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The Homosexualities and the Therapeutic Process consists of fourteen chapters, in addition to a brief introduction by the editors. The book is focused almost entirely on the psychoanalytic and psychotherapeutic treatment of men. Only one of the chapters and an occasional clinical illustration in the others refer to women.
Most contemporary clinicians, regardless of theoretical framework, recognize that homosexual patients as a group manifest a range of
psychopathology that is more or less comparable to that of heterosexual patients (Hooker 1956; Saghir and Robins 1973; Friedman 1988; Isay 1989; Gonsiorek and Weinrich 1991). The cases in this book, however, depict patients who are integrated at a low borderline level (Kernberg 1984), are pathologically narcissistic, or are otherwise comparably impaired. These patients, mostly men, are not only unrepresentative of gay and lesbian people in the general population; they are unrepresentative also of homosexual patients seen in clinical practice.
Although the clinical vignettes are for the most part well written, they tend to neglect some important issues. One of these is psychoanalytic diagnosis of the whole patient. The reader is likely to be presented with a patient manifesting many borderline symptoms (and perhaps numerous other symptoms as well). No detailed, methodical approach is taken toward diagnosis of character pathology in these vignettes. The impression is frequently conveyed that all of the patient's symptoms are a function of the homosexuality. The chapters would have been greatly strengthened had the authors systematically diagnosed the character pathology of each patient and discussed the way in which the patient's adaptation was influenced by this pathology. If a patient has an obsessive-compulsive personality integrated at a low borderline level, for example, his or her functioning will be impaired in a number of specific ways, regardless of whether he/she is homosexual, heterosexual, or bisexual. Chara