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“I think I'm in love with you.” The words hung in the air, and I knew it was a crucial moment in the course of the treatment. What to do? Interpret them? Ignore them? Refer? I hope to demonstrate with this case presentation that my appreciation of the hope-filled nature of the sexualized transference allowed my client, Josh, access to and flexibility with a greater range of affect states, and thereby an increased sense of self-cohesion. I believe that the sexualization occurring in this case expresses hope that injuries to the self can be healed, hope for engagement in selfvitalizing relationships, and hope that a relationship can in some way be a vehicle of self-transformation.
Sexualized phenomena manifest in many forms and represent various dynamics in the clinical setting. Recognition of the multiple roles sexualization can play, even in the course of a single analysis, provides invaluable perspectives within which to organize dynamic material. Kohut (1977) proposed that:
The increased sexual activities and especially the so-called sexualization of the transference encountered in the early phases of some analyses of narcissistic personality disorders are usually manifestations of the intensification of the patients' need to fill in a structural defect. The manifestations should not be understood as an eruption of drives but as expressions of the patients' hope that the selfobject will now supply them with the needed psychological structure [pp. 217-218; emphasis added].