Homosexuality and Psychoanalysis III: Clinical Perspectives

Abstract

ABSTRACT On May 1, 2004, the Association of Gay and Lesbian Psychiatrists (AGLP), with co-sponsorship from St. Luke's–Roosevelt Medical Center, The Haworth Press, and the William Alanson White Institute, organized an all-day conference in New York City entitled Homosexuality and Psychoanalysis: New Directions. The proceedings of the third panel focused on “Clinical Perspectives.” The first contributor is Deborah F. Glazer, PhD, who discusses the impact of homoerotic desire and same-sex object choice on the intrapsychic world and the experience of one's self, including one's sense of adequacy in one's body based, gendered self, and the ability to feel sexual desire. In working with a largely gay and lesbian patient population, Glazer finds that many patients enter treatment organizing their self-experience around themes of gender and sexual orientation. These organizing self-identifications can interact in inhibitory ways that need to be addressed in the analytic work. While these kinds of identifications may not be unique to lesbian patients, the heterosexual bias in society at large, and within psychoanalysis, results in some lesbian patients entering treatment with a more powerful need to address these themes. Jeffrey R. Guss, MD, asks, “What does psychoanalysis have to say about homosexuality?” He acknowledges that gay and lesbian therapists have much to say about gay life and therapy with gay and lesbian patients. They share profound life experiences with their patients, including internalized homophobia, stigmatization, denial of sexuality, denial of relationships, and a fierce expertise in conducting fictive or hidden lives. However such knowledge, even if acquired in an analytic therapy, is not analytic knowledge about homosexuality. Guss, in discussing a clinical example, explores what psychoanalysis has revealed about itself in its long relationship to homosexuality, particularly the field's need to regulate gender and sexual desire. Ann D'Ercole, PhD, shifts the focus to clinical work with same sex couples. She underscores the importance in the clinical work with same sex couples of attending closely to expressions of feeling “different” as such feelings can often obscure shameful feelings that can infiltrate and contaminate a relationship. She further notes that it takes courage to invite a stranger, albeit a good-intentioned one, into the intimate workings of a couple's private life. For lesbian and gay couples seeking treatment, this invitation may invite greater risks than those taken by their heterosexual cohorts. Historically, psychoanalytic practitioners obscured the lives of lesbian and gay individuals in the language of pathology, immaturity and immorality, and psychoanalytic theorizing about same-sex couples rarely went beyond judging them as unworkable. While gay-affirmative clinicians have illustrated how cultural messages can hinder intimacy for couples by creating barriers in an otherwise functioning relationship, mainstream psychoanalysis still lacks normative models for understanding the interpersonal dynamics of gay and lesbian couples. D'Ercole's aim is to begin a process of correcting that omission. Towards that end, she presents a clinical example of a lesbian couple that entered treatment after one of the partners discovered the other in an act of infidelity. Scott Masters, MD, concludes the panel with clinical material from an ongoing treatment. In the process, he puts forth some contrasting ideas about the concept of “hypersexuality” as being either a defense or an addiction. During treatment, gay patients describing their sexual activities can create a host of countertransferences, regardless of the gender or sexual orientation of the therapist. At times therapists may find themselves intrigued, disgusted, envious, or even sexually excited. Therapists are forced to examine the value judgments about certain sexual acts that constitute their own sexual hierarchies. Masters presents a complex case in which because of the patient's potentially self-injurious sexual behavior, it became difficult to stay the course and manage his countertransference.