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A few months into his four times weekly analysis, my patient Jason came to a Friday session, looking slightly more anxious than usual. He was silent for a moment after which he said: “I had some thoughts after our last session, about some things we touched on, like
sex. I knew I would have to talk about sex at some point in therapy, because everybody knows you have to talk about sex in therapy, but I guess I was delaying that. I really did not want to. I still don't want to, but I think I should.”
Jason had been fully engaged in his analysis from the beginning and had always shown interest in “doing therapy the right way,” taking cues from my participation as to what he should be focusing on. This time was different, though, because it was the first time he was saying he would talk about something that he did not really want to. At this moment, I was faced with a dilemma: On the one hand, I knew that doing things he did not want to, just out of a sense of obligation, was a pattern in Jason's life, which we had been working on with some progress. Hence, if I were to go along in talking about sex, I would be engaging in the same unhelpful pattern with him. On the other hand, if I were to tell him he did not have to talk about sex if he did not want to, I could be foreclosing a possibly useful exploration. And, I would have to live with having been, in that instance, a therapist who said no to talking about sex.
Jason and I were able to explore the multiple aspects of this moment in a way that allowed us to further our work. The details of this would be beyond the scope of this review; however, the fact that this moment has occurred is relevant. Like many patients, Jason was thinking that sex was central to the therapy process, and it was an end point of sorts to arrive at. One would, at some point, talk about sex and that would be the deep and real part of therapy. In this widely held assumption, one can see the origins of a classical psychoanalytic perspective, acco