The simultaneous uniqueness and universality of human experience is encapsulated in the experience of sexuality and sexual attraction in the therapeutic encounter. While sexuality, as a matter of psychobiological fact, is inevitably – if uncomfortably – present in the consulting room, the experience of sexual psychodynamics between the therapist and the client is idiosyncratic. Where sexual attraction emerges in a significant way (for it cannot be argued that sexual attraction is always a dominant factor in the client–therapist interaction), the therapist requires a coherent and measured strategy for dealing with the experience (Pope, 2000, 2001). Such a strategy requires an effective theoretical foundation, which can account for the ethical and pragmatic aspects of sexual attraction. Existentialism, as an applicable theoretical model for psychotherapeutic practice, provides a means for assessing and negotiating the challenges presented by sexuality in the consulting room, which acknowledges the universal elements of human experience that confront the participants in the clinical encounter, and helps to identify the unique aspects of the encounter and its participants.

Existentialism is a lot of things. While it is, in the first instance, a philosophical movement, it has close links with visual and literary art such that Sartre, the existentialist philosopher and litterateur par excellence, was offered the 1964 Nobel Prize for literature (though he refused it on the basis of artistic principle). Against this backdrop, existentialism can be understood as an essentially humanist philosophy, offering a phenomenology of lived experience that situates the individual, and her/his unique human experience, within the context of universal existential struggles. Sartre’s work, for instance, is no less than an attempt to account for the human individual’s place in the universe – perhaps the most fundamental of questions. This rather ambitious pursuit leads to a distinction, in the pivotal work Being and Nothingness – arguably the preeminent text of existentialist ethics – between beings-in-themselves and beings-for-themselves, effectively a distinction between conscious (nonhuman) and self-conscious (human) creatures (Sartre, 1943). Whereas beings-in-themselves are subject to binding and inalienable laws, which predict their behaviour and define their essential qualities, humans are different. Human beings are ‘without essential natures’ and are defined by choice rather than ontological predetermination. In simpler terms: you are fundamentally the product of your own choices.

My focus in this chapter is on the philosophy of existentialism and on the phenomenological commitments of this philosophical model as they pertain to the difficulties associated with sexual desire in the consulting room. Existentialism can offer a profound and meaningful conceptualization of ethical choice, grounded in the concepts of meaning and authenticity – themes that I will elaborate as the basis for determining ethical action in the consulting room. Of particular interest are existentialism’s integration with psychotherapy (Van Deurzen, 1998; Yalom, 1980) and the way existentialism’s foundational principles and underlying ethical commitments may inform the taboo central to this book: the fraught issue of sexual attraction in the psychotherapeutic encounter. In the next discussion, I will outline some of existentialism’s core themes in order to illustrate how this philosophical framework might account for the practical and ethical challenges of therapist–client sexual attraction.

I begin by outlining the theoretical framework of existential psychotherapy, highlighting how the key concepts of this dynamic psychotherapy model may account for the initial, taboo experience of sexual attraction between the therapist and the client. After outlining the core existentialist principles that are considered most significant in the psychotherapeutic field, generally, I elaborate the concept of personal meaning, an essential existentialist concept that has particular bearing on the sexual dimensions of the client–therapist encounter. I then use two case examples to outline the clinical approach an existentialist psychotherapist may use to address an apparent sexual attraction between her/himself and the client. A discussion of the integration of theory and clinical practice follows. Here, I address the notion of ethical action, vis-à-vis sexual attraction in the consulting room, as it relates to the fundamental principles of existential psychotherapy. Building on the concepts of authenticity and meaning, I outline how psychotherapists may develop a set of existential clinical strategies for addressing sexuality in the client–therapist relationship. I advise that the therapist introduce the intersubjective client–therapist relationship as a topic for clinical discussion, from the outset of the therapy process. This critical acknowledgement of the therapy relationship can provide a way forward, enabling a reflective discussion of the possible meanings and nature of the attraction, grounded in an explicit discussion of core existential themes. I conclude the chapter by emphasizing how existential psychotherapy principles underscore the consequentialist importance of the ethics of the clinical profession (Watter, 2012). Here, I re-emphasize that, from an existentialist ethical framework, the clinician must maintain authenticity by addressing sexual attraction where it becomes relevant to the clinical process, using sensitively attuned language to avoid alienating the client, an idea central to the book, particularly in Chapters 2, 5, 13 and 15. The existential therapist, I conclude, simply cannot bite her/his tongue.

