Too close for comfort: the challenges of engaging with sexuality in work with adolescents

Earlier versions of this paper were presented at the ACP Annual Conference, London 2011, the Birmingham Trust for Psychoanalytic Psychotherapy, 2011 and the Tavistock Clinic’s Psychoanalytic Forum in 2015.

Abstract

This paper explores some of the ways in which sexuality can intrude into the psychotherapeutic relationship and present both opportunities and risks to our work with adolescents. It highlights some of the complexities of this area of the clinical encounter, exploring the particular difficulties encountered by both patient and therapist when sexuality emerges in the transference and countertransference. While we are well aware of the centrality of sexual development during adolescence, far less has been written about the way in which sexuality and the erotic transference emerges and impacts on both patient and therapist. Given the profoundly unsettling nature of this area of work and its capacity to disrupt our thinking and psychic equilibrium, it is easy to underestimate how much we are drawn to avoid, negate and defend ourselves against registering such experiences. Through the discussion of clinical material with two adolescent patients, this paper explores some of these dynamics, addressing some of the technical dilemmas that frequently challenge us in this area of work. These include questions about whether and when it is therapeutically important and effective to take up and interpret the emergence of sexuality more directly in the transference and some of the risks to our patients when we ‘play safe’ and fail to do so. Most importantly, this paper aims to facilitate further thinking and discussion about an important but uncomfortable and easily neglected area of our work.

Keywords:

• transference
• countertransference
• adolescent psychotherapy
• erotic transference
• sexual transference
• adolescence

Acknowledgements

I would like to acknowledge my appreciation of Steve Dreyer and, separately, members of my clinical supervision group at the time I was working with the patients described in this paper, for their invaluable supervision and support through some of the most difficult periods of this work.

Notes

Earlier versions of this paper were presented at the ACP Annual Conference, London 2011, the Birmingham Trust for Psychoanalytic Psychotherapy, 2011 and the Tavistock Clinic’s Psychoanalytic Forum in 2015.

1. I have written elsewhere about the challenges that teachers have to manage in containing sexual anxieties in schools (Jackson, 2015).

2. There is a question here, worthy of further discussion, about whether a health and safety culture has diminished our willingness as therapists to engage with ‘dangerous’ sexual material, especially perhaps as a male therapist with female patients given this is the most common form of sexual power dynamics.

3. All names and identifying details have been changed to protect confidentiality.

4. One can see here how reductive it would be to describe Hannah’s difficulties as ‘separation anxiety’.

5. Whilst not the focus of this paper, it is important to note that material such as this, did later result in additional and separate work with Hannah’s parents being arranged.

6. The complex ways that the gender and sexuality of both patient and therapist manifest within the transference and countertransference is an important one, deserving of further exploration, though beyond the scope of this paper.

7. Personally I do not like the term ‘guarantee factors’ as I think the idea of a ‘guarantee’ may itself be a potential risk factor.