A sexual violation in an analytic treatment and its personal and theoretical aftermath

SEXUAL VIOLATION  IN AN ANALYTIC TREATMENT 

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nation of power and shame in the analyst/patient hierarchy has some-

thing to do with why sexual betrayal of patients by analysts is a systemic 

hazard: it has nowhere to go but up and out. Analysts suffering the dis-

sociated, unforgettable abjection of having been patients may indeed 

find themselves inducing that very feeling in their own patients, in order 

to cleanse themselves and, thus cleansed, to become pure and strong. 

Hence, perhaps, the draw of that “subtle continuum” of gratification, 

which, as identified by Twemlow and Gabbard (1989, p. 72), “reminds us 

that the potential for exploitation of patients exists in all of us.”

That the analyst knows indicates another subtle dilemma: professional 

shame. The analyst, knowing, knows that there’s something wrong, 

something to be ashamed of. But the act we least want to be caught in is 

the act of self-shaming. We do not want colleagues to transgress, and, by 

identification, are shamed by such sexual misconduct. More poignantly, 

the condition we dread being found in is self-shame. We do not want 

anyone to know that we are ashamed, because being ashamed, as is fa-

miliar from childhood, means we know we are doing something wrong 

but cannot—even do not want to—stop ourselves. As analysts, we aware 

of our common problem (Celenza & Gabbard, 2003), a primal crime that 

we have not yet solved. We do not, however, want this crime and our 

knowledge of it to be public, either among ourselves or the laity, lest we 

risk the shame that shames. No wonder that, for all our contemporary 

acceptance of analysts’ fallibility and even selfishness, when it comes to 

the primal crime of nearly every analytic institute—that is, sexual exploi-

tation—not curiosity but preemptive, regulatory silence carries the day.

Let’s not kid ourselves: the problem is not going away, anymore than 

incest is about to disappear. But perhaps there is a way to keep the im-

pulses toward it in mind, fantasy, and speech, to ensure that, when coun-

tertransference infractions happen, the analyst knows how to discuss 

them. To do that, analysts need to be able locate sex in relational context. 

For a long time, sexuality had dropped off the psychoanalytic radar. We 

can be relieved that it is once again in our sights (Green, 1996 1997; Mac-

Dougall, 1995; Bach, 1995; Kernberg, 1995; Lesser & Domenici, 1995; Psy-

choanalytic Dialogues, 5(2), 1995; Davies, 1994, 1998, 2003; Stein, 1998; 

Widlocher, 2001; Fonagy, 2008; Blechner, 2009), for we may thereby find 

a language in which to address our recalcitrant difficulty.

Many reasons have been offered for this temporary if protracted 

eclipse: the repudiation of reductionist orthodoxy; the runaway success 

of ego psychology, attachment theory, and the two-person psychologies; 

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MURIEL DIMEN, Ph.D.

classical theory’s incapacity to incorporate insights about sex and gender 

from the humanities and feminism; and so on. Perhaps yet another cul-

prit is our collective impotence in the face of our family transgression: 

unable to solve this refractory problem, psychoanalysis just decided not 

to think about sex any more. Or, more kindly, maybe we merely took a 

little break; like artists, we looked away from our work to get a little 

perspective.

Psychoanalysis has, fortunately, now returned to the port from which 

it set sail.

7

 Much of the revived thinking about psychosexuality focuses 

on reconstruing sexual phenomenology, identity, and development. In 

my view, this renewal is also a first-rate opportunity to fine-tune our de-

cryption of erotic countertransference, so as to make sexual infraction 

grist for the analytic mill before it happens. Until now, our way of fore-

stalling sexual transgression has taken what we might call a super-ego 

form: “Don’t.” As with all top-down injunctions, however, this one, prob-

ably intensifies the problem it aims to solve by inciting guilt and shame, 

which oddly impel us to mime the perpetrator and act without thinking. 

To help engage sexual countertransference, it would be useful, in both 

clinical and supervisory settings, to have some ideas, to think about how 

desires that actually feel forbidden routinely emerge in treatment and 

how they inhere in subjective and intersubjective process. Lichtenberg 

(2008, pp. 9–15) suggests one might employ what I (Dimen, 2005b) have 

called “the Eew factor:” if you feel this mix of excitement, alarm, and 

disgust in response to a patient’s sexual or other material, you might twig 

sexual countertransference and self-reflect accordingly.

The development of those ideas exceeds this article’s needs and the 

reader’s patience, so I will suggest only some key requirements: (1) lo-

cating sexual infraction and its refusal in a two-person psychology so 

that it can be part of clinical conversation between analyst and patient; 

(2) a relational theory of the subject as psychosexual, to help analysts 

keep sexuality systematically in mind as they work with their patients—

and themselves; and (3) a three-dimensional relational theory of the in-

cest prohibition that, as I have already begun to indicate in Part II, 

encompasses both children’s desire for parents and adults’ desire for 

children. A clinically pertinent theory would also show why analysts, 

7

 It has been moved to do so, I would assert but cannot here argue, by the multiperspectiv-

alism of the contemporary cultural climate as informed by feminism, gay politics, queer 

activism and thought; the discovery of the ubiquity of child abuse (Rush, 1980; Masson, 

1984); investigations into sexual transgressions in professional relationships; and a new 

psychoanalytic generosity toward other bodies of thought.

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