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The subject of disclosure in treatment has been the source of significant controversy since the early years of psychoanalysis. Despite traditional restrictions regarding self-disclosures, examples have become more prevalent in psychoanalytic writings in recent years. This evening's scientific meeting featured a moving account by Gilbert W. Cole of the disclosure of his HIV seropositive status in his work with one patient, and his preference for a dialectical, rather than dichotomous, approach to the issue of sameness and difference in the treatment.
Dialectical thinking, he proposed, allows for the consideration of multiple viable options, rather than the either/or, good/bad choices of dichotomous thinking. With regard to self-disclosure, Cole illustrated his point by describing a case presentation he gave while in training. The guest analyst hearing the clinical material viewed homosexuality as pathological, and Cole's disclosure of his own homosexuality as denying the patient the opportunity to “feel accepted by a heterosexual man in his treatment.” Cole felt that an interchange of ideas could not take place due to the guest analyst's inability to see past her dichotomous viewpoints on the difference of sexual preference between them.
Cole stated that patients are often referred to him because he is gay, and described how in some cases he has felt it was necessary to disclose his seropositive status. In presenting his work with one patient, he described the transformative experience he believed came about due to the process of this disclosure, and how observing their senses of sameness and difference allowed him to understand the changing meanings of the disclosure.
This patient sought help for pervasive anxiety that sometimes caused him to feel panic and disorganization, and the treatment focused on work-related stress. Sexual compulsiveness and overeating were issues that the patient had struggled with previously. After three years of work together, the patient saw