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Sexual Orientation and Psychodynamic Psychotherapy

Sexual Orientation and Psychodynamic Psychotherapy: Sexual Science and Clinical Practice

Richard C. Friedman
Jennifer I. Downey
Copyright Date: 2002
Pages: 363
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  • Book Info
    Sexual Orientation and Psychodynamic Psychotherapy
    Book Description:

    This book bridges psychoanalytic thought and sexual science. It brings sexuality back to the center of psychoanalysis and shows how important it is for students of human sexuality to understand motives that are often irrational and unconscious. The authors present a new perspective about male and female development, emphasizing the ways in which sexual orientation and homophobia appear early in life. The clinical section of the book focuses on the psychodynamics and treatment of homophobia and internalized homophobia.

    eISBN: 978-0-231-50489-8
    Subjects: Sociology, Psychology

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Preface to the Paperback Edition
    (pp. ix-x)
  4. Acknowledgments
    (pp. xi-xiv)
  5. Part 1 Theoretical / Developmental

    • Introduction to Part 1
      (pp. 3-4)

      This book, written for psychoanalytically oriented psychotherapists, is divided into two parts, scientific/theoretical and clinical. The sections may be read independently or in reverse order. Clinicians working with gay patients who wish to focus on the treatment of internalized homophobia, for example, may wish to get directly to the clinical part of the book and return to the more scientific/theoretical section at leisure. The authors are psychiatrist-psychoanalysts, graduates of the Center for Psychoanalytic Studies of Columbia University, and engaged in the practice of psychoanalysis and psychoanalytically oriented psychotherapy in New York City.

      Many traditionally trained psychodynamically oriented clinicians have remained...

    • 1 Sexual Fantasies in Men and Women
      (pp. 5-37)

      A major theme of this volume is that males and females develop along different pathways. There are many reasons for thinking this, including the psychoanalytic treatment and study of gay men and lesbians. The brains of men and women are differentially influenced in utero by sex steroid hormones. This difference influences psychological development in many ways. The minds of boys and girls, men and women, develop differently; and important aspects of sexual experience and activity are unique to each sex and not shared by the other. Sexual orientation of any type—homosexual, heterosexual, or bisexual—is best conceptualized as part...

    • 2 Genetic Influences on Sexual Orientation
      (pp. 38-58)

      In chapter 1 we suggested that one consequence of the extensive recent attention that psychoanalysis has devoted to homosexuality has been its increasing sophistication about sex differences in erotic experience and behavior. Psychoanalytic and psychotherapeutic experience with gay men and lesbians contributes to an understanding of male and female psychology as well as that of sexual orientation. We now turn out attention to homosexual orientation beginning in this chapter with discussion of genetic influences.

      Extrapsychoanalytic research in the areas of genetics and psychoneuroendocrinology is often invoked in many clinical and nonclinical discussions about sexual orientation. Research in these areas is...

    • 3 Psychoendocrinology and Sexual Orientation
      (pp. 59-71)

      In this chapter we discuss hormonal influences on homosexual orientation. Our consideration of this area is relatively brief, since we selected only those aspects of the field that we felt it essential for psychoanalytically oriented therapists to be aware of. The reason that this line of research is so important for psychoanalytic developmental theory is that it is about prenatal influences on brain and mind. During the years that psychoanalysis was created, these influences had not yet been described. The psychoanalyst Robert Stoller was the first to direct the attention of the psychoanalytic community to the burgeoning new field of...

    • 4 Psychoendocrinology and Gender Role Behavior
      (pp. 72-86)

      In the last chapter we discussed the evidence that prenatal sex steroid hormones may influence the sexual orientation of adults. The idea that something that occurs very early in development can influence adult behavior is a familiar one to psychoanalysts. In traditional psychoanalytic theory the earliest time of potential influence on the mind and personality is the oral phase of infancy, and the type of influence is interpersonal (e.g., the maternal-child relationship). The prenatal hormonal theory hypothesizes an earlier occurring influence—during prenatal life—and one that involves the brain directly. The two types of theories are not mutually exclusive...

    • 5 Freud, Oedipus, and Homosexuality
      (pp. 87-97)

      Throughout the history of psychoanalysis Freud’s ideas about the Oedipus complex have arguably been the single most important influence on the way psychoanalysts think about childhood development. Indeed, this influence remains pervasive to this date, and oedipal theories still provide the structure for much formulation about the psychodynamic functioning of adults (Greenberg 1991; Friedman and Downey 1995). Even though the central role of the preoedipal maternal child relationship in psychological development received full psychoanalytic attention, nonetheless, the emphasis on orality and preoedipal functioning complemented but did not replace or invalidate many of Freud’s views. Freud’s ideas about the Oedipus complex...

