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Whenever a new patient enters my office, I feel a rush of anticipation and curiosity about embarking on a new psychoanalytic journey. Not knowing what
to expect, I try explicitly to keep any preconceived theories and ideas I have about people out of my mind as I approach my work. Yet I must admit that I hold implicit expectations about what might enter the clinical situation; one such expectation is that sexuality will at some point become part of the exploration. This is so because I believe sexuality to be a fundamental arena of human experience. This is not to say that sexuality appears prominently in all patients’ stories or is the core of all problems. But it is interwoven into the fabric of all of our minds, in bold colors, or in indistinct threads.
I was trained in the certainty of conflict theory and ego psychology . Thus, I was taught that sexuality, more explicitly conflict between the sexual (and aggressive) drives and defenses, was the heart of the clinical work. In fact, it was common then to get a complete sexual history and to inquire about the patient's masturbation fantasies in the initial evaluation. (I was never comfortable with this, as whatever ‘knowledge’ was gained about the patient was lost in the resultant damage to patient's sense of safety.) Now, even as I have come to work more within the framework of the object relations in which the individual's needs and drives are embedded, and to appreciate the importance of following my own feelings in the clinical situation, I must acknowledge that my initial training about the centrality of sexuality has left its imprint. Sooner or later, in any analysis, I begin to intuit or try to understand the place sexuality has in my patients’ inner world