When sexual fantasy becomes violent reality: working psychoanalytically with sex and violence

Jessica Yakeley

All of us have sexual fantasies, some of which we may feel comfortable with and others which may cause distress or shame. How do we decide what is normal and what is abnormal? When do fantasies become enacted in sexual behaviours? How do we treat patients who come to us for help with the disturbing and violent use of their bodies with other bodies?

This workshop is based on my experience of working at the Portman Clinic, a National Health Service out-patient clinic in London offering psychoanalytically-informed assessments and treatment with patients who present with problematic violent and/or sexual behaviours. Focussing on the psychoanalytic concept of perversion, I will describe the patients that we see, the difficulties in defining and understanding their presenting symptoms and behaviours, and some of the challenges of treatment, including those of working as a female therapist with men with perverse sexual fantasies and behaviours. Participants are urged to discuss their own work for discussion.

Jessica Yakeley is a Consultant Psychiatrist in Forensic Psychotherapy and Director of the Portman Clinic, and Director of Medical Education, Tavistock and Portman NHS Foundation Trust. She is also a Fellow of the British Psychoanalytic Society and Editor of the journal Psychoanalytic Psychotherapy. She specializes in the psychoanalytic and psychodynamic treatment of people presenting with violent and sexual problems at the Portman Clinic, a National Health Service out-patient clinic in London. She has published widely on topics including medical education, violence, risk assessment, prison health, and antisocial personality disorder, and is the author of Working with Violence: A Contemporary Psychoanalytic Approach (Palgrave MacMillan (2010), and has edited three other books on Medical Education, Medical Psychotherapy, and Forensic Psychotherapy respectively. She is Research Lead for the Royal College of Psychiatrists Psychotherapy Faculty and for the British Psychoanalytic Council. She is currently leading the national development and implementation of new services for a multi-site randomised-controlled trial of mentalization-based treatment for antisocial personality disorder as part of the UK Government’s National Personality Disorder Offender Pathways Strategy.