Sexuality and Attachment in Clinical Practice

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The second book in the John Bowlby Memorial Conference Lecture Series. It explores our thinking about the developmental, relational and interpersonal aspects of the links between attachment and sexuality as they emerge in clinical practice.Contributors:Bernice Laschinger; Chris Purnell; Joanna Ryan; Joseph Schwartz; Kate White; Rachel Wingfield; and Judy Yellin.

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CHAPTER 1: SEXUALITY AND ATTACHMENT IN CLINICAL PRACTICE INTRODUCTION TO THE MONOGRAPH OF THE JOHN BOWLBY MEMORIAL CONFERENCE 2004

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Kate White and Joseph Schwartz

The significance of attachment and its relationship to sexuality is crucial in our psychological worlds. This selection of T papers from the 11th John Bowlby Memorial Conference, with an additional paper by Chris Purnell, brings together the work of a group of outstanding clinicians and innovative thinkers in the field of attachment and relational psychoanalysis. Each paper is richly textured, weaving together the themes of sexuality and attachment, taking us from a wonderful historical overview through intricate theoretical pathways to vivid descriptions of how it feels to both analyst and analysand in the intensity of a therapeutic relationship.

Why does sexuality become the arena in which fundamental relational issues and struggles are played out? Mitchell (1988, p. 102) suggests that in part it is because of the connections of sexual desire to body sensations, and the echoes that these have with our early attachment relationships. It is perhaps how these experiences are registered in our bodies that has such an impact on our sexual relationships. As Susie Orbach suggests (2004, p. 28): “There is … no such thing as a body, there is only a body in relationship to another body”.

 

CHAPTER 2: ATTACHMENT THEORY AND THE JOHN BOWLBY MEMORIAL LECTURE: A SHORT HISTORY

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Bernice Laschinger

The theme of this year’s Bowlby lecture marks the movement within Attachment theory towards the integration of sexual-T ity in its theory and clinical practice. Sexuality was not a focus of theoretical concern for Bowlby. He emphasized that attachment was a motivational system in its own right, apart from sexuality and feeding. Like other relational theories, Attachment Theory has been criticized for its failure to theorize these areas. Recently, however, it has come to be understood that attachment is a bodily experience; it has always been implicit in the basic premise of the child’s need for proximity to the body of the mother. This recognition has, in turn, highlighted the child’s sensual bond with the mother in influencing adult patterns of sexuality. Indeed, within contemporary relational theories, sexuality has come to be seen as the central arena in which the dramas of attachment are played out—in which “emotional connection and intimacy is sought, established, lost and regained” (Mitchell, 1988, p. 107).

 

CHAPTER 3: “SUCH STUFF AS DREAMS ARE MADE ON": SEXUALITY AS RE/CREATION

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Judy Yellin

Mapping the territory?

As a member of the Centre for Attachment-based Psychoid analytic Psychotherapy’s planning group for this Bowlby Memorial Conference of 2004, I have been charged by my colleagues with the awesome responsibility of “mapping the territory” of contemporary relational psychoanalytic thinking about sexuality and attachment. The mapping of this territory, it seems to me, is a very tricky business, particularly where that territory is as vast, complex, and strongly contested as that of sexuality.

So which territory am I to talk about exactly? Where is it and how do we get there? How does it take its shape, how large an area am I to try to explore, where am I to perceive its borders to be? Are sexuality and attachment one territory, in any case? Should they be? Or are they two separate territories, with different terrains, cultures, languages? If so, do they adjoin, or are there disputed border areas between them?

Given that sexualities are expressed through and in the territory of bodies, how are these bodies constructed, how do they come about? What do they feel like when we experience them as “feeling sexual?” Does the way they look to the outside bear any relation to the way they feel on the inside? Should it? Are men’s bodies always male, masculine? Are women’s always female, feminine? What do we mean by “men” and “women” anyway? When we desire, who are we? And who or what do we desire? Is our desire always and inevitably gendered? Can we imagine our desire in a different gender? Without gender? What would this mean?

 

CHAPTER 4: CLINICAL IMPLICATIONS OF QUEER THEORY A RESPONSE TO JUDY YELLIN'S PAPER

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Joanna Ryan

Judy’s paper is a tour d e for ce, mappin g a very com plex, dense, and ch angin g ter ritory, in a delightful an d engaging way.

I would like to elaborate on some of Judy’s arguments as to why any psychoanalysis, any psychotherapy, attachment-based or otherwise, should take note of and incorporate queer theory approaches. I want to address the question of how we relate what Judy has so clearly laid out to clinical practice. I hope that in the ensuing discussion many people will raise their own experiences of how this kind of approach has been helpful to them, or, indeed, express their doubts about it.

For myself, in writing Wild Desires and Mistaken Identities (O’Connor &Ryan, 1993), queer theory ideas have been essential in trying to understand how psychoanalysis, which originally had so much liberal and inclusive potential, could also lend itself to so much excluding thought and practice. Queer theory, as part of postmodernism, has also been helpful in evolving new clinical understandings in working with lesbians and gay men in therapy. Here I want to raise a series of issues that often arise in clinical work.

 

CHAPTER 5: ATTACHMENT AND SEXUALITY WHAT DOES OUR CLINICAL EXPERIENCE TELL US?

