means as well to render sexuality grist for the training and supervision mills, the peer group and lecture hall mills, and so on (see also Green, 1996Green, , 1997Shalev & Yerushalmi, 2009). I am aware that, in wondering how to steal a march on sexual harm, I may seem, at the end of this critique of Freud's regulatory thrust, to be calling in the cops myself.…”

Excessive behaviors in clinical practice—A state of the art article

“…The interaction between client and practitioner is expressed both verbally and nonverbally, and therefore the clinician must listen not only to what is being said, but also to what is not being said and what is being insinuated (Freimuth et al, 2008 ; Punzi et al, 2014 ; Shedler et al, 1993 ). There is a risk that practitioners may avoid sensitive topics such as difficulties with alcohol, sexuality, or food intake, both during assessment and treatment (Freimuth et al, 2008 ; Greenberg & Schoen, 2008 ; Shalev & Yerushalmi, 2009 ). Difficulties in acknowledging excessive behaviors are thus not necessarily connected to unawareness about the possibility that the client might experience excessive behaviors, but might also be connected to emotionally charged reactions and attitudes among practitioners (Dimen, 2005 ; MacDonald, 2008 ; Power, 2005 ; Southern, 2007 ).…”

“…We need to focus on how we as practitioners might improve our capacity to have a dialogue about excessive behaviors and be prepared to listen to the considerable suffering in our client's experiences. We also have to find our own “blind spots.” If, for example, practitioners do not believe that sexuality is a relevant topic in treatment, they might be reluctant to raise questions about sexuality and may even be reluctant to deal with difficulties with sexuality that clients raise (Shalev & Yerushalmi, 2009 ). Another example is that difficulties with excessive shopping might be trivialized, and in such cases the capacity to identify and support clients with such difficulties will be considerably limited (Benson & Eisenach, 2013 ).…”

The History and Evolution of Sex Therapy and its Relationship to Psychoanalysis

“…The separation between psychoanalysis and sex therapy is hardly the result of a unilateral action by sex therapists. Psychoanalysis – despite its origins as a discipline heavily focused on psychosexuality – has moved drastically away from sexuality (Fonagy, ; Shalev & Yerushalmi, ; Target, ). As Fonagy () suggests, psychoanalytic interest in psychosexuality has, apparently, declined in recent years.…”

“…First, sex therapy as a distinct clinical discipline “evolved from the tradition of behaviourism” putting it at odds with psychoanalysis from the start (Segraves, , p. 485). Second, the “marginalization of sexuality in psychoanalytic theory and practice” have effectively limited psychoanalysis’ sphere of influence over the treatment of sexual issues (Shalev & Yerushalmi, , p. 343). In effect, psychoanalysis’ inattention to sexuality and psychosexuality likely has reduced its utility and impact as a clinical tool in the treatment of sexual problems.…”