One of the most challenging experiences that occurs in the course of therapy is when the topic of sexuality comes into the room. Exploring the topic is a sensitive matter that can challenge the most experienced therapists, even more challenging is when a client presents with an alternative or divergent mode of sexual expression. In many cases, these clients have spent years hiding the nature of their sexuality from co-workers, family and even friends. Many therapists even now flinch at the idea of treating a client who’s sexuality does not conform to the image of what the therapist considers to be ‘normal’. Part of this can be attributed to societal conditioning and the fact that sex, for many people, is still something of a taboo, however it must also be noted that up until relatively recently, in main stream psychology, any deviation from the ‘normal’ sexual aim was considered to be a paraphilia or in other words a perversion.
Perversion is a word that carries serious connotations, which of course are counter productive in many cases. It is a word that has been carried on from before Victorian times, before psychotherapy was even conceived of. Freud (SE7) made reference to the many different sexual appetites that form part of the normal spectrum of behaviour stating that he believed that some measure of perversion was present in all normal development, in other words Freud believed that everyone is into something. His understanding of the difference between a perverse act and a perverse structure is key to the work of psychotherapy when it comes to talking about sex. This is a difference that all therapists need to come to understand, and it revolves around one key principle, the desire of the Other. A sexual act that appears perverse to the understanding of one person can be part of a healthy sexual life between two consenting adults.
In the sense that the normal sexual aim can be supplemented by a divergent interest there should come as no surprise that certain sexual acts will be deemed more acceptable than others. In many cases, these things fall short of what should be considered pathological in a client. As Freud (SE7) suggested it is only when the normal sexual aim is supplanted that we should be concerned about the pathological nature of a sexual act. For example, there are many cases where people will have an unusual interest in feet, which to many may seem weird or disgusting, however as long as that interest does not become the entire aim of sexuality then we can reasonably judge that it is within the non-pathological realm and thus while potentially interesting from an academic perspective it is largely irrelevant to clinical work. Where this ceases to be the case is where such an interest begins to either impede the normal sexual aim or the interest becomes disturbing to its object. In terms of true pathological perversions as Stoller (1975) suggests, it is unlikely that the masochist will choose the sadist as an object, as the sadist cannot permit the masochist their enjoyment of the perverse act. The true perversion is the disavowal of the desire of the Other, it is the desire to deny the other its jouissance. As the joke says when the masochist asks the sadist to hurt them he replies “No”.
Problems of sexual difference often present themselves in therapy, sometimes the client may come to therapy as they feel that there is something wrong with them or they have experienced rejection by family, friends, or prospective partners on the grounds of their preferences and attractions. In some cases the client can even become afraid of certain fantasies as they conflict with what they think they should want by way of a sexual encounter. This fear can lead to a repression of the fantasy and even a level of sexual dysfunction as they struggle to find satisfaction in their sexual lives.
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