Lucian Freud, Hotel Room (Paris 1954)

IPA Blog: The place of sexuality in psychoanalytic treatment and training today: Can we observe a disappearance of sexuality in case reports and supervisions [1]

The starting point of my work is Sigmund Freud's view that sexuality lies at the roots of the neuroses - and thus at the origins of psychoanalysis. The successive elucidation of unconscious or repressed sexual material was the movens of progress in the treatment of his patients. In recent years reports have appeared periodically in the media about an increase in sexual dysphoria amongst people from a younger generation. 

This raises questions: Is such a development also reflected in psychoanalytic case reports and could it mean that  sexual problems are pushed to the margins in psychoanalytic training? Furthermore: is sexuality losing its central position within psychoanalysis? Could Freud’s theory of drives still be considered our relevant reference point when thinking about sexuality? 

8 points for discussion:

1. Can we observe a decline in sexual activity in the young generation? 
Paradoxical phenomena arise: According to an ONLINE sex podcast (Sex in the Media, “Die Zeit” 25 Sept 2017) and other reports, the sexual activity of young people today is decreasing despite the omnipresence of sexual material in public life. How do the two sides of the coin  - (a noisy, large-scale media dissemination of sex on the one hand - and a de facto decline in the sexual activity of individuals on the other - fit together)? Does this apparent contradiction show up in the patient’s material and the case reports in the mirror of the supervisions? Could it be precisely this contradiction that makes it difficult to put into words? 

2. A matter of language: How to speak about sexuality?  
 Sexuality is involving, at the same time, the body and the psyche in their interrelatedness, inner and outer reality and the role of phantasy. It is a highly complex relation. Not everybody is a master of language as Freud was, and we have lost a common language as psychoanalysts. Dealing with sexuality amongst colleagues involves sharing concepts. In the past, it was most obvious to attach sexual identity to the binary difference of the primary genitals: male – female. This conceptualization of sexual identity is in the process of being dissolved. We ourselves as psychoanalysts are affected by today’s landslide in a same way as our students and our patients are, crushing our so far familiar concepts and approaches on sexuality.

3. Sex and sexuality: A difference?

Sex is a rather harmless superficial momentary process. Sexuality is a life long project, encompassing the person as a whole, creating anxiety, shame and guilt. Sexuality is a task with the possibility to fail. That is truly shocking. [2]  It needs narration, “longitudinal studies”, reaching from infancy to old age. In his representations of larger than life nudes, the painter Lucian Freud, helps us to find a criterion for differentiating between sex and sexuality, pornography and art. He put into painting what his grandfather Sigmund Freud found words for in the narrations of his case studies as we know them: Anna O., Dora, the Rat man, the Wolf man and Little Hans.

4. Changes in diagnostics. Changes in technique
The increase of anorexia, bulimia, cutting and skin affections in young girls is no longer related to conflicts around sexuality. The diagnosis of hysteria has vanished in favor of “Traumatic reaction” and ICD – 10 Diagnosis. Could this also have an influence on the conceptualization of our patient’s illnesses  - and possibly have an effect on the central place of Freud’s theory in the psychoanalytic landscape on the whole? In psychoanalytic psychotherapeutic work the focus today would not be on making unconscious sexual material conscious. The level of intensity and sophistication that our technique has reached since Freud, including picking up preverbal body communications in the transference-countertransference analysis with the idea of growth of the patient in a two person relationship, may as a consequence have a decline in speaking explicitly about sexual content: There is also the fear of accusation of transgressions and “me too”. 

Freud's j’ appelle un chat un chat" - is it still happening? 
However: It was Freud’s rigid technique to make Dora flee from the treatment with him. She wanted to keep her secret to herself - her longings for a breast, not a penis. Today, one out of three girls and young women worldwide become victims of violence by beating or rape.[3] We can detect from the contents of young girls fantasies like Dora the self - protective measures they seek to defend against sexual intrusion – be it in reality or phantasy – in the wish to become a boy. 