Theoretical Framework

The fundament of existentialism is conveyed in Sartre’s succinct quote: ‘existence precedes essence’ (Sartre, 1945, p. 20). This notion underlies the ‘first principle’ of existentialism: ‘man is nothing else but what he makes of himself’ (Sartre, 1945, p. 22). This principle is the cornerstone of existentialist subjectivity: the individual’s essential self (essence) is determined by her/his choices in the material world (existence). Consequently, human existence is a state of being in which we are both free, with respect to self-determination, and responsible, by virtue of our choices and the powerful ethical implications that they have. The latter notion – that humans’ unique capacity to choose implies a profound personal responsibility – is a central existentialist concern, which lies at the core of existentialist ethics. Sartre, in fact, went so far as to argue that each action we choose ‘involve[s] all humanity’ and that, by implication, ‘I am responsible for myself and for everyone else. I am creating a certain image of man [sic] of my own choosing. In choosing myself, I choose man’ (Sartre, 1945, p. 23). Thus, a psychotherapist confronted by a powerful sexual attraction towards a client – and/or the perception of the client’s sexual desire for the therapist – inevitably faces the burden of choice, as, according to Sartre, inaction or avoidance itself, insofar as the refusal to choose, paradoxically, constitutes a choice in itself. This choice invariably carries a profound ethical responsibility that exceeds the parameters of the specific relationship in question (Sartre, 1945). In this regard, existentialism is deeply focused on the ethics of experience, within a humanistic framework that situates the human individual’s choices and struggles at the centre of its concerns (Daigle, 2006; Warnock, 1967).

Existentialism is, at first glance, focused on rather bleak humanistic themes. Five core themes, drawn from existentialist philosophy and entrenched within the field of existentialist psychotherapy can be identified (Yalom, 1980). These are freedom, responsibility, death/nothingness, isolation and meaning/meaninglessness. The first two concepts, freedom and responsibility, are inherently linked. While ‘freedom’ holds a positive common-sense meaning of being exempt from unwanted restraint, existentialism perceives it somewhat differently; we are free by virtue of a fundamental lack of external structure. ‘The human being’, Yalom (1980) writes, ‘does not enter (and leave) a well-structured universe that has an inherent design. Rather, the individual is entirely responsible for – that is, the author of – his or her own world, life design [and] choices’ (Yalom, 1980, p. 9). Thus, we are not only free to choose but we are also responsible for choosing – choice is inevitable and marked by our core ethical responsibilities.

The existential conceptualization of death implies an elemental anxiety – anxiety grounded in the fear of nonexistence/nothingness – that is a root of much psychopathology (Van Deurzen, 2002). Similarly, isolation and meaning/meaninglessness imply an inherent psychological tension. Isolation, existentially, is no less than the knowledge that there is a fundamental gap between ourselves and the universe we occupy – implicating a deep desire for an ultimately impossible fundamental connectedness (Warnock, 1970).

Meaning/meaninglessness, likewise, implies anxiety and an essential desire: in the absence of a fundamental ‘meaning of life’ – which Yalom (1980) designates ‘cosmic meaning’ – we are left searching for personal meaning, meaning in life. The latter quest can help us understand how the client and therapist affiliate with particular events or behaviours, as sources of apparent meaning. In the psychotherapy setting, specifically, the concepts of freedom/responsibility and choice help us conceptualize the psychotherapist’s possible responses to a client–therapist sexual attraction, while the notions of isolation and meaning offer a conceptual framework for interpreting the experience of sexual attraction itself.

Viewed existentially, sexuality is a particular instance of the simul­taneously unique and universal aspects of human existence. Sexuality is construed as an ‘embodied perceptual experience in our relations with others … an embodied intersubjective response to alterity [otherness]’ (Smith-Pickard & Swynnerton, 2005, p. 48). While this embodied experience is subjectively and experientially unique, the existential themes that underlie it are universal. As such, the experience of sexual attraction can be interpreted in light of the fundamental aspects of human existence, including the aforementioned experience of mortal awareness, freedom, isolation, and meaninglessness. We may conceive of sexuality and sexual attraction as driven by an attempt to assuage our core existential anxieties and as imbued with a desire to overcome existential isolation and to derive a sense of meaning from life (Van Deurzen, 2002; Yalom, 1980, 1991). This desire for solace, interconnectedness and meaning can naturally evolve into a strong experience of sexual attraction, even between the therapist and the client.