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Joseph Schwartz

Introduction

Due to the culturally loaded nature of sexuality, it is particularly important to emphasize that case material is sensitive, especially so when countertransferential feelings are involved. As such one must be careful to view clinical material from the clinician’s experience of the therapeutic encounter, avoiding the temptation to “get in on the case”. With this method in hand, I will discuss how, in a clinical exploration with colleagues, we found ourselves concluding that, in the first approximation, sexual feelings are like any other feelings in the therapeutic relationship, to be explored with openness and interest without foreclosure. I will discuss some of the special difficulties that can occur in working clinically with sexuality in the consulting room and some theoretical implications, particularly for male sexuality.

There is, of course, no such thing as simple clinical observation. We always approach our clients with theory in mind. It would be impossible to be an effective clinician without a framework for understanding and relating to our clients. So the question of what our clinical experience tells us about sexuality is far from a trivial project. We have to be careful not simply to hear what we already know.

 

CHAPTER 6: REFLECTIONS ON THE ROLE OF FRUSTRATION OR AGGRESSION IN SEXUAL PLEASURE FROM AN ATTACHMENT POINT OF VIEW

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Rachel Wingfield

Is our capacity to tolerate frustration directly linked to our capacity to experience sexual pleasure? This provokes all sorts of questions. Is tolerating frustration the same thing as anticipating pleasure? I am wondering why anticipating or experiencing an increasing intensity of pleasure would be conceived of, or experienced as, frustration? Is that inevitable? Or does the very fact that arousal is experienced as frustration tell us something about that person’s own developmental history?

As an interesting exercise I asked colleagues and friends to imagine, in fantasy or memory, an experience of the most delicious sexual passion. I approached a range of people: male and female, gay and straight. I got a diverse range of responses, a range of experiences: some people imagined giving pleasure to their partner, rather than aiming towards orgasm for themselves; others thought about the moment of orgasm itself, and of feeling fully satisfied. Some thought about having sex, others about realizing for the first time their desire for someone, and the excitement of that promise of connection.

 

CHAPTER 7: MASCULINITY AND SEXUALITY IN THERAPEUTIC WORK WITH MALE SURVIVORS OF CHILDHOOD SEXUAL ABUSE

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Chris Purnell

For adult male survivors, a major obstacle to recovery is the popular image of masculinity. The widespread belief that the sexual abuse of boys is relatively uncommon means that male survivors will often minimise the effect the sexual abuse which they have suffered has had on them. Where sexual abuse of young males is given serious attention by the media is in a larger context of paedophile activity, usually within an institutional setting. These cases are shocking in detail and in extent, and legitimately deserve the attention that they attract, particularly if it results in an increased awareness of the plight of young people in institutional care.

Male survivors of childhood sexual abuse, however, will often compare their own experiences with these well publicized cases and conclude that their own abuse was not as serious and therefore not worthy of their own or anybody else’s attention:

I remember the sex games that this older boy used to get me to play; I never felt comfortable with what went on, and I hated it when he asked me to do those things to him, but there was no one who I could talk to about it apart from him, and so I just convinced myself that this was a normal thing which everybody did. Even now when I think about it I have very mixed feelings, but when I compare it with what I hear on the news then I think that what happened to me was nothing—it was minor and I shouldn’t be worrying about it. It’s like when I compare myself with some of those others, then I feel that I have nothing to complain about but it still bothers me. [Male survivor]

 

APPENDICES I: SEXUALITY AND ATTACHMENT IN CLINICAL PRACTICE READING LIST

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Reading List

Benjamin, J. (1988). The Bonds of Love: Psychoanalysis, Feminism, &the Problem of Domination. London: Pantheon.

Benjamin, J. (1998). The Shadow of the Other: Intersubjectivity and Gender in Psychoanalysis. London: Routledge.

Benjamin, J. (1998). Like Subjects, Love Objects: Essays on Recognition and Sexual Difference. New Haven, CT: Yale University Press.

Benjamin, J. (1991). Father and daughter: identification with difference—a contribution to gender heterodoxy. Psychoanalytic Dialogues, 1: 277-299.

Bloom, A. (2003). Normal: Transsexual CEOS, Cross-dressing Cops and Hermaphrodites with Attitude. London: Bloomsbury.

Bollas, C. (1992). Cruising in the Homosexual Arena. New York: Hill and Wang.

Burch, B. (1993). Gender identities, lesbianism and potential space. Psychoanalytic Psychology, 10: 359-375.

Butler, J. (1990). Gender Trouble: Feminism and the Subversion of Identity. London: Routledge.

Butler, J. (1993). Bodies that Matter: On the Discursive Limits of “Sex”. New York: Routledge.

 

APPENDICES II: INTRODUCTION TO THE CENTRE FOR ATTACHMENT-BASED PSYCHOANALYTIC PSYCHOTHERAPY

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The Centre for Attachment-based Psychoanalytic Psychotherapy (CAPP) is an organization committed to the development of this particular approach to psychotherapy. It provides a four-year training for psychotherapists and a consultation and referral service.

Attachment-based psychoanalytic psychotherapy has developed on the basis of the growing understanding of the importance of attachment relationship to human growth and development throughout life. This approach to psychotherapy, developing from the relational tradition of psychoanalysis, draws upon psychoanalytic insights and the rapidly growing field of attachment theory.

Understanding psychotherapy within the context of attachment relationships leads to an approach to psychotherapy as a cooperative venture between therapist and client. The aim is to develop a sufficiently secure base to enable the exploration of loss and trauma in the course of development. The therapy is designed to create a safe space in which the client can reflect upon their lived experience, their experience of relationships in the present, and their experience of their relationship with the therapist.

 

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