Sexual Interviewing, Evaluation, and Therapy: Psychoanalytic Emphasis on the Use of Sexual Fantasy

Sexual fantasy in initial interviews and during psychotherapy and psychoanalysis is explored for its contribution to understanding psychopathology, both sexual and nonsexual. The focus is on distinguishing between the sexual and the seemingly sexual. "Sexual" behavior and fantasy are regarded as having sexual pleasure and orgasm as the predominant goal. Seemingly sexual behavior and fantasy have a predominant goal that is not sexual, even though a sexual mode is used. Predominant goals in the seemingly sexual are emphasized such as coping with intense aggression and problems of self-esteem, self-definition, self-cohesion, and the maintenance of object relations. Sexual fantasy and behavior can be especially useful for repairing negative self- and object images and the associated intensely negative affects. This does not imply that all more primitive patients are incapable of experiencing intense sexual pleasure and orgasm. On the contrary, borderline patients, with extensive use of splitting mechanisms at the level of dyadic object relating, may have intact sexual functioning.