Introduction

In this chapter, I will argue from my experience as an existential psychotherapist that sexual feelings within therapy are not only unavoidable, but attempting to deny them can be more problematic than accepting them. This is particularly so in styles of therapy, such as my own, where dialogical relatedness and psychological proximity are regarded as central elements in the work. I describe myself as an existential psychotherapist, meaning that my work is informed by phenomenology and philosophical and sociological thought found in continental philosophy.

It seems that sexual feelings between therapist and client are rarely discussed, except in the context of professional misconduct or as erotic transference. There is an implicit consensus that sexual feelings in the consulting room are problematic and are therefore best avoided. This is by no means an original observation and we might even see it as a stereotype or cliché of therapy that extends into the public domain. Consequently, we find ourselves living and working in an all-pervasive climate of opinion that is deeply suspicious and cautious of anything sexual in the consulting room. I came to the conclusion quite early on in my career that most therapists find it inappropriate to have sexual feelings towards their clients, and yet, it is accepted and even possibly expected that clients will be sexually attracted to their therapist.

Rather than avoid sexual feelings by attempting to put them out of play, either by a phenomenological bracketing, re-framing them as erotic transference or denying their existence by placing an asexual boundary around the work, I would argue that sexual feelings can be an appropriate and important element in the therapy that can be productively and safely incorporated. However, for this to happen, it is necessary to accept certain existential givens. The first is the primacy of embodiment as a central feature of existence, meaning that we always exist in and through our body. The second is the ever-present phenomenon of existential sexuality, whereby sexual feelings are a constant horizon to our existence.

In this chapter, I will examine the implicit taboo on sexual attraction, before presenting embodiment as a unified system of mind and body, exploring the nature of sexual attraction, and the interpersonal dynamics of existential sexuality. Finally, I will suggest ways to work with psychological proximity and with sexual feelings as a legitimate aspect of the encounter. Then, by using the metaphor of lovers, explore similarities between the intimate narratives of lovers and the dynamics of both verbal and non-verbal dialogue involved in negotiating relatedness in practice.

Theoretical Framework

I will begin by examining the all-pervasive climate of opinion mentioned earlier to try and understand why sexual attraction is seen as unwelcome or threatening to psychotherapists. The implicit taboo surrounding sexual feelings that emerge in therapeutic practice is linked to issues such as professional codes of conduct, institutionalized ethical boundaries, cultural taboos, social perceptions and, of course, the legacy of Freudian psychoanalysis. I remember attending a conference workshop on ethics and being presented with the high incidence of male American psychiatrists accused of sexual misconduct with their clients. At that time, state regulation of the profession was being proposed, and the presenter was attempting to base a whole strategy of ethics for psychotherapy in the United Kingdom on the sexual misconduct of some male psychiatrists in another continent. I am not arguing against sexual misconduct being regarded as a major ethical transgression, simply pointing out that making it the foundational image for an ethical strategy, when there are many ways in which to be unethical, besides sexual exploitation and misconduct, is an overt example of an institutionalized repressive attitude towards anything sexual in psychotherapy.

The findings of my own research (Smith-Pickard, 2006b) supported the view that sexual attraction is potentially present in the majority of therapeutic encounters. Many of my co-researchers, all psychotherapists, experienced sexual feelings as problematic. They reported a sense of shame and failure when they were sexually attracted to their clients, and if a client expressed sexual feelings towards them, they assumed that they had done something wrong and felt responsible for allowing it to happen. They reported a rupture in the focus of the therapy and in their ability to maintain psychological contact, becoming disconnected from their clients. They were also reluctant to take this to supervision for fear of being judged as unethical or inappropriate in their work. Other co-researchers, however, were prepared to accept the inevitability of sexual feelings being present. They spoke enthusiastically about the value of being able to hold and negotiate the feelings between them and their client and to work innovatively at the edge of therapeutic boundaries. None of my co-researchers suggested that working with these issues was either straightforward or without risk, but some of them did recognize the potential for therapeutic gain.

