Initially the treatment focused on helping Charlie to acknowledge the vital need to take better care of himself physically, to manage his finances more effectively and to assess and modify his avoidant behavior both in the sessions and in running his life. Initially he talked in a scattered fashion, bouncing from one topic to another in a way that was difficult to follow and nearly impossible to address in a meaningful way. Still he was very motivated to understand himself and the effects of the chaotic working class background in which he had been raised.
He described his mother as overly invested in him in a way that was not overtly sexual but too close for his comfort. She sacrificed to send him to a private religious school when neither of his two younger siblings was sent there. His mother ultimately had an affair with a co-worker and that broke up the parents’ contentious marriage. His father died when the patient was in his twenties of the same genetic disease that the patient carries.
Both parents abused alcohol and held wild parties in which numerous relatives came to drink. The men in the family, his father’s brothers, were much worse than his father—drinking and hitting their wives. They were known to be cheating on them as well. The patient witnessed all of this even as he attended a private school where he was admonished to avoid any impropriety, sexual or otherwise. He dated a girl through high school and was afraid even to kiss her because of the teachings of the church and school.
Throughout a lengthy treatment the patient has progressed in many ways. He is better able to manage his medical issues and his finances. He is able to set limits with his daughter and yet provide much needed help to her. His confidence at the non-profit agency where he works has improved and he reports accolades for his accomplishments there. Yet he continues to pursue activities that he had mentioned as a problem from the beginning of treatment. That is, he persists in searching out prostitutes and spends inordinate amounts of time and money on porn sites. He keeps this activity secret from everyone including the woman who was his romantic partner and is now his housemate.
He is however aware of the problems that these activities pose, both in terms of safety and his lack of integrity in regard to his partner. We have explored the roots of this behavior in relation to his upbringing and the activities that he witnessed as well as the hypocrisy that so angered him in the form of teachings at his religious school. Yet it is only as I have been able to listen to detailed accounts of his exploits—cruising for women, visiting them in seedy apartments owned by pimps and drug lords, hearing about the needs of their neglected children and vivid accounts of the sexual acts they pursue—that we have begun to break through the defenses and compartmentalization that he has constructed. I have expressed my physical and emotional discomfort in listening to the material. He is now in the presence of a living, breathing woman, one whom he finds helpful and trustworthy. He is able to see first-hand that women are human beings with feelings and not merely a collection of body parts.
Charlie prides himself on treating women as equals at work and in other relationships. He doesn’t decline, for example, to do “women’s work” in the home. But in the sexual arena he views them differently. His motivations are a complex interaction of internal fantasies, family background and cultural messages that have combined to view women as objects—not human beings—there for his exploitation. For the purposes of this argument we will focus on the cultural messages he was given-- that women are not to be treated with dignity but as sexual objects, part objects which only serve to complete him as a person.
Ellen Toronto is a clinical psychologist in private practice in Spring, Texas and has been practicing since 1980. In 2017, she was elected a Fellow in Psychoanalysis by the American Psychological Association. In 2016, Dr. Toronto's practice was recognized as one of the top Ann Arbor Psychology practices. She received her Ph.D. in Psychology from the University of Michigan. Dr. Toronto is married to Robert Toronto, Ph.D., and together they have four sons and eleven grandchildren.