Psychotherapy with Gay Men and Lesbians: Contemporary Dynamic Approaches (Book Review)

Author:  Drescher, Jack, Ann D’Ercole, and Erica Schoenberg
Publisher: New York: Harrington Park Press, 2003
Reviewed By: Scott D Pytluk, Spring 2005, pp. 46-48

As does any good psychoanalytic clinician, I pay attention to my fantasies. I would like to open this review with two of them—one I had before I read Drescher, D’Ercole and Schoenberg’s edited volume, and one that emerged afterwards. Immediately upon receiving a flier from the publisher announcing the upcoming release of this book, I felt a rush of excitement—the kind that comes when a valued cause’s time finally draws near. Here it is, the piece I had been waiting for: a volume that would comprehensively and artfully expose the reader to the state of the art of contemporary gay-affirmative psychoanalytic theory and practice all in one place, a tightly coherent collection of essays that would represent well the extant canon of this rapidly evolving domain! In other words, I was expecting an idealized vision of Oedipal perfection with which I could be enthralled. (Davies, 1998, 2003) Because I have been adequately analyzed, however, I soon realized I ought not anticipate perfection if I were to relate fairly to this text. After all, no book could possibly fulfill my fantasy.

This realization brings me to my post-reading fantasy, this time, a post-oedipal (Davies, 1998, 2003) reading of the book. The story goes something like this: Jack Drescher, Ann D’Ercole, and Erica Schoenberg, three notably important contributors to the contemporary, gay-affirmative psychoanalytic literature, are on a conference call, each sharing his/her fiery eagerness to put a volume together that would take advantage of the finally achieved critical mass of scholarly and clinical energy devoted to LGB-affirmative perspectives evident in the literature. In the Journal of Gay and Lesbian Psychotherapy (JGLP) alone, they could identify more than enough pieces written by some of the stars in the discipline to fill a volume that would signify the discipline’s healthy solidity and that would offer readers enough of a taste of the extant thinking to find it meaningful, evocative, and worth pursuing further. And so, in their enthusiasm, the group expeditiously culls a group of previously published JGLP articles and produces a work of value, but with some rough organizational edges. In other words, they create an object I could love post-oedipally, an object whose worthwhile offerings I can appreciate despite any imperfections, or maybe even because of them.

The editors introduce their collection with the notion that analytic clinicians today work with gay, lesbian, and bisexual patients during an era in which clinical thinking and theory about sexuality and gender is ever evolving. They describe the clinical landscape as one where novel approaches co-exist with more traditional ones, all of which can be located at various points along the essentialist/social constructionist continuum. Their choice of selected readings and case discussions represent this landscape, drawing on the work of Petros Levounis and Ubaldo Leli, who generously offered case material for critical commentary, as well as clinician-writers such as Adria Schwartz, Kenneth Lewes, Martin Stephen Frommer, Jack Drescher, Karen Maroda, Joyce McDougall, Robert Wallerstein, Gilbert Cole, Adrienne Harris, and Bertram Schaffner. Divided into four sections, the volume covers topics such as the gay patient-gay therapist dyad, erotic transference/countertransference (which might have been more accurately labeled “gender and erotic dynamics in the treatment of lesbian/’gay/bisexual [LGB] patients”), and treatment with the gay patient with HIV/AIDS. This somewhat loosely held together mélange of subject matter not only addresses many of the unique developmental and clinical themes relevant to affirmative analytic theory of LGB individuals, but also several currently “hot” general clinical controversies such as relational/intersubjective vs. one-person psychology approaches, the vicissitudes of therapist self-disclosure, the various takes on the implications of flexibility of psychoanalytic frame, among others.

