A Self Psychological Approach to Gender and Sexuality was the theme for The 25th Annual International Conference on the Psychology of the Self, held in Washington, D.C., on October 25, 2002. Panel 1, Gender and Sexuality: A Challenge to Self Psychology opened the conference with presentations by Shelley Doctors, Ph.D. and Mal Slavin, Ph.D., followed by a discussion from Estelle Shane, Ph.D. In the most recent decades of the past century, the concept of self in psychoanalytic theorizing has been more dramatically examined, transformed, and debated than ever before in the history of psychoanalysis. We are in a "taffy-making" process with our psychoanalytic ideas: heating, cooling, pulling, pushing, separating, molding - or in the language of our field we view the self as: co-constructed, deconstructed, core and cohesive, fluid and multiple, paradoxical, coherent, and so on. Nowhere are these theories more contested than when we attempt to understand self-organization through the concepts of gender and sexuality, as this first panel illustrated.

Dr. Doctors, presenting first, challenged the monolithic models of gender and sexual development based on biological and constitutional factors and described a mutually constitutive relationship among self, gender, and sexuality. In contemporary theory, gender (and sexuality) is considered less as a core identity or essential developmental process and more as a fluid, complex construction with multiple functions. From a dynamical systems perspective, Dr. Doctors described the complex interpenetrating dimensions of gender and sexuality and their continuous reconfiguration: "Depending on the context, sex may be romantic love and eroticism, power or attachment, comedy, violence, or yet again something else." And I would add to this, at any given moment in the relational dyad, how gender may serve as mask or performance, desire or desired, identification or disavowal, defense, shame, or that which is yet unknowable. Thus, any behavior imbued with subjective meaning can express a gendered experience.

Continuing, Dr. Doctors noted how self psychology, as a whole, has not prominently contributed to the development of theory in the areas of gender and sexuality. The basic assumption, she stated, is when self development is on track, issues of gender and sexuality fall into place. Problems in gender and sexuality, on the other hand, are seen as by products or breakdown products of a fragmented self. Emphasizing the mutually constitutive relationship among self, gender, and sexuality, hence the title of her paper, "The Fish is in the Water and the Water is in the Fish: Gender, Sexuality, and Self - A Mutually Constitutive Relationship," Dr. Doctors renders this hierarchical process senseless. She contends that one's self-experience is equally informed by gender and sexual development as is one's gender or sexual experience is informed by self development. In agreement with Dr. Doctors, I would also emphasize there is a paradoxical circuitry between self and gender; although gender is not a core identity, it can be a core experience of identity. To highlight this perspective, Dr. Doctors chose to describe a specific moment in an analytic treatment with an adult female patient, focusing on the body and its sensations.

The patient, Mrs. S., confided to Dr. Doctors that she had been gang raped in her early teens, something she had never disclosed to anyone, including her parents nor prior therapists in previous treatments. The most distressing aspect of this experience for Mrs. S. was how, upon returning home that evening, she discarded her torn clothing along the corridor and bedroom and climbed into bed nude. This behavior seemed to mortify Mrs. S. She felt it to be "lascivious" and saw herself as disgusting. Dr. Doctors responded that she thought, perhaps, the patient was attempting to reclaim her body and its skin sensations as hers, to redo what had been done to her. Seeing an alternate meaning to the rigidly felt debasement of this experience seemed to shift some of the patient's self organization from shame to agency. The patient could appreciate the "erotic sensation of skin against clean sheets" as a self-preservative ego need that only she could provide for herself. I believe herein lie the excruciating loneliness, despair, confusion and shame that had been described to beset the patient's childhood. Having been brutally raped, she feared further humiliation and culpability if ever she were to reveal the incident to her parents. Yet she leaves strewn her torn and dirty clothing in full view, yearning and fearing their recognition.

It is certainly a poignant clinical moment and I admire Dr. Doctors' depth of sensitivity and visceral capacity, allowing meaningful, reflective resonance with her patient. Dr. Doctors considered her focus on the self-enhancing meanings of this experience to have emerged from a self psychological perspective, emphasizing the "leading edge" of development. She believed that her distinguishing sensual experience from sexual experience, based on Lichtenberg's motivational systems theory, was key in organizing subjectively felt self states in both patient and analyst and most importantly, to allow a shift in the patient's concretized and over-simplified meaning(s) to a provisional function of containment and regulation. Dr. Doctors defined her interaction and interpretation as a perturbation of a rigidly held, malignant attractor state.

