Sexuality in the Consulting Room

Sexuality in the Consulting Room

What happens when patients talk openly and even vividly about sex? Roberto Colangeli, 4th-year candidate, describes such an encounter with a patient and how he grapples with feelings that arise in the room and within himself.


As a psychoanalytic candidate, the topic of sex in the consulting room tends to generate anxiety. Readings, conversations, and seminars on the topic only partially prepare us for when and how our patients talk about sex. Even more difficult, and perhaps less considered, is how analysts-in-training will react and work with sexual issues when they arise.

During my first year of training, one of my patients, a middle-aged married man, described a sexual encounter between himself, his wife, and another man. His description of the threesome was comprehensive and graphic, with detailed images of various intimate aspects of the experience. At first, I felt nervous, uncomfortable, and concerned about my reactions. I also worried that he would sense my anxiety. At the same time, I was intrigued and curious. Shortly after he began his narrative, I found myself lost in the scene he was describing, and feeling what he was experiencing. This fantasy continued until I realized that I was becoming aroused. The realization brought me back sharply to the reality of consulting room.

I reacted with surprise, followed by anxiety, shame, and a feeling that something bad had just happened. I worried that my sexual reaction was inappropriate and wrong, that I was unable to control my sexual fantasies, and that I had broken analytic boundaries with my patient. In addition to all of these feelings and thoughts, by nature internal, I was aware that, as a man, my sexual arousal might have been apparent, potentially noticed by my patient.

As I listened to my patient’s words, another part of my mind wondered why his vivid description of a sexual encounter made me so uneasy, and also why I felt so astonished by my reaction to his story. I came to realize that much of my feelings of anxiety and shame were associated with the topic of sexuality entering the consulting room.

Sex and sexuality can awaken in the analyst, and perhaps especially the analyst-in-training (definitely in myself), primitive emotions, archaic fears, shame, reticence, hidden desires, vulnerability, anxiety about losing control, and maybe even fear of acting on one’s own wishes and fantasies in the consulting room. These powerful internal experiences have the potential to create a sort of hubbub in ourselves which interferes with the “right now” moment we share with our patients. This consideration helped me calm down and realize that becoming aroused by a provocative sexual description was not something to be afraid of, but instead, a natural response to intense stimulation.

If our goal is to feel our patients’ experiences when they talk about their sexuality, it is critical that we be able to organize and analyze our emotions without being overwhelmed.

This is yet another instance in which I realized the importance of my own analysis. I believe that our analysis is perhaps the most powerful and effective tool to deal with the topic of sexuality, a key component in our psychoanalytic training. My analyses—one in Italy as a teenager, and a few in New York over the last twenty years—have greatly helped me to understand and become more comfortable with my own sexuality. My experiences as a psychoanalytic patient have made my fears and demons less frightening; in some ways, they have become travel companions that inform my work as an analyst today.

Lessening the fear of my own internal experience encourages openness to possibility. Perhaps my patient’s sexual description was an invitation to join his experience and connect on a more intimate level, in the security of the consulting room, safely framed by the boundaries of the psychoanalytic relationship. The threesome was, after all, with another man (maybe with me?), and my arousal an acceptance of his invitation.


Roberto Colangeli, PhD, is a 4th-year psychoanalytic candidate at the Manhattan Institute for Psychoanalysis and assistant professor of Microbiology at Rutgers University.



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