Notes from the Margins: The Gay Analyst’s Subjectivity in the Treatment Setting (Book Review)

Author:  Sherman, Eric
Publisher: Routledge
Reviewed By: Geneva Reynaga-Abiko, XXIX, no. 3, Summer 2009, p. 51

Let me begin by saying that this book is one of the most informative I have ever read regarding the struggles clinicians actually face with their patients. It is highly accessible and honest, with a clear sense of humor present throughout the work. That being said, it is also a book that I never would have willingly purchased, given the title. I am not a gay [male] analyst, so what could I learn from Sherman’s subjectivity in the treatment setting? This is an interesting paradox that pervades the work. How much do our biases affect our clinical work? How well would we do if we were somehow able to shed them? How much can we learn from those who, on the surface, appear so different from us?

Sherman and I share very little in common from a sociocultural perspective. He identifies as a European American gay male. I identify as a Mexican American heterosexual female. We live and practice in different parts of the country. He is a psychoanalyst while I simply practice from a psychodynamic framework. I could go on and on… Yet I find his text so personal, so relevant, and so illuminating. It is even humorous in the sometimes-playful way he discusses his reactions to ideas most of us would repress, or at least never admit to our colleagues (e.g., sexual attraction to a patient). Sherman discusses his reactions to patients, and how they may relate to his personal history and experiences, with such honesty that I sometimes felt a sense of shock at what I was reading. Never before have I encountered such honesty and self-disclosure in a psychoanalytic text.

Sherman addresses the impossibility of keeping our personal selves hidden from our patients. He talks about how we are always “outing” ourselves, even if we never utter a verbal self-disclosure. How we dress, our office decorations, what we do and do not react to are all statements about our values:

That … illustrates the importance of knowing oneself and one’s blind spots as much as possible. The goal is not to get rid of countertransference and the effects of one’s personality, but to be aware of how profoundly important, and potentially beneficial, a role it plays in the treatment. This is no easy task. Understandably, when an analyst feels that shameful parts of his personality are being exposed, he may be quick to move away from the material to protect himself. The patient, sensing his analyst’s discomfort, may try to protect the analyst by changing the subject or refusing to express any criticism. When such collusions take place, an opportunity to deepen the transference is temporarily lost. (p. 18)

Sherman is quite clear that the information he presents is coming from his individual perspective, but I find myself identifying with it throughout the work. Granted, I do not know what it feels like to be a gay male analyst. However, I can certainly identify with the feeling of being oppressed, internalizing this oppression, and having it spring forth at [seemingly] inopportune times during treatment in the countertransference. And I think we can all identify with feeling shame at some point in our lives. Few works discuss how internalized oppression affects treatment, especially when it applies to the clinician. I appreciate Sherman’s discussions about re-experiencing shame and oppression in the treatment room with patients.

Sherman has written a book that illustrates very powerful enactments, various countertransference reactions, and feelings he has had about patients that are historically considered taboo. His accounts are highly personal and, what I found especially enriching, was his discussion of things he did that were both helpful as well as unhelpful. It is illuminating to find that other clinicians are human too and that countertransference is often a messy entity that one finds oneself in the middle of, rather than an easily recognizable process to be analyzed and digested.

Sherman’s work illustrates how much we internalize the values of the dominant culture and how this may enter the therapy room. Sherman discusses it in terms of internalized homophobia, or internalized heterosexism, but we could apply it in any other way: sexism, racism, etc. I appreciate his honest portrayal of how all of us are biased and, therefore, we need to learn how to recognize it and work with it. He even discusses how much we may learn from our patients when we engage this process. Overall, his honest and courageous account is a model of transparency from which the entire field may benefit. Bravo, Sherman!

Dr. Geneva Reynaga-Abiko is currently Acting Director of Counseling and Psychological Services at the University of California, Merced. She completed her doctorate at Pepperdine University and has since worked in both university and hospital settings. Her interests include multicultural competence, Latino psychology and Buddhist psychology.

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