In the opening section of the book, in which a case presentation of Levounis’s work as a gay therapist with a gay male patient is followed by five critical commentaries, the discussants use the forum not only to speak to the case at hand, but to touch upon their way of thinking about therapeutic work with gay patients in general. It is in these chapters that the reader will find a treasure trove of wisdom on relational (e.g., Adria Schwartz’s “A Place of Recognition: Commentary on a Case Report” and Martin Frommer’s “Reflections on Self-Disclosure, Desire, Shame, and Emotional Engagement in the Gay Male Psychoanalytic Dyad”), social constructivist (e.g., Ronnie Lesser’s “Discussion of Gay Patient-Gay Therapist: A Case Report of Stephen”), and interpersonal (e.g., Jack Drescher’s “Dream a Little Dream of Me: A Case Discussion”) psychoanalytic theory.

In her critique, the late Adria Schwartz makes use of Jessica Benjamin’s (1992) ideas about recognition in the relational sense to interpret the case. Schwartz contends: “…just as the mother’s recognition of her child’s nascent subjectivity forms the basis for the baby’s ‘sense of agency,’ so should psychoanalysis/psychotherapy balance attention to the intrapsychic and the intersubjective…” (p. 32), Schwartz points out that Levounis’s patient sought recognition from Levounis so that he (the patient) might recognize himself. She astutely adds that, for the gay man, “coming out” is “a more direct quest for recognition of one’s sexual subjectivity” (p. 32). In “Reflections on Self-Disclosure, Desire, Shame, and Emotional Engagement in the Gay Male Psychoanalytic Dyad,” Martin Stephen Frommer explains that in the two-person psychotherapeutic perspective,

“the therapeutic relationship and the transference are always contributed to mutually by both participants in the interaction. The therapist’s responsiveness becomes a primary vehicle for emotional growth and therapeutic movement within the dyad. Therapeutic action is dependent on the therapist’s ability to somehow use his subjectivity in a measured way that ultimately allows him to emotionally engage with the patient in a manner that creates new experience. Often, this process first consists of repeating what has been, before new emotional ground can be broken. (p. 70).”

In the focal case, Frommer points out that in entitling his case “Gay Patient-Gay Therapist,” the reader’s perspective is oriented in the two-person direction. As Levounis is not explicitly “out” to his gay male patient as gay himself, Frommer seizes the opportunity to highlight the controversies surrounding the use of therapist self-disclosure in general, and of disclosure of a therapist’s same-sex sexual orientation in particular. He observes:

“As therapists who are gay and lesbian, we all bring a history of having had to hide our sexual orientation at some point in our lives, whether past or present, to avoid ridicule, harassment, or pain. The specific histories of our having had to sidestep questions about our sexuality, or even lie about it and our feelings about these events, come into play both consciously and unconsciously when we grapple with issues concerning the disclosure of our sexual orientation to our patients (p. 62).”

Here, Frommer teaches the reader important lessons about the developmental history of LGB individuals. He highlights the ubiquity of early experiences of interpersonal homophobia normative in LGB development, experiences that put their stamp on the psychic interior of these individuals only to be externalized again into the interpersonal arena in the form of lifelong efforts at stigma management later in life.

Finally, Section I ends with Jack Drescher’s commentary, “Dream a Little Dream of Me.” Among many other equally invaluable observations therein, I would like to highlight one in particular. This experienced “out” gay psychoanalyst concisely offers what I consider to be a perspective on homosexuality truly psychoanalytic in spirit. He remarks:

“Although some might say ‘This family constellation was the cause of the patient’s homosexuality,’ we do not know what causes homosexuality, or even heterosexuality for that matter. I have yet to be convinced that two people talking to each other in a therapist’s office will ever discover the cause of anybody’s sexual orientation. However, I do believe that a therapist and patient can together discover what homosexuality means, either to the patient or to the therapist, and possibly to the patient’s family and social milieu (p.77).”