    • 6 Toward a Revised Formulation of Male Oedipal Aggression
      (pp. 98-117)

      In the last chapter we discussed evidence indicating that many of Freud’s ideas about the role of the Oedipus complex in male development are invalid. Psychotherapy sessions, dreams, and childhood stories and imaginative play are often organized around oedipal themes, however. How can we account for the conundrum?

      We conjecture that the aggressive component of oedipal themes is much more prevalent than the erotic component and that the competitive-aggressive motivations of oedipal-aged boys do not occur as a consequence of sexual desires for the mother. Rather they are experienced and expressed as a result of the influence of prenatal androgens...

    • 7 Psychobiology of Late Childhood The Significance of Postoedipal Development
      (pp. 118-135)

      In this chapter we discuss postoedipal development in boys and girls. The fact that their developmental pathways are asymmetrical has been under-emphasized in psychoanalytic theory and is important for understanding the origins of adult sexuality. In boys intolerance of cross-gender behavior in peers, homophobia, and homosexual orientation have their origins in late childhood. In girls late childhood is a time during which themes emphasizing emotional closeness, particularly in familial settings, become elaborated in fantasy. This provides the context for romantic and sexual development throughout life. Girls, anchoring their self-esteem in intimate relationships to a much greater degree than boys, are...

    • 8 Female Homosexuality: Classical Psychoanalytic Theory Reconsidered
      (pp. 136-159)

      In this chapter we discuss the status of “classical” psychoanalytic thought about female sexual orientation. Taking a historical perspective, we reassess key areas in light of advances in a number of extrapsychoanalytic disciplines. We use the words traditional or classical to refer to a body of psychoanalytic work published in such journals as the International Journal of Psychoanalysis, the Journal of the American Psychoanalytic Association, and in scholarly monographs and books. We distinguish between contributions from “psychoanalysis proper” and from psychoanalytically informed psychology, which tends to be discussed in different scholarly publications.

      The psychoanalytic theory of female homosexuality occupies an...

    • Afterword to Part 1
      (pp. 160-162)

      At the time this book was being written, psychoanalysis had radically revised its models of gender identity development and of the psychological development and functioning of women. These modifications in psychoanalytic theory occurred primarily because of extra-analytic research carried out by Masters and Johnson (1966) and the work of gender identity researchers and clinicians (Money and Ehrhardt 1972; Stoller 1968). The dramatic changes in theory were followed by vast changes in psychotherapeutic practice. Countless psychoanalytically oriented clinicians responded to new knowledge about psychosexual development and functioning by revising their approach to the treatment of women and of patients with diverse...

  6. Part 2 Clinical

    • Introduction to Part 2
      (pp. 165-166)

      The clinical half of this volume focuses on homophobia and internalized homophobia. We discuss women and men across a wide range of ages and adaptive capacities and different psychotherapeutic approaches including psychoanalysis and exploratory and supportive psychotherapy. The area of sexual orientation is broad, and we hope to consider many topics in the future—other than homophobia and internalized homophobia—that we could not here.

      Throughout most of the twentieth century heterosexual orientation was conceptualized as the norm and nonheterosexual orientation as deviant, even pathological. Psychoanalysis, if not totally responsible for this view, certainly contributed to it heavily. American psychoanalysis...

    • 9 Homophobia, Internalized Homophobia, and the Negative Therapeutic Reaction
      (pp. 167-193)

      The many new developments in psychoanalytic ideas about homosexuality have led to a need for revised psychodynamic formulations about the causes and treatment of psychopathology, particularly in gay/lesbian people. The most important influence on symptoms that cause distress and disability in gay/lesbian people recognized only recently is homophobia. In fact, it is not possible to understand clinical problems involving sexual orientation without understanding homophobia. Whereas specific aspects of homophobia vary to some degree across ethnic, religious, socioeconomic, and geographical groups (e.g., countries of origin or areas of origin within countries), common themes occur that are rooted in history. The clinical...

    • 10 Internalized Homophobia, Pathological Grief, and High-Risk Sexual Behavior in a Gay Man with Multiple Psychiatric Disorders
      (pp. 194-204)

      Male sexual fantasy motivates sexual activity, yet its determinants have not yet been completely described. In this chapter a patient is discussed who experienced the onset of a new erotic fantasy during middle age. This motivated risky sexual behavior during a seven-month period. Although the patient’s self-destructive sexual activity ceased as a result of supportive psychotherapy and pharmacological treatment of his psychiatric disorders, his sexual fantasy persists. In order to understand X’s history and course it is necessary to have a psychodynamic perspective. The reasons that his treatment included both psychopharmacology and psychotherapy are discussed.