Generally speaking, however, emotional involvement in therapy is treated with some caution, as Van Deurzen-Smith (1997, p. 219) suggests: ‘There is much evidence from a century of psychotherapy that the realities of what is usually referred to as “transference” and “countertransference” can only be neglected at one’s peril’. This mention of transference brings us to one of the legacies of Freudian psychoanalysis, namely, the disavowal of the therapist’s body by accepting the sexual feelings of the patient while at the same time attempting to deny their impact on the therapist. At its core, the transference hypothesis relies upon a Cartesian split of mind and body, privileging mental processes over embodied experience, where desire becomes a disembodied mental construct. This, according to Mann (1997, p. 16), is an attempt ‘to de-erotize the inherently erotic’. From an existential perspective, this attempts the impossible as sexual desire is always incarnate. What I desire is another person, a body brought to life through consciousness, a person who will desire me in return. What I desire is to be desired and existentially validated by existing in someone else’s eyes as someone who has sexual significance. Any form of psychotherapy aiming at relational connection and closeness will inevitably open up a non-verbal affective dialogue, and it is within this dialogue of embodied inter-experience and relational proximity that sexual feelings and desire emerge, experienced as a form of self-consciousness and disturbance within our bodily senses.

Although the origins of the taboo on sexual attraction in psychotherapy may in part be traced back to the origins of psychoanalysis, not all of the blame can be attributed to Freud. It is universally acknowledged that sexual activity with a client is an exploitative abuse of power and trust. It is the ultimate ethical misdemeanour. Unfortunately, this ethical taboo extends into the realm of anything sexual, or potentially sexual, including the use of touch and the presence of sexual feelings. While sexual misconduct may be relatively infrequent, sexual attraction between client and therapist, or therapist and client, appears to be a more frequent phenomenon. Indeed, it has been so since the dawn of psychoanalysis when, according to Webster (1996, p. 111), Breuer fled in panic from the bedside of his patient Anna ‘O’ when she expressed sexual feelings for him, thus providing the inspiration for his colleague Freud’s hypothesis of ‘transference love’ as an attempt to explain sexual attraction in the patient and to absolve the therapist from responsibility.

To be sexually attracted to someone is to recognize his or her sexual significance for us. They emerge as someone we have sexual interest in, as opposed to those whom we do not. Although we can experience this attraction as a longing or a feeling of enchantment, it does not necessarily mean that we have a desire for physical intimate contact or sex with this person, although obviously this could be the case.

In many ways, sexual attraction in the consulting room is probably no different from everyday life, where, as a fundamental aspect of our lives, the desire to be found attractive as well as finding oneself attracted forms the basis of many, if not most, of our interpersonal relationships. We develop a sense of self in the world through our impact on others and their impact on us through acts of mutual reciprocity, where we feel significant in our own and others’ lives. The therapeutic encounter differs here from other reciprocal and complementary relationships in as much as the therapist’s desire to be found attractive, however subliminally experienced, cannot override the client’s needs for existential validation.

There are also other obvious differences between everyday life and therapy, such as the feelings of anticipation that develop out of the ritual of regular appointments, along with the deliberate attempt to engage in a deeply personal way with another human being in the intimate proximity of a private space for a limited time span. Merleau-Ponty (1996, p. 156) proposes that there is an erotic structure to the way in which we perceive the world, so that whatever situation we find ourselves in, we will be looking for the sexual value or meaning in that situation. He describes this as ‘the mute and permanent question that constitutes normal sexuality’. While we might take exception to the normative imagery of sexuality, it should not get in the way of seeing that we approach life with sexual interest and anticipation. Consequently, whenever two people meet, there is always the possibility and potential for sexual interest to develop, especially if they are alone. I am certainly not suggesting that every consulting room is a cauldron of desire, anymore than it is a sterile emotional space, but I would suggest that sexual feelings and attraction, at some level, are a likely outcome, and even possibly, an inevitable consequence of the proximity within the relational therapeutic encounter, as Maria Luca intimates in the introduction. So what might we understand by sexual attraction from an existential perspective?

Sexual attraction does not lend itself to precise definitions or logical causality. It is highly subjective and covers a wide range of phenomena, from mild erotic interest to overwhelming sexual desire. Although constructed on a range of cultural, sociological or psychological factors, there is usually another more mysterious element at play in sexual attraction. This is the unexpected element of amorphous randomness exemplified in mythology by Cupid’s arrows.

