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Sexual acting out can be one of the most anxiety-provoking and destructive forms of resistance manifested by patients. It is particularly common in patients suffering from borderline and other character disorders. Although sexual acting out always has been a concern of the psychoanalytic practitioner, the recent crisis around Acquired Immune Deficiency Syndrome (AIDS) lends special urgency to the understanding and resolution of this form of resistance.
In this paper, we provide a selective overview of the psychoanalytic literature on acting out and the erotized transference. We then present three cases in which sexual acting out occurred at a key moment in the treatment and conclude with a discussion of the nature of such acting out and the central role played in this resistance by the patient's desire for revenge.
Freud (1914) defined acting out as behavior that emerges in the place of verbal recall, a resistance to remembering childhood conflicts that have become activated in the transference. Acting out was understood as an aid to remembering and a communication about events that could not be put into words because of repression, or because they originated in the preverbal period.