      Among gay men a behavioral...

    • 11 Internalized Homophobia and Gender-Valued Self-Esteem in the Psychoanalysis of Gay Patients
      (pp. 205-217)

      This chapter discusses the relationship between self-condemnation for being gay and self-condemnation for feeling unmasculine. The patients who are its subjects are reasonably well-adjusted men, homosexual in erotic fantasy orientation, comfortable with gay identity and social role, integrated at a neurotic, nonborderline level (Kernberg 1975). Although they recall having been labeled “fag” or “sissy” as children, the most painful aspects of this taunting are now out of conscious awareness. They are usually integrated in the gay subculture and in conventional heterosexual society as well. During analysis, however, as often happens (Isay 1989), negative feelings about being homosexual come to the...

    • 12 Homophobic Parents
      (pp. 218-234)

      The parents of most lesbian/gay people are heterosexual and many harbor homophobic attitudes. They tend to seek assistance from mental health professionals for many reasons. The psychologist George Weinberg, who introduced the term homophobia, wondered how heterosexual people could be so horrified by homosexuality that otherwise apparently caring parents would actually consider it justification for rejecting their children (Weinberg 1972). Actually, parents who consult psychotherapists about their children’s homosexuality are a select group in that they are usually motivated to preserve the child-parent bond. Hence they tend not to have the most extreme antihomosexual attitudes and beliefs of those found...

    • 13 Psychopathology, Suicidality, and Homosexuality: New Developments
      (pp. 235-251)

      In the 1950s Evelyn Hooker, a psychologist, carried out an important psychodynamically informed investigation (Hooker 1957). Hooker reasoned that the large psychoanalytic literature on the etiology of homosexuality might be biased toward global psychopathology and therefore not be valid. Psychoanalytic patients understandably seek assistance because of psychological distress and impairment in functioning. It was therefore risky for psychoanalysts to generalize about all homosexual people from a patient sample. Through word of mouth, Hooker recruited highly functional, socially well-integrated homosexual men. She matched these with a heterosexual control group and administered Rorschach tests to all the subjects. Their written records were...

    • 14 Coming Out at Eighty-Four: The Psychotherapeutic Treatment of Internalized Homophobia in a Lesbian Patient
      (pp. 252-264)

      Since the depathologization of homosexuality, substantial attention has been devoted to the psychological functioning of gay and lesbian people throughout the life cycle, including development during old age (Cabaj and Stein 1996). Older gay men have been discussed in the literature, somewhat more than lesbians, and the psychodynamically informed literature on older lesbians remains sparse (Berger and Kelly 1996; Raphael and Robinson 1980). One dimension of healthy development in gay and lesbian people involves the complex psychological processes that together have been termed coming out (Troiden 1979; Coleman 1982; Cass 1989, 1996). Investigators tend to agree on the broad psychological...

    • 15 Sexual Orientation and Psychoanalysis: Current Problems and Controversies
      (pp. 265-283)

      Psychoanalytic developmental and clinical theory is presently incomplete in many areas, and clinicians often find it difficult to anchor their techniques in ideas that are generally accepted throughout the world. Absence of empirical validation of key concepts has provided a context for turbulent disagreement and polarized debate. We have selected three topics to discuss in the field of sexual orientation/gender psychology that are especially fraught with conflict. The first of these is bisexuality.

      The notion of a universal, basic bisexual disposition in human beings was close to Freud’s heart from the very beginning of his explorations. In 1899 he wrote...

    • Chapter 16 Origins of the Model of Homosexuality as Psychopathology Science and Psychoanalysis
      (pp. 284-308)

      In the United States organized psychoanalysis has rejected the pathological model of homosexuality. This was the result of a paradigm change that had occurred, so far-reaching that younger therapists entering the field today often ask why homosexual orientation was once considered, in itself, to be evidence of profound psychological disturbance. The historical roots of this belief, almost universal among psychoanalysts for about four decades, are discussed below. By way of introduction, however, it is helpful to review selected contributions of psychoanalysts and scholars who helped change what appeared to be a view of sexual orientation that was solidly anchored in...

  7. References
    (pp. 309-340)
  8. Index
    (pp. 341-352)