Sexual attraction is an interpersonal phenomenon that we experience as felt sensations within our bodies that requires another embodied being to be the focus of our interest. This silent dialogue of desire is experienced through the body as ‘an erotic comprehension not of the order of understanding … desire comprehends blindly by linking body to body’ (Merleau-Ponty, 1996, p. 157). Our consciousness is drawn down into our body, and if we are unused to recognizing or focusing on bodily felt sensations, then we might not immediately recognize the subtle impact of sexual attraction. Awareness of our sexual interest may only be subliminal so that we may not know why we are attracted, or even why we are attractive to another. Sexual attraction can feel as if it has crept up on us unawares and has taken us by surprise.

Sexual attraction is not necessarily mutual and reciprocal, and there is a whole matrix of possibilities within the dynamics of sexual interest that can get played out in therapy. Attraction may be overtly or covertly expressed and we are not always aware of others’ feelings towards us. We may realize that they like us, have warm feelings towards us, or even find us attractive in some way, but we are not always aware of them finding us sexually attractive. In addition, we may recognize that another person has all the attributes of being sexually attractive, but it does not necessarily mean that they are sexually attractive to us, or that we have any sexual interest in them. What creates sexual interest for us in another person can often seem unexpected and confusing, not just to ourselves but also to others around us.

However, if someone expresses a sexual interest in us and demonstrates in some way that they find us sexually attractive, then it can stimulate a response in us, where a person who was hitherto someone who we had no specific sexual interest in may suddenly become someone who we have a sexual attraction for. This induced reciprocity comes about by their existential validation of us as someone significant in their eyes. However, if they realize that they are not sexually attractive in our eyes, our unresponsiveness can invoke a sense of failure in them. It can feel at some level like an annihilation of their existence in their inability to make a difference to us.

This illustrates some of the complexity surrounding sexual feelings in negotiating relatedness in the consulting room. Psychological proximity can become a dance in the tension between proximity and distance, requiring sensitive presence to regulate and maintain therapeutic contact. It also reminds us of the immense power of these feelings and how fragile our sense of self can be around them. One way into understanding this labyrinth of dynamic relational possibilities is through the interpersonal phenomenon that I have described elsewhere as existential sexuality (Smith-Pickard, 2006a, 2009).

Existential sexuality is, first and foremost, an embodied interpersonal phenomenon extending beyond orgasmic or genital focus. It is present throughout the lifespan and describes the primary way in which we project ourselves into the world and seek existential validation from the world by claiming some significance in the lives of others.

Sex and sexuality are clearly related but only in as much as sex is but one aspect of sexuality, ‘an imaginary point determined by the deployment of sexuality’, says Foucault (1990, p. 155). Using the terminology of existential philosophy, we could describe sex as an ontic manifestation of an ontological sexuality that, according to Merleau-Ponty (1996, p. 168), is ‘always present like an atmosphere’. Existential sexuality exists much of the time without sexual intention or genital focus and this is an important link with sexual attraction because it too can also be experienced without the intention of sexual contact. In fact, I would suggest that in the consulting room, it frequently is without sexual intent, although as in everyday life, it can easily become sexualized if the possibility of sex emerges from the ground of existential sexuality and social encounter.

In existential sexuality, there is an attempt to focus the other’s consciousness within their body, to make them aware of bodily sensations as self-consciousness while at the same time offering one’s own body/self to be impressed upon by receiving the resemblance and otherness of the other. What we have is a relational system that aims at a mutual reciprocity by attempting to capture or appropriate the embodied consciousness of the other. It is reciprocal or intersubjective because the body I have/am is the site of my perception, and because I can see, I am aware that I can also be seen, sense and be sensed. I am in the world and the world is in me and I cannot step outside of this reversible relationship with the world to become a detached observer or an isolated subject. My awareness of my own visibility means that I am always self-conscious and conscious of the potential gaze of the other. In other words, subjectivity is always intersubjectivity.

What I am describing as existential sexuality is a system of reciprocity whereby we fascinate and are fascinated by the other, appropriate and are appropriated by the other, and desire the other’s desire for us. Existential sexuality and embodiment are irreducible elements of existence that carry the possibility of sexual attraction into all our relationships. This can create an edge of ambiguity in negotiating relatedness in therapy that I will attempt to illustrate in the next section, with some reflections on sexual attraction and the use of supervision.