Clinical implications of contemporary gender theory

What Use is Freud?

More than a hundred years into our field's development, examining Freud's place in psychoanalytic education is timely. What authority does he hold for psychoanalysts in 2021? Is he still the architect, or overseer, of psychoanalysis? Freud has been a metonym for psychoanalysis, yet the history of Freud's identification with the totality of psychoanalysis has had important unfortunate consequences. Negative aspects of this identification subtly linger, interfering in our collective appreciation of post-Freudian theoretical innovations. Too much of psychoanalysis has been "bought at the company store" of Freud's ideas. Though part of this problem is created by idealizations of Freud, much of it stems from Freud's precocious emphasis on psychoanalytic findings within his tripartite definition of psychoanalysis. As a result, many of his theoretical accounts were taken prematurely as definitive building blocks for a comprehensive psychoanalytic theory, when in fact they were only provisional formulations. Presently, portions of Freud's theories are silently withering on the psychoanalytic vine. Data from the PEP-Web archive reveal the declining use of a set of once important, closely linked conceptions-Freud's psychosexual theory and his characterology-and illustrate the kinds of Freudian ideas that have lost their usefulness. The indispensable and enduring elements in his work are identified.

The elusiveness of masculinity: primordial vulnerability, lack, and the challenges of male development

Reaching beyond the Oedipus prototype to address the unrepresentable vulnerability founded on the boy's infantile helplessness in contact with the mother's body, the author aims to identify the inherent tensions and enigmas of being male. He proposes that both the repudiation of femininity and the overvaluation of phallicity are unconsciously constructed to withstand the fundamental deficiency grounded in the asymmetry of the boy's prephallic relation with his primary object. This bodily based primordial vulnerability, marked by absence and lack, remains elusive-an unsymbolizable experience that provides the archaic matrix for adaptive and defensive phallicism, the oedipal complex, and genital progression. A clinical vignette is presented to illustrate these concepts.

Shifting sexual cultures, the potential space of online relations, and the promise of psychoanalytic listening

How we listen to the potential space of online relations is rapidly becoming part of our daily work. Two treatments are examined where themes of sexual shame, repression, and relational difficulties were found and refound through online relating and hooking-up. Consideration is given to the ways in which online exploration opens a potential space that affords sexual practice and the reach of relationality. Moving with these patients into this potential space opened onto an intriguing and productive relational field. These cases help illuminate a shift in our modern social order, and how that shift has followed on a reconsideration of our psychoanalytic ideals about sexual well-being. We are now positioned to reflect not only on the evolution and revolution of our shifting sexual cultures, including the increasing role of technology in our modern relational world, but on how this new world finds its way into our consulting rooms.

"Strange and otherwise unaccountable actions": category, conundrum, and trans identities

Despite recognizing that gender identity is a complex compromise formation, psychotherapists struggle to tolerate gender variance. We still tend to favor binary gender identities and clear developmental lines, rather than embracing a stance of subversive curiosity about the variability and fluidity of gender in our patients. When gender identity is fluid or ambiguous, countertransferential affective disturbances can arise that meld states of abjection and excitement, challenging theoretical constructs and threatening therapeutic neutrality. Case material from the treatment of a female-to-male trans person is presented from the perspective of the transference-countertransference matrix.