Sexuality in the Therapeutic Process

I should like to preface my remarks on the role of sexuality in the doctor-patient relationship by alluding to the historical datum that the concept of

sexuality as an etiological factor in the genesis of neurosis has undergone considerable modification since Freud wrote his “Three Contributions.” The libido theory has been seriously questioned in many quarters and has been subjected, as we know, to outright attack and rejection by some.

Nevertheless, despite the existence of differing ideologies with regard to the role of sex, clinical phenomena in the area of sexuality do take place and these phenomena will be discussed presently as they are manifested in the patient-doctor relationship. No new theoretical postulates will be offered but some clinical observations will be made which, it is hoped, will illustrate some of the forthcoming propositions.

It is a well-known truism that patients enter into an analytic relationship utilizing every facet of their character structure, including sexual responses, in relating to their therapists. The word responses in this connection comprise feelings, attitudes, and ideas as well as activity.

In the past it was assumed that the emergence of any sexual feeling on the part of the patient for his analyst was ipso facto irrational and pathological; it was consideed to be part of the transference that inevitably developed and had to be worked through from that point. A bit of theoretical reflection will indicate that this attitude is untenable. In the first place, it ignores a clear-cut reality factor, namely, that when a biologically mature male and female are brought together in any undertaking, there is some degree of probability that there will sooner or later emerge an erotic feeling. Should this phenomenon take place in an analytic undertaking, why couldn't it be assumed that a similar erotic feeling could have emerged in a non-therapeutic endeavor? In other words any erotic feeling which erupted in an analytic relationship mi