I noted earlier my wish for the title of Section II of this book to have more clearly done justice to its content. This section is not only about erotic transference and therapist self disclosure of erotic countertransference in work with LGB patients (although Rosiello’s piece “On Lust and Loathing: Erotic Transference/Countertransference Between a Female Analyst and Female Patients” and Karen Maroda’s critical commentary on it contain some of the most incendiary of clinical disagreements I have seen in the literature), it is equally about the role of gender as construction in the clinical dyad (as discussed in Barbara Tholfsen’s “Cross-Gendered Longings and the Demand for Categorization: Enacting Gender Within the Transference-Countertransference Relationship” ) as well as the impact on clinical work of the status quo of our (woefully inadequate) language and concepts vis-à-vis gender and sexuality (see Linda Meyers’s “Gay or Straight? Why Do we Really Want to Know?”). The reader will find much of value in these pieces, but will have to do some of his/her own organizational sifting through of the material. I recommend treating the Rosiello piece and Maroda’s commentary on it as conceptually independent of those of Tholfson and Meyers.

As for Section III, “Gender Identity and Creativity,” I suppose I can understand why the editors would have chosen to include in it only one essay and one whose title is the same as that of the section! After all, this work was composed by a world-renowned senior psychoanalyst who has authored many clinically incisive and poetic books and articles who chose the JGLP as the medium via which to publicly explain that she had rethought her earlier homophobic understanding of the meaning of homosexuality. In her present article, Joyce McDougall sensitively and humbly, and in her uniquely evocative way, presents a case of a “female homosexual” wherein the patient grows enormously, both in her ability to “freely assume her sexual orientation” (p. 172) and to write her first novel. (One respectful criticism is still in order, however. Dr. McDougall still makes a common error that many well-intentioned authors make when writing about sexual orientation. She seems consistently to conflate gender identity and sexual orientation in this essay, sometimes implying that these two largely independent dimensions of sexual identity are indeed distinct while sometimes considering them synonymous. McDougall begins her article like this:

“This paper is intended as a modest contribution to conceptualizing the construction of gender and sexual role identity as well as its role in creative activity…Whether we are considering homosexual or heterosexual object orientation, there is no evidence that a psychic representation of core gender identity is inborn (p. 167).”

Finally, this volume ends with two of its most emotionally evocative and lovely examples of psychoanalytic treatment of queer patients up to this point. Ubaldo Leli and Robert Weinstein describe their work with gay men afflicted with HIV/AIDS. Leli honestly and generously shares his painful and life-affirming work with this patient, one whose “analyzability” he initially doubted. Weinstein, in a brief, beautifully simple, yet rich and emotionally textured description tells the story of his hospital bedside analysis of a memorable patient. Both heeding their desire to help men in need and their faith in the psychoanalytic process, these two clinicians went ahead with their “unconventional” analytic work. I am glad they did—as were the four commentators who all praise the presenters for shedding the treatment-suffocating effects of rigid adherence to inflexible psychoanalytic rules in favor of more progressive, but no less theoretically-sound ways of working. They also highlight the moral and existential dimensions of work with patients with HIV/AIDS (for both patient and therapist), reminding us of how easy it often is to overlook the centrality of the virus in patients’ psyches in the post-protease inhibitor era of HIV treatment.

So, is it fair to claim that there exists a canon of contemporary gay-affirmative psychoanalytic literature of which Psychotherapy with Gay Men and Lesbians: Contemporary Dynamic Approaches is a part? I am not sure. However, with the motivation that the essays in this book and others like it are sure to inspire, my guess is that it is just around the corner.

References

Davies, J.M. (1998). Between the disclosure and foreclosure of erotic transference-countertransference: Can psychoanalysis find a place for adult sexuality? Psychoanalytic Dialogues, 8, 747-766.
Davies, J.M. (2003). Falling in love with love: Oedipal and postoedipal manifestations of idealization, mourning, and erotic masochism. Psychoanalytic Dialogues, 13, 1-27.

Reviewer Note

Scott D. Pytluk is Associate Professor at the Illinois School of Professional Psychology, Argosy University—Chicago, where he coordinates the school’s Psychoanalytic Minor. He maintains a private practice in downtown Chicago and acts as liaison between Divisions 39 and 44 (Society for the Psychological Study of Lesbian, Gay, and Bisexual Issues) of APA.

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