Sexuality and Psychotherapy

Patricia Stewart

Did Bill have an affair with Monica, or, perhaps more interestingly, did she have 
an affair with him? Certainly, it was sexual, but was it sex? And can sex, as some 
commentators sympathetic to Clinton seem to be claiming, be compartmentalised?
 Reflection on the role that sexuality plays in the lives of prominent politicians and
 world leaders (remember that this has increased Clinton’s popularity) yields more
 questions than answers because there is little serious analysis in the public domain
 of the role of sexuality in all our lives. As Foucault tells us, sexuality is always 
understood in terms of the dominant discursive orthodoxies of the epoch, and
 despite Freud’s undoubted impact on culture, popular culture still operates within 
the confines of a pre-Freudian paradigm. This paradigm denies the unconscious,
 conflates sexual behaviour and sexuality, which is a much broader, more 
encompassing concept, and feigns support for a petrified stereotype of sexual
 propriety. It is constructed from a mish-mash of residual clericalism and self-
gratifying voyeurism. And yet the Clinton affair may signal the fragmentation of 
the dominant discourse, with liberalism being given at least as much of a hearing 
as puritanism.

But of what relevance is all this to psychotherapy? We all work in a cultural
 climate that is beyond our power to change single handed – although we may of 
course add our pennyworth to the pot – and our clients live in this climate, too. The
 sort of culture we inhabit, with its complex and largely unwritten rules, sets out the
 parameters for a more, or less, comfortable existence. To live in community, as 
humans do, and within language, is to live with certain restrictions. Psychoanalysis 
attests to this fact. Freud discovered that being human entails that we are 
designated in many ways, the most fundamental of which is the designation that 
names our sex. A central tenet of psychoanalysis is that there is no human identity 
outside a sexed identity. That does not mean that we cannot talk of a person, but 
in a radical way there is no such thing as a mere person: a person is either a woman
 or a man, and there is a difference between men and women. This is an important 
point, because all psychotherapies entail a model of what it is to be human, a theory 
of human subjectivity, whether explicit or implicit. Therapeutic approaches may 
claim an atheoretical position, but this stance is ultimately untenable. And how a 
theory conceptualises human subjectivity has obvious implications for the conduct
 and aims of the therapy.

For psychoanalysis, then, sexuality is central, but in what ways? How is this 
central position significant theoretically, and what practical effect does it have on
 the therapy ? For Freud, and one of his most famous disciples, Jacques Lacan the
 paramount distinguishing feature of human beings is that we recognise Law, and in
particular, the law against incest. The taboo of the mother is, they tell us the 
primary law of humanity. And what this means in practice is that for each person who comes into therapy, it is the struggle with the acceptance of this taboo that lies 
at the root of his or her difficulties. There is always unfinished business with the
 mother of early childhood, the mother, as Lacan styles this first Other in the child’s 
life. This Other may be replaced throughout life by substitutes who are wheeled in 
to play the parts in the drama that is largely of the subject’s own creation. This 
original relation to the mother emerges in the context of the infant’s desire to hold
 on to and repeat the unrestrained bodily and sexual excitations and pleasures of the 
early childhood period experienced with her.

Freud’s major work dealing with the topic, Three Essays on the Theory of Sexuality
 [1905] does not, as has been suggested, lead him into a sort of pan-sexualism, 
where a pencil is never just a pencil, and everything in the world is imbued with 
sex. There are desexualised functions in the psyche for all of us, but that is have become so. All psychic functions may be referred to sex at their origin. 
For Freud, one of the effects of reaching a relative maturity of development is that
 sex is put in its place. The over-sexualisation of the world we inhabit, for example
 by being unable to relate to people in any other than a sexual manner, regardless of 
the context, is a neurotic activity. But the individual who is able to ‘love and
 work’, as Freud puts it, (a deceptively simple-sounding achievement) is someone 
who has been able, to some extent at least, to put sex in its place.