5.The universality of the Oedipus complex: Still a concept for today?
For Freud, two important premises applied that are no longer self - evident today and not shared by everyone: This concerns the libidinal drive nature of sexuality with the Oedipus complex, and, related to this - the central importance of repression. With his writings, Freud did not only provide enlightenment in the field of clinical psychoanalysis: The task of naming sexual conflict and repression as the causes of pathological symptoms in the individual, was even more urgent because he was interested in showing the link between individual and collective denial in society, including the denial of the consequences for our civilization – the upsurge and dominance of aggression leading to war and destruction. 

6. The role of sexual phantasies 
In the case of Dora, Freud had to experience how one meaning in a phantasy conceals another, and behind it yet another - or its opposite. And that the meanings found were possibly not what he “thought” was meant, but a reflection of his own projections. However, it is the merit of psychoanalysis - and thus of Freud - to have to treat the symptoms only with words if paid attention to the phantasies – and those behind  - and behind  - and behind … point that Laufer strengthens in his concept of the central masturbation phantasy?

Is the centrality of sexuality in psychoanalysis still recognized, and in this context the importance of masturbation with the specific content of the masturbatory fantasy, a point that Laufer strengthens in his concept of the “central masturbation phantasy”? Do we still recognize it’s central meaning for sexual maturation adolescence and does it get worked through in the analysis?  Human sexuality, needs “longitudinal studies”. What psychoanalysts do know about is phantasies and they make use of this knowledge in their consulting rooms to the benefits of their patients cure. No We possess all that it takes to treat the symptoms only with words  - if paid attention to the phantasies – and those behind - and behind...and behind. 

7. A way of listening: The candidates own desire 
What then, of the complexity of sexual matters, gets taken up, put into words and written about in their reports for supervisions in the cases of the candidates. The first place to investigate sexual phantasies for the candidates is in their analysis, in the presence of an analyst who is prepared to go along in knowing the limitations and secure them. As training analysts, we have to think about how to listen and speak with the candidates on their own sexuality. They must be given the room to investigate freely. Otherwise, the tendency for avoidance of the sexual material is reinforced. Also, their desire vis a vis their own training cases needs to be brought in and understood profoundly, unless there is a risk for transgressions. 

8. The “spark”  
How do we find ways not to evade the subject of sexuality, between patient and analyst, candidate and training analyst, to keep “the spark”  (of Eros) alive? This is what the patients come for, with their depressions, their anxieties, their compulsions. They have a right that we turn to them with the spark, only then to help them do the painful work of renunciation - that their wishes will not be fulfilled with this object of desire – the analyst  - just as it had not been possible to be fulfilled with their primary objects: the objects of early infantile sexual desire. The Oedipal constellation, the family, is still today the most frequent place where transgressions take place. 
It does not mean that desire is bad, on the contrary - it is the spark of life, a derivative of the life drive that we are not allowed to deny our patients  - out of fears from our own unresolved neurotic Oedipal conflicts. To that, we need to pay attention.  

[1]  A full version of this paper has been published in Tagungsband DPV Hamburg 2022.
[2] De Clerck, R. (2007) The Penetrative Gaze: Sigmund Freud - Lucian Freud"; De Clerck, R.( 2019) and "How Deep is the Skin: Surface and Depth in Lucian Freud's Women Portraits"
[3] Statement International Women’ s Day 2023

Rotraut De Clerck, psychoanalyst in private practice. Training analyst at the Frankfurt Psychoanalytic Institute (FPI) and the Mainz Psychoanalytic Institute (mpi). Post graduate training in Kleinian Psychoanalysis at the Tavistock Clinic and the Institute of Psychoanalysis in London. Associated with the Institute of Psycho-analysis as long term guest. Chair of the EPF ad Hoc Group: “Psychoanalysis in Literature – Literature in Psychoanalysis”; Consultant IPA in Culture Committee two terms.


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