Meeting of the Psychoanalytic Association of New York

November 16, 1987. THE SPECIFIC TASKS IN THE PSYCHOANALYTIC TREATMENT OF WELL-STRUCTURED SEXUAL DEVIATION: A PROVISIONAL TREATMENT. Charles W. Socarides, M.D.

Dr. Socarides described a tentative approach to several explicit therapeutic tasks crucial to the psychoanalytic treatment of sexually deviant patients. This therapeutic technique can be used with patients with well-structured sexual deviations arising from a common core disturbance in the preoedipal phase of development: a failure to traverse separation-individuation phases, which can lead to preoedipal fixations and the persistence of the original primary feminine identification with the mother. This may result in a disturbance in gender-defined self-identity, deficiencies in ego functions, including pathological internalized object relations, and an object relations class of conflict, i.e., anxiety and guilt in association with insufficient self-object differentiation. Dr. Socarides stated that his clinical experience with sexually deviant adult patients has led him to conclude that oedipal-phase conflict in certain deviant patients is superimposed on a deeper, basic preoedipal nuclear conflict. His overall strategy is to discover the location of the fixation point—whether rapprochement, practicing, differentiation, or symbiosis—and to define ego deficits and the type of object relations dominating the patient's life. He added that in all patients his aim is the elucidation of the three great anxieties of the rapprochement subphase: fear of the loss of the object, fear of the loss of the object's love, and undue sensitivity to the approval or disapproval of the parents. The aim of the analysis is the resolution of preoedipal conflicts in order to promote a process of developmental unfolding. The removal of these conflicts makes it possible for the patient to progress along the road to heterosexual functioning, as the need for deviant gratification becomes less obligatory. Thus, according to Dr.