The Three Essays begins with a description of the myriad ways in which human
 sexuality diverges from a heterosexual, reproductive norm. How is it, he asks, that 
there are so many perverse sexual behaviours among human beings? The ‘sexual
 aberrations’ he describes provide incontrovertible evidence for Freud that human
 sexuality is not simply biological or natural. Human sexuality is not animal
 Instinct, which is stereotypical and predictable, but human Trieb (drive), which is 
extremely variable. The human sexual drive is marked by language, an exclusively 
human phenomenon. The infant (infans, without speech) who learns to say ‘no’
 before ‘yes’, gradually discovers the degrees of bodily and sexual prohibition and 
licence that are accepted within his own family, his society and his culture.
 Humans begin life in a position of uninhibited sexual voracity, being what Freud
 terms ‘polymorphously perverse’, where nothing is prohibited. The baby initially
 drinks his fill, exposes his naked body without shame, receives intimate caresses
 and demands attention and love with no concern whatsoever for moderation or 
limitation. But this state of affairs cannot persist, and the child begins to 
understand that there are limits to his dominion and that he has to learn to share,
 and to wait his turn. He does not have exclusive rights of ownership over either 
his mother or his father, and they likewise do not own him.

Gradually he begins to sort out the different roles, identities and relationships of 
those closest to him. Sexual identity and orientation which do not figure for the 
child initially are gradually brought into focus as the child grows and develops
 towards the pivotal Oedipal period, when relatively stable positions are adopted.
 The infant, who was for Freud das Kind (unsexed), and to whom he referred as Es, must move on to the position of either Sie (she) or Er (he) as the mother tongue 
learned and the child begins to find a place for himself in the world. People who 
seek out psychotherapy have not sufficiently positioned themselves, and accepted
 this limitation, and many other limitations besides. (If I occupy one position, then
 I relinquish claim to all other positions.) They practise a sort of refusal to b
e relegated to what they regard as a lesser category when they are asked to make the 
traumatic move from the position of The One (which Freud mischievously calls
 ‘his majesty the baby”) to one among many.

Confusion concerning the identity (‘who am I?’) and fundamental desire (‘what do
 I really want?’) of the troubled individual which is seen so frequently in
 psychotherapy stems from this original confusion about the child’s place in the
 scheme of things as a sexed being who relates intimately to those members of his
 family surrounding him at the beginning of his life. Disturbances in identity,
 motivation and desire spring from the first love relation and are therefore
 ultimately sexual. It is often the case, however, that the presenting symptoms of
 the person seeking psychotherapy are not sexual, and the sexual position of a client 
usually takes some time to emerge fully. Disturbance in sexual life may take many 
forms, such as a confusion about sexual orientation, profound doubts about
 manliness or womanliness, about desirability or desirousness, perverse fantasies
 desires and behaviours, aversion to sex, inhibition or loss of sexual desire, sexual
 obsession, impotence, promiscuity, and so on. These disturbances may be hidden 
from the client, or the therapist, or both, but they are always present. The 
psychotherapy which ignores matters sexual is eliding something essential in the 
constitution of a human being.

This does not mean, however, that the therapist badgers the client to deliver up 
intimate secrets, or even directs the client towards this sort of talk. The only 
request made in psychoanalytic psychotherapy is that the client speak, freely and
 without omission. As soon as the first words are uttered, desire, from which the
 suffering individual has been alienated, begins to be given voice. In a 
psychoanalytic psychotherapy, there is no pre-ordained end-point or destination in
 the sense that there is a list of attributes or characteristics which may be ticked off
 as they are acquired, nor is there a set of problems that are to be solved. And there
 is no Nirvana to be reached either. Late in his career, in his article Analysis
 Terminable and Interminable [1937], Freud talked of the difficulty he had 
experienced in bringing analyses to a definitive conclusion. Here he suggests that 
it may be impossible, because he always comes up against the psychological
 bedrock, the ultimate point of resistance beyond which he cannot penetrate, of the
 castration complex. He talks in terms of penis envy for women and the masculine
 protest for men. neither of which admit of explanation brief enough to be embarked
 upon here, but perhaps it is sufficient to say that both of these points of impasse
 indicate how great a struggle it is to accept fully the limitations and losses that are
 integral to the human condition. To assume an identity as a woman or man with
 all that that entails and meet the disappointments and challenges of life is probably plenty to be going on with, so that we are, as W.H. Auden says:

Able to approach the future as a friend

Without a wardrobe of excuses, without

A set mask of rectitude or an

Embarrassing over familiar gesture.


Foucault, M. The History of Sexuality, Vol. 1 London, Penguin, 1976.

Freud, S. Three Essays on the Theory of Sexuality S.E., 1905 Vol.7.

Freud, S. Analysis Terminable and Interminable S.E., 1937 Vol.23 (The Standard 
Edition of the Complete Psychological Works of Sigmund Freud Hogarth, London)

Lacan, J. Ecrits London, Routledge, 1977.

Patricia Stewart works as a psychoanalytic therapist with CDVEC Psychological
 Services and lectures in psychoanalysis in LSB College, Dublin.