Let’s Talk About Sex (and Gender): Insights from Edie Hitchcock

Q – How do you see sex and gender diversity playing out in your patients’ day-to-day lives?

When we talk sex and gender diversity, many of us first think of the LGBTQ+ community – and since that’s my specialty, I’ll start there. Although I encourage readers to dive into the fascinating history of LGBTQ identity and activism, I’ll just mention a few brief points from the perspective of using the term Queer as a catch-all term.

Currently, Queer (a word which previously meant “peculiar”) has become an umbrella term for many different minority and subcultural groups in the arenas of both gender and sexuality. However, one can be Queer in their sexuality without being Queer in their gender presentation or feelings about their bodies. That is, it is perfectly possible for a subject to identify as Queer, be perfectly happy with the body they were born in, present as overtly feminine or masculine, use the “they/them” pronouns, and still consider themselves trans, nonbinary, or any of the other multiplicity of identity markers that abound today. Any other sapiosexuals out there?

As queer people develop their identities, many are confronted with external and internal conflict – bi-erasure, misgendering, rejection from family, and or micro-aggressions (even in an urban, generally progressive environment like Chicago). They might experience a great deal of uncertainty – how does one live a more overtly queer life by like taking hormones, getting surgery, switching pronouns, or dressing differently.

The point is, all of these choices and paths of discovery are potential sources of great meaning, authenticity, and empowerment.

However, these experiences are not unique to the LGBTQ+ community. Many of the above feelings and uncertainties that can come up with regards to heterosexual and cisgender individuals as well.

Straight individuals might not be used to considering the role of sex or gender presentation in their lives but we as therapists want to talk deeply with straight and cisgender individuals about their sexual and gendered experiences. It can be uncomfortable at times but as Freud recognized so many years ago, sexual experience is an incredibly important part of being human; it deserves our attention, consideration, and mindful awareness. Thinking carefully about sex and gender in our lives can aid in processes of discovery and meaning making with regards to who we truly are and how we can get closer to living our lives with grounded passion and authenticity.

Q – How do gender and sexuality play out in the psychotherapy process?

What a great question! Because I specialize in working with the LGBTQ/poly/kink communities, we work with gender and sexuality all the time. My patients and I discuss the ins and outs of hormone treatments, scheduling difficulties with multiple partners, putting on makeup for the first time, getting masculine-cut clothes altered or tailored, the pleasures and sorrows of online dating, the consideration of Gender-Affirming Surgeries, and so many other things. But that’s just the more concrete material.

We also delve into the areas that are difficult for us to feel and think about regarding gender, sexuality, and relationships. What we learned about sex from our peers, parents, and (often shoddy) sex-ed classes and how that education affected us are important stories that we rarely have space to explore in a deeper way. Our sexual feelings are often compartmentalized; a really important part of a good psychotherapy is opening up those compartments and taking a look at what happens to us and how we actually feel when we’re in the bedroom.

Another way gender and sexuality play out in psychotherapy is between the therapist and the patient. Sometimes a patient might feel attracted to the therapist or might develop a crush – it’s normal! Figuring out how to talk about that and what it means to both individuals in the relationship is complex but can often be a source of great meaning and growth for both patient and therapist.

The point is, we talk about these difficult feelings and moments of vulnerability. A psychodynamic therapist is trained to handle these “hot” (pun intended) aspects of the relationship; we don’t pathologize, deny, or reject the development of these types of feelings. Psychodynamic psychotherapy can be an intimate process; this fact is likely the reason it can lead to true, long-lasting change, however, I cannot stress enough how important it is to bring difficult feelings like sexual attraction into the work instead of denying and disavowing them.

Lastly, I frequently help clients with the effects of sexual trauma, abuse or neglect, and of course, the ever-present (but frequently downplayed or even denied) elements of privilege and power dynamics. Each of these require far more time and space than I have here but these elements can sometimes define an entire treatment. They are completely entangled with our conscious and unconscious perceptions and feelings about our gendered roles and our sexual experiencing of our bodies, ourselves.

Q – What are some of the common myths about the kink community and polyamory? What tends to bring clients in for therapy who have those identities/orientations?

