Summary

In this paper, Blechner explores the evolving relationship between psychoanalysis and the study of sexual issues, emphasizing the field’s diminishing authority on sexual matters. He traces this decline back to the mid-20th century, when psychoanalysis distanced itself from empirical sexology. Early pioneers like Freud collaborated with prominent sexologists, fostering a comprehensive understanding of diverse sexual behaviors. However, this productive interplay diminished following criticism of empirical studies, such as Kinsey’s groundbreaking research on human sexuality. This historical rift, Blechner argues, has contributed to psychoanalysis’s limited engagement with contemporary sexual practices and identities.

Current Challenges in Psychoanalysis

Blechner highlights significant gaps in psychoanalytic training regarding sexual issues. Most programs inadequately address sexual diversity, leaving clinicians unprepared to work with individuals whose sexual practices deviate from societal norms. This lack of education fosters discomfort, judgment, and avoidance among therapists when dealing with such cases. Moreover, the paper critiques the psychoanalytic field’s reliance on traditional, often pathologizing, views of sexuality, which can obscure rather than illuminate the complexities of patients’ experiences.

Broadening the Psychoanalytic Perspective

To bridge these gaps, Blechner advocates for an enriched understanding of sexual variation. He suggests that psychoanalysts engage with first-person narratives and online communities, which provide invaluable insights into lived experiences of sexual diversity. These sources complement empirical research and challenge preconceived notions about “normal” and “pathological” sexuality. Furthermore, Blechner underscores the importance of distinguishing between personal discomfort and the patient’s actual distress. This distinction is crucial for creating a therapeutic environment that prioritizes the patient’s goals rather than the clinician’s biases.

Sexual Excitement and Emotional Complexity

The paper delves into the intricate interplay between sexual excitement and other emotions, such as anxiety, shame, and taboo. Blechner argues that these emotions, far from being antithetical to sexual arousal, often heighten it. This perspective challenges simplistic categorizations of “healthy” and “unhealthy” sexual behavior. He introduces concepts like the “lovemap,” a unique script that intertwines sexual desire with personal history and emotional experiences. Understanding this dynamic, he suggests, is central to effective psychoanalytic practice.

Clinical Examples

To illustrate his principles, Blechner shares clinical case studies, including work with individuals engaging in coercive voyeurism and masochistic rituals. These cases reveal how patients’ sexual behaviors often serve as mechanisms for managing complex emotions, such as fear, rage, or humiliation. By empathizing with the pleasure these behaviors provide and exploring their emotional underpinnings, clinicians can support patients in finding healthier, less destructive ways to fulfill their needs.

Shifting from Pathology to Acceptance

Blechner critiques the moralistic roots of terms like “perversion,” which often reflect societal judgments rather than clinical realities. He advocates for a shift in psychoanalytic attitudes, moving away from pathologizing diverse sexual expressions toward understanding and acceptance. For instance, male cross-dressing, often misconstrued as a pathological behavior, is recontextualized as an expression of “bigenderism.” This perspective challenges cultural biases that stigmatize behaviors deviating from rigid gender norms.

The Role of Psychoanalysis in Sexual Therapy

Blechner emphasizes that psychoanalysts should focus on understanding patients’ sexual goals and helping them navigate the challenges posed by societal disapproval. He critiques traditional psychoanalytic approaches that prioritize uncovering developmental origins of sexual behaviors while neglecting their present significance. Instead, he calls for a nuanced exploration of how these behaviors fit into patients’ broader emotional and relational lives.

Contemporary Tools and Techniques

Acknowledging the limitations of psychoanalytic theory, Blechner encourages integration with other disciplines, such as sex therapy and neuroscience. He underscores the importance of factual knowledge about sexual anatomy and physiology, citing the rediscovery of the clitoral structure as an example of how outdated beliefs can hinder clinical understanding. Additionally, he highlights the potential of affective neuroscience to elucidate the interplay between emotions and sexual arousal.

Ethical Considerations

Ethical practice, according to Blechner, involves respecting patients’ sexual identities and desires while challenging societal prejudices that exacerbate their distress. He warns against imposing personal values on patients and stresses the need for psychoanalysts to confront their own biases. By fostering a nonjudgmental space, clinicians can empower patients to explore their sexuality without fear of condemnation.

Conclusion

Blechner concludes with a call for psychoanalysis to reclaim its relevance in the study of human sexuality. This requires not only bridging the divide with empirical sexology but also embracing the diversity of human sexual experiences. By integrating first-person accounts, empirical research, and contemporary tools, psychoanalysts can offer meaningful support to patients navigating the complexities of their sexual identities and relationships.

MAIN TAKEAWAYS

The article highlights the tension between connection and separation, arguing that development involves not just moving towards autonomy but also learning to tolerate and appreciate the differences between self and others. This tension is central to Benjamin’s concept of intersubjectivity, where both the self and the other are seen as having equal significance in the relational dynamic. The recognition of the other person’s subjectivity allows for attunement and the development of empathy, which is essential for healthy relationships and psychological development.

Quotes

They found that many analysts did not want to hear about their patients’ sexual experiences. Some felt the sexual experiences per se were not critical but masked underlying relational issues. When the therapists were put off or disgusted by their patient’s sexual practices, they often presumed that the patient was trying to attack them or shock them, rather than considering the limitations of their own experience, knowledge, and tolerance.

Understanding alternative sexual patterns makes the clinician more sensitive and skilled in understanding the sexuality of all patients. Once immersed in working with patients with atypical sexual patterns, the clinician be- comes sensitized to the specific and subtle ways that each of us develops a unique and private pattern of sexuality and tries to live with it.

Understanding alternative sexual patterns makes the clinician more sensitive and skilled in understanding the sexuality of all patients. Once immersed in working with patients with atypical sexual patterns, the clinician be- comes sensitized to the specific and subtle ways that each of us develops a unique and private pattern of sexuality and tries to live with it.

Summary

Summary