In the language of chaos theory and nonlinear dynamic systems the unpredictable organizing and self-organizing experience that emerged for Mrs. S. was stimulated via Dr. Doctors' reinterpretation of her behavior and its affective meaning. The distinction between sensuality and sexuality was an intriguing differentiation, one, which is very complex and paradoxical. Lichtenberg's motivational system, although, compelling, I believe does not fully capture the complexity, paradox, contradictions, uncertainty, and multiplicity of self states. The particular body sensation of a specific event and its consequent meaning is an enigmatic experience in and of itself. What gets symbolized, what gets dissociated, what is unspeakable?

Dr. Doctors' theoretical perspective that the organization of self-experience is mutually constituted within a relational matrix, provokes infinite questions with infinite understandings. Mrs. S.'s use of her body to manage feelings was long standing. We are told in childhood Mrs. S. had an eating disorder and superficially cut herself. What about these bodily and flesh sensations? How did they become gendered or degendered? Was her flirtation a gendered experience of identification, connection, power, objectification, or disavowal? How did Mrs. S. experience her gender and sexuality at 5 years old, at 10 years, old, after the rape, and as an adult married woman? How did the mother's own gender and sexual identity influence that of Mrs. S.? How did the father's? I believe that theory is also mutually constituted from a complex interactive system that attempts to give definition, but is also based on the assumption that knowledge is fluid, contradictory, paradoxical, and mystifying.

Dr. Slavin, interested in comparative theorizing, contrasted several different theoretical perspectives on the gender and sexual development of an adult female patient, Tanya. It was a complex, evanescent portrait of a creatively lived gender and sexuality, chronicled through many years of an analysis with Dr. Slavin. Tanya refused to be categorized, delineated within a hegemonic gender (and sexual) binary system. Her gendered and sexual self were described, not to have generated psychic conflict, as much as confusion and non-recognition and this less to herself than to others. She was described as creatively organizing her self experience within the most challenging tensions of an ambiguous, dialectic life. This challenge, however often culminated in "moments of intense, disorganizing anxiety" and alienation. Tanya's self experience, notably her gendered and sexual self, was often enigmatic and destabilizing such that she was occasionally mistaken for a "guy," even though described as "no doubt, an attractive woman," a most intriguing contradiction and one that insidiously reveals how deeply entrenched are our notions of femaleness and maleness. What does it mean to be experienced as a guy to Tanya, to others, to Dr. Slavin?

It is no wonder that her efforts to evolve the meaning from the paradox of simultaneous yet irreconcilable contradictions left her feeling how life as a whole became an impossible place to live. Any gender and sexual identities that fail to conform to norms of cultural intelligibility are seen as developmental failures or logical impossibilities (Butler, 1990). I believe that what Tanya felt and what Dr. Slavin learned from the interaction with her was that she braved to live in the spaces between categories, where definitions were defied, and self experience is an on going creative process, seemingly knowable, yet continually unfolding. As Dr. Slavin stated, he never once viewed Tanya's gender experience or transgressive sexual behavior as pathological, however, he was aware of how culture, society, politics, and family construct selective meanings with potential destructive consequences, particularly with respect to her creativity and important relationships.

Dr. Slavin discussed multiple theoretical perspectives by comparing among a self psychological narrative, a classical narrative, and a relational narrative to illustrate how the various aspects of Tanya's sexual and gender identity could be understood through a combination of theoretical lenses, an inclusive both/and approach as opposed to an exclusive either/or approach. From a self psychological perspective, Dr. Slavin illuminated how early maternal failures in recognition and mirroring eventuated Tanya's necessary flirtations and affairs as ways to both protect her from vulnerability to self-doubt and object loss and as a means to obtain self-regulation, self-efficacy, and recognition in order to restore her sense of continuity and intactness. Through the classical lenses, Dr. Slavin focused on the unresolved Oedipal relationship and the consequent repression and repetition inherent in Tanya's transgressive gender and sexual enactments. Lastly, Dr. Slavin reflected upon the dialectical tension between passion and attachment referring to the relational concepts of Steven Mitchell. Dr. Slavin saw the "over-inclusiveness", multiplicity, and contradictions of Tanya's subjective experience of self, including her gendered and sexual self, reflecting her capacity to bear the unpredictable in oneself and the other and her capacity to forgo an illusory security for a more vitalizing life of not knowing, which depicts Mitchell's formulations of the dialectics between passion and love or safety and risk.