Thus, sexual attraction between the patient and the psychotherapist may be assessed vis-à-vis the universal desire for meaning in life, and the sense of meaning and connectedness that may be at the root of the sexual attraction. The existential psychotherapist may be compelled to ask: what does this sexual attraction really mean (i.e., what does it reflect about how the patient and the therapist are negotiating the core existential challenges)? Exploring this line of questioning, in consultation with the patient, may serve as a pragmatic clinical technique, as I outline in the following section.

Considerations of Technique/Clinical Approach

A recent interview with a clinical supervisor, an expert in psychosexual therapy, indicates that sexuality in the consulting room is inevitably situated within a psychologically and emotionally complex intersubjective experience (Openshaw, 2013). While the ethics of the psychotherapy profession avow an objective detachment, the reality of the psychotherapy encounter, as understood within the existential framework, implies a kind of intellectual and emotional closeness between two individuals whose shared (though still unchangeably individual and singular) search for meaning and connectedness may evolve into a sense of intimacy and sexual attraction. The premise of this chapter and, I believe, the importance of this volume on clinical practice are predicated on the fact that simply ignoring sexual attraction in the consulting room may often be an unviable clinical strategy. Not always, but perhaps more frequently than we care to admit, it is clearly necessary to acknowledge, examine and deal with the elephant in the room. This, however, can hardly be a process of identifying unambiguous thoughts and feelings and tidily bracketing them out of the clinical equation. As most therapists can attest, sexual desire is often unwanted or inconvenient, but it rarely disappears simply because we wish, or will, it away.

Consequently, the therapist must address the dilemma of whether to deal explicitly with the sexual dimensions of the client–therapist relationship. This challenge, which may be fundamental for all psychotherapists, is uniquely impacted by a core value of existentialist therapy: authenticity (Sartre, 1945). The therapist who refuses to address sexual attraction in the consulting room may be acting in ‘bad faith’, a refusal to choose, which, again, is itself a choice. This bad faith is no less than an attempt to evade the responsibility that comes with being-for-itself (Sartre, 1943). The mores of the psychotherapeutic profession make this type of bad faith all the more probable by creating a social pressure for the therapist to conform to a predetermined value set (i.e., to discuss sexual attraction would be a breach of professional boundaries) and disavow her/his freedom to act authentically. From this vantage point, a therapist’s refusal to discuss sexual attraction with the client may undermine the therapeutic encounter by leaving unresolved a potentially distracting, or destructive, interpersonal dynamic, and perhaps engendering in the patient questions about the therapist’s thoughts and intentions and indeed competence.

The consequences that the therapist’s reticence may have for the client, and for the therapeutic process, are the preeminent concern for existential ethics. Existentialism is less concerned with the moral question of ‘right’ and ‘wrong’, since a universe defined by freedom in the existential sense can be seen as lacking a fundamental moral imperative (Warnock, 1967). In fact, to assert that an external moral absolute governs our behaviour is an act of bad faith, insofar as it serves to deny personal responsibility for ourselves and our actions (Sartre, 1943). Once again, the important message here is that choice is inevitable. Considering the issue from within the psychotherapeutic framework, Van Deurzen (1998) writes, ‘I do not believe that we can make judgements about what is right and wrong, but we can have some sense of what effects might be beneficial or harmful and what we want or are able to live with in the long run’ (p. 69). Two brief case studies, one from my own counselling practice and one shared with me by a clinical colleague, help illustrate how a therapist or counsellor may act, with a view to the consequent outcomes for the client, in bad faith, or authentically.

Related posts:

Acknowledgements I: Relational Perspectives on Sexual Attraction in Therapy An Acceptance Commitment Therapy Approach to Sexual Attraction Bound to the Mast: Reflections on Analytic Abstinence The Self-Preservation Society: A Discourse Analysis of Male Heterosexual Therapists and Discourses of Sexual Attraction Index

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