Complex Sexualized Transferences When the Patient is Male and the Therapist Female

The expression of sexual feelings toward the therapist is a common development in psychotherapy regardless of the gender constellation of the dyad. Much of the literature on this topic has been written about female patients by male therapists, though, and some authors (1, 2) have suggested that male patients either are too inhibited to express sexual feelings to a female therapist or tend to act out such transferences by involving themselves in outside sexual relationships. In the last 20 years or so, however, a growing literature written by women clinicians has suggested otherwise (3–7). In primitively organized male patients, sexualization may be deceptive since it often represents only the phenomenological surface of the transference, and female therapists need to be aware of underlying aggressive and dependency themes beneath such transferences (7, 8). Resident-therapists beginning to learn psychotherapy may be surprised by this inextricable connection between aggression, dependency, and sexuality in such patients, as the following case presentation will illustrate.