Mature intimacy/passion indeed involves risk, however, I view this risk not so much in a dialectical sense with safety, but rather, that which is an element of a more primitive basic dialectic between loss/separation and connection/reunion. I question whether risk is even possible without a context of safety. Furthermore, I question why safety has to be a deadened or uninteresting experience. What about the eroticisation of safety, dependency, vulnerability? I would be curious to understand why these experiences so often evoke deadness, impotency, and/or shame, and how/when they are gendered expressions. The awareness of one's vulnerability and dependency is what makes adult romance risky, and it is this risk which pushes one to further know and explore the self and the other; the courage to honestly and authentically express vulnerability.

What constitutes adult romantic relationality, I think Tanya best describes when she declares, "My greatest dread is having to blind myself to Rob (boyfriend) - which is inseparable from his blinding himself to me - so that I won't see things anymore." Thus, is not the real challenge to sustaining a vibrant long-term intimacy the risk of seeing and being seen within an ever-evolving relational space which offers endless views?

In conclusion, Dr. Slavin maintained that the challenge to self psychology is whether we can appreciate the transgressive aspects of sex and gender without reducing them to pathological forms of sexual need emerging out of self-protective responses to developmental trauma. The challenge, he continued, is to appreciate the transgressive aspects of gender and sexuality in a dialectic tension with one's overall self experience, in which gender and sexuality may introduce paradoxically creative and destructive tensions.

Dr. Shane's discussion succinctly highlighted the salient themes of these two presentations, noting that both Dr. Doctors and Dr. Slavin conceptualized sex, gender, and the self as complex, interpenetrating concepts, which cannot be reduced to a single narrative nor appreciated from a single theoretical viewpoint. Dr. Shane described how similarly both presenters located theoretical implications regarding sex and gender within the intersubjective context of the clinical dyad. She also identified clinical shifts in each presentation as "now" moments, referring to Daniel Stern, et al, which enhanced relational knowing in the patient and in the patient-analyst system. Dr. Shane concluded that although she believes a relational perspective promotes an expansion of our views on the individualized and idiosyncratic nature of developmental experience, especially the complex organization(s) of gender and sex, it is nevertheless, important to retain a self psychological perspective, by which she sees Lichtenberg, Fosshage, and Lachmann's motivational systems model as achieving this end.

These discussions provoked extremely important considerations of how we as analysts/ theoreticians begin to understand the multiple processes through which gender, sexuality, and subjectivity inform one another within and beyond a self psychological perspective. It is not so easy to sustain dialogue about these concepts, in all their complexity and paradox, with multiple and ever shifting meanings and contradictions, and I believe this conference was a crucial beginning to examining some of the more subtle aspects of gender and sexuality. However, as I listened to these presentations I was strikingly aware of the absence of a crucial component in these current conceptualizations of gender and sexuality - the body. Although Dr. Doctors did focus on alternative meanings to a specific body experience of her patient, we need to go further in attending to the nuance and subtlety of the interaction of body-based experiences. Our theories and our treatment practice often adorn and conceal the body in a world of words, obfuscating the subsymbolic level of body experiences for both patient and analyst. Where are these bodies and the significant meanings of interactively generated body experience? The bodies that know shame, fear, annihilation - the bodies that have been done to or are doing to - the bodies that are the very site of trauma - the bodies which know but cannot yet speak. What about those places of shame, guilt, loss - those places that resist language - remain unspeakable, unthinkable, yet reside unsymbolized, in the bodies of patients, analysts, families, cultures? How do we begin to give voice and symbolic meaning to these unformulated experiences alive in our bodies, especially those pertaining to gender and sexuality?

Gender and sexuality evolve and are evolved by and through inter-altercations with culture, societies, families, politics, biologies, and theories. It is most important that our theories keep us searching for meaning at the same time we stay aware of how ineffable any particular meaning is. Our theories need to recognize differences without polarizing or pathologizing these differences into hierarchical paradigms. As Bohr declared that the task of physics is not to find out how Nature is, but rather to discover what we can say about Nature, so is the task of psychoanalysis not to find out how the Self is, but to discover what we can say about the Self.