There are dozens of misconceptions about kink: it’s violent and dangerous; submissives have self-esteem issues; dominants are power hungry and sadistic; people that like BDSM are weird or sick; a dominatrix must hate men; men who enjoy anal play are gay.

The same goes for polyamory: “polyamory” is just another word for cheating; poly folks are unable to commit; polyamory is just a phase, poly folks are sluts; poly folks are anti-monogamy; polyamory is the same thing as non-monogamy, open relationships, and polygamy.

No, no, no, and NO.

Individuals who play in the kink community are not any more crazy or odd than the rest of us. It is a community that places high value on safety and strong, verbalized boundaries – if anything, kinksters are better than many at setting and respecting boundaries because they have so much practice openly talking about what they want, what they desire, and how to go about getting those desires met in a safe, creative, and playful way. Kink can be a form of stress relief, a place for privacy, a site for self-exploration, as well as many other things.

At the same time, as I mentioned above, sex and forms of sexual play are complex and deeply individualistic. When my kinkster patients talk with me about what and how they enjoy, we go deep into how they think and feel about their desires and the complex ways in which they relate to those they love and/or play with.

In the poly community, each person experiences and explores their non-traditional modes of relating differently and uniquely. Some lovers make rules for themselves; others make hierarchies. Some lovers make no distinction between partners, others settle down with two or more long-term partners and don’t ever date outside again. Again, the possibilities are endless and again, each person navigates these relationships differently. Intensities arise, confusion and jealousy can billow, and self-doubt can undermine our resilience or commitment to those we love. These are all important aspects of life and love to examine with an intelligent, thoughtful, and nonjudgmental clinician. Poly might not be for the relationally faint of heart but exploring how we experience our processes of living the questions can be a courageous and challenging journey.

Q – Depth Counseling strives to go “beneath” presenting symptoms to understand the person in greater depth. This means understanding the private, and sometimes unconscious, needs, wishes and emotions that shape their lived experience. How does this approach differ from other approaches when it comes to understanding gender and sexuality diversity?

Gender and sexuality can be difficult to talk about openly even on the conscious level, which is probably why having a psychodynamically-informed therapist is even more useful.

The psychodynamic perspective began in the office of Sigmund Freud, who theorized, among other things, that our frequently repressed thoughts and feelings about sexuality are often a major source of the suffering and struggle that we face as we navigate this crazy world. A psychodynamic therapist like myself and my colleagues at Depth will often seek out ways to help the patient feel more comfortable talking openly about sex.

We live in a very contradictory culture: with our puritanical history still informing our sexual lives (no matter how sex positive we think we are), Americans often struggle to work out how they really feel about sex and their relationships with partners. Our private fantasies, wishes, and dreams, often deeply sexual or gendered in nature, are often discarded as not meaningful, but the long and successful history of psychodynamic psychotherapy states otherwise. As psychodynamic therapists, we don’t shy away from difficult or dark thoughts, feelings, or fantasies, we get up close and stay with you until we work out what’s going on in the substrata of our lives and relationships.

We might like to think we know what’s going on under the hood, under the surface, but often it takes speaking the self in the presence of an engaged and open-minded person, for us to truly discover what we thought we knew all along.

Q – What might you say to a prospective patient who is considering starting therapy with you?

I do my best to utterly respect the unique individuality of each patient. Different humans need, wish, and want different things. That means not jumping to conclusions or thinking that I understand a person before I do. But in addition to creating a space marked by flexibility and openness, I also really show up! This means holding, managing, and containing what emerges in the therapeutic space while simultaneously taking an active role and speaking forthrightly into the lives of patients if that is called for.

Even if I spend much of a session in silence, I am listening intently, perhaps in a way that individual might not have even experienced before. This is a special type of listening, one that allows the patient’s self to unfurl in new ways as they allow a bit of surprise or curiosity into the autopilot of their lives.

When a new or prospective patient arrives in my office, I might let them know a bit about how I work if they’re curious or we might just jump in, beginning to untangle what’s at stake, what they hope for, what they struggle to face, what they might actually be dreading. I engage, think, feel alongside another human subject.

Then, we see what happens.

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