How are Sex and Gender Embodied in the Therapeutic Relationship?
December 7, 2024

I’d like to step back and widen the angle from which we consider this question. Along with Freud, Wilhelm Reich was one of the first who emphasized the question of sex and the body in relation to our clinical work and in relation to its central place in life itself. This was true in his early studies in Vienna when he first formulated his focal notion that sexual expression was a healing avenue for aliveness and vitality and that sexual inhibition was the source of neurosis. At the age of 20, Freud invited Reich into the Vienna Society, and he began work in Freud’s clinic, the Ambulatorium, and subsequently opened six clinics in the city, treating citizens of all classes on the importance of sexual health and expression. Especially from his early writings, you get a deep impression that he was very sexy himself. He wrote and spoke with a seductive passion that was very different from other early Freudians who wrote with an air of scientific dispassion. Reich drew people in. It was beginning with this early work that Reich founded his reputation. He coined the term “The Sexual Revolution” and was cited in the 60’s by Michel Foucault as being the early great liberator of sexual repression. Reich saw this repression (both social and psychological), from his Marxist leanings, as one of the sources of fascism and its systems of control, rigidifying sexual expression in terms of cultural norms that sequestered the vital, creative, and aesthetic, in our ways of living. Reich drew on Freud’s emphasis on the libidinal freedom of childhood, the polymorphous perversity of early life that becomes shaped and curtailed in the oedipal family.

Reich was deeply interested in sexuality in relation to the body, specifically in relation to how we unconsciously carry ourselves, how we express the existential reality of our subjective uniqueness in the nuance of our flesh. Inhibited sexual energy (Freud’s libido) found its expression in the body as different forms of character armor (Charakterpanzer), which were patterns of behavior, speech, body posture, and comportment that diverted expressive openness into stilted and anxiety-filled repetitions that can be descriptively explored and changed. Crucial in this exploration in the clinical setting, was close attention to a person’s basic expressive attitude, the manner in which patients unconsciously conveyed their experience. He would pay attention to how patients expressed themselves and not so much to what they talked about. With such a focus, a whole world opens, having to do with bodily engagement, with our characteristically restrictive ways of carrying ourselves, which for Reich are understood in relation to sexual inhibition. Release through sexual expression, specifically through full and uninhibited orgasm, was curative according to Reich.

This formed the basis for his theory of the orgone or orgone energy. Unlike libido, orgone energy is not restricted to the somatopsychic region of the drive. The orgone was a fundamental form of energy in the natural world. Unfortunately, from my perspective, this led Reich into an increasingly concrete set of pseudo-scientific researches into the cancer fighting and life enhancing properties of this energy, taking Freud’s Eros theory to its logical extreme with his orgone accumulator, culturally fêted (Norman Mailer owned several of them) and parodied (think of Woody Allen’s orgasmatron in his movie Sleeper).

But the fundamental stance of seeing bodily comportment and expression as a source and modality for vitality or its redirection into different kinds of pathological foreclosures is a powerful heuristic that can be vividly experienced in the clinical setting. For Reich, this was explored in what he called vegetotherapy, based on the vegetative or autonomic mode of bodily experience. His work expanded from character interpretation to body therapy and forms the basis of many kinds of body work, that are deeply familiar to my colleague Bill Cornell and elaborated in their own way by our hosts Jon and Doris. We can see Reich’s direct influence in the Bioenergetics of Alexander Lowen, in the work of the Norwegian, Ola Raknes’ Characteranalytic Vegetatherapy, in Fritz Perls’ Gestalt Psychotherapy and others. We also see deep parallels in the psychoanalytic work of Reich’s contemporary, Donald Winnicott with his elaboration on the psyche-soma, and with his revolutionary paradigm shift toward the ontological, toward the experiences of going-on-being, being alive and creatively spontaneous. These is not a matter of what is conscious or unconscious, but a matter of finding a personal way of being alive and vital. Winnicott and his contemporary Bion, attended to processes and not so much to content. In line with Reich, this was attending to how experiences emerge in the here and now rather than attending to what is talked about in the past.

The sexuality of libido was broadened in the direction of Eros for Freud, Orgone for Reich, and also in the direction of Élan Vital for Henri Bergson, who was their contemporary. The sexual becomes life-force and generativity, a non-mechanistic, creative and open-ended pulsation of ever-new forms of expression. Giles Deleuze elaborated this more recently in compelling ways, where élan vital is a vitalizing movement that finds expression in multiplicity, in dynamic, non-static and spontaneous processes that deconstruct the repressive structurations of social order. (this is actually a point that becomes very important when considering gender.) Following Reich, especially in his earlier thinking, this always comes back to the vitality of bodily expression or its foreclosure.

The broadening of sexuality as a mode of being is elaborated by Maurice Merleau-Ponty, who sees sexuality as “continually present in human life as an atmosphere.” Sex is a central mode of being-in-the world, where it is neither purely physiological nor psychological, but part of our lived existence. In this way, sexuality is an ambiguous and ever-present animation of self, other, and world. Sexuality is embodied every moment, but not just in my body, but though my bodily expression and reception in relation to others and the world. It is inherently relational, at times reduced to doer-done-to force but also offering a vital connection and interweaving with everything we encounter. Nature is sexy in ways that seduce, that inspire, that threaten, always bringing us back to something carnal that we are part of. Merleau-Ponty calls this experience flesh, and Reich offers a direction for its exploration in the clinical encounter.

Sexuality is interwoven through every moment of our experience. As a teenager, first out and about with friends, we had a game when we went to Chinese Restaurants. We’d get the fortune cookies, sequentially open them and read the proverb, but then would add “in bed” at the end of each fortune. “A pleasant surprise is in store for you…in bed.” “Your hard work will pay off…in bed.” In our clinical work, the sexual isn’t an inadvertent add-on. It’s there as an implicit organizer of experience that can be attended to in ways that catalyze and deepen an encounter. I’ll rely on my erstwhile colleagues to begin us with clinical examples, and in discussion, will offer thought or the social construction and deconstruction of gender that has an uncanny parallel to sexuality as addressed by Reich and his followers.