Psychoanalytic concepts and psychosexual therapy: A suggested integration

Abstract

This paper is concerned with psychosexual development and adult sexual difficulties from intrapsychic interpersonal and physiological perspectives. An attempt is made to integrate these levels of understanding to provide a coherent approach to arousal phase disorders. In the first section psychoanalytic concepts of the holding environment, containment, primal scene phantasies and oedipal relationships are discussed with relevance to sexual functioning. Gender differences in physiological responses and presentation of psychosexual problems are outlined. An object relations formulation of impaired arousal in men is proposed, which views erectile loss as sexual disempowerment. This occurs when a destructive maternal is re-evoked with a female partner, causing psychological and physiological withdrawal. The second section describes the clinical application of the theoretical ideas with three single men referred for erectile difficulties. The psychosomatic nature of the sexual response is, and behavioural interv addressed in therapy via psychodynamic entionsthe therapeutic Technical integration, process and the role of the therapist are also discussed.

In order to understand the complex structure of affects, impulses, phantasies and anxieties which make up the adult sex life, we must turn our attention to the nature of the coital relation of the internal parents…… which has an overwhelming relation to that dependence of infantile parts of the self on the internal mother as the foundation of all stable and healthy psychic structure. (Meltzer, 1973, p. 68)