How can psychotherapy help with concerns about sexuality?

Well, what does sexuality refer to?

There is actual sexual behaviour, specifically sexual intercourse, sexual arousal (excitement of the genitals), sexual orientation (choice of sexual partner) and masturbation.

It might also include concerns around too much or too little need or desire for sexual behaviour, cultural patterns or expectations, fear, shame, loyalty, and conception and childbirth.

Questions might arise regarding a person’s perception of their body (too fat, too thin), feeling unwanted, noticing unhelpful patterns (‘I always seem to land up with men who have a terrible temper/ women who dominate’ etc), as well as the aftermath of sexual assault.

Psychotherapeutic literature famously talks a lot about sex, for which it is both scorned and admired. Freud was the first and most noteworthy person to bring sex to public attention as central to how we feel about being alive, and found it to be the key element in our capacity to feel that life is worth living. I think it’s fair to say that when sexual feeling and behaviour is very anxiety provoking it is really difficult to create and sustain a deep and loving relationship with another adult. And without one to one love, life is a lot less satisfying.

One of the controversial things Freud said about sexuality was that it is present in each of us from the beginning of an individual’s life. What Freud did was to expand the concept of sexuality – and here, sexuality is a better term that sex, which tends to carry the association of doing sex as an adult. He expanded it to include all the pleasurable, demanding, exciting physical and emotional experiences which take place in the body – in the fingers, the skin, the eyes, the breath etc as well as in the genitals. He brings to our attention the idea that each of us has to learn – be taught – how to moderate their desire and contain it in socially manageable forms – as we all know, some behaviours are forbidden. And most people accept that.

It stands to reason then that we’ll learn an awful lot about our adult sexual responses by examining what we longed for, what we learned and how it was conveyed to us, throughout our growing-up years. That makes it sound easy to analyse, and logical too. Although I am sure that we can indeed follow a train of thought, with its consequences, what is often forgotten is that attitudes can develop in childhood and afterwards that derive from a whole host of feelings, and can become entrenched.

Here’s an example. There are three sisters, one of 8 (A) and twins of 5 (B1and B2). A puts her fingers into the vagina of B2. B2 thinks it’s funny and exciting, and likes the special attention she gets from A. She feels superior to B1. This happens a lot. Every weekend when they have a babysitter, A wants to do this. After a couple of months, B2 gets bored with it and refuses her big sister. A gets angry, and bullies her into doing it. The experience has now gone bad for B2. Then A says she’ll tell the parents that B2 has been doing stuff, and then it seems to B2 that there is something wrong and secret about what they have been doing. Because she is frightened and ashamed, she can no longer feel at ease with her twin, B1, and B1 notices this, and feels hurt and rejected. Maybe she clings to Mum more – maybe she picks fights with her twin.

At no point do the children think of these experiences as “sex” – perhaps the older one does as she’s already been to school and taken in the overt sexual imagery that surrounds us.

This pattern might fade away after another couple of weeks, or maybe it lasts for years. Is this a bad thing? Is it abusive? Does it matter? Is it normal?

Obviously there are so many variables that we just can’t say. But I think it is clear that by looking and remembering as fully as possible, attempting to be honest and challenging suppositions, we will be able to discern or to discover what each of those sisters truly wants and needs in an adult sexual relationship, unhindered by hidden patterns and forgotten upset.

One more thing. Both the person seeking therapy and the therapist are gendered, sexual beings. Tackling the truth of the here and now, of longing, shame, fantasy, and dream in the therapy encounter offers live insight into the daily lived experience of the therapeutic couple, and by extension any couple that the patient creates outside the consulting room. With the therapist’s professional boundaries, the seeker is in a position to explore the feelings and all the ramifications, without risk of opinionated judgement or harm.

Perhaps this is the place to state that in any psychodynamic/analytically orientated psychotherapy, no touching of any kind is ever permitted.  Ever. It’s in the Code of Ethics.