An Intersubjective Systems Perspective on Compulsive Sexuality

From an intersubjective systems perspective, compulsive sexuality is a form of emotional disturbance born from contexts of developmental trauma where aloneness is the most pervasive and consistent experience of the relational environment; sexuality is in turn used as the antidote to the resulting unbearable affect. Current research regarding the neurobiological underpinnings of compulsive sexuality (needed as evidence for a sexual addiction framework) is inconclusive. This has created uncertainty and division about how psychotherapists think about and talk about this complex phenomenon. The language and conceptualizations that psychotherapists utilize when striving to understand patients who depend on fantasy and sexual enactments to express and maintain (pre-reflective) organizations of subjective experience can facilitate or impede therapeutic understanding. Intersubjective systems is congruent with the psychoanalytic shift in primacy from drives located deep within the interior of a person to affect located in the subjective experience of co-constituted relationships and represents excessive sexuality as a form of compulsion rather than addiction. Utilizing clinical material from the treatment of Steven, a man with a history of unstable interpersonal relationships who pathologically accommodated to his lascivious father, I illuminate the intersubjective contexts and underlying principles from which his sexualized pattern of conduct derives. Then I demonstrate how the empathicintrospective mode of treatment provided a new intersubjective context that allowed for the beginnings of transformation of his shameful affects and sexualized behavior