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Affirmative Dynamic Psychotherapy with Gay Men is a highly effective edited volume that moves from a review and broad theoretical reframing of traditional psychoanalytic views on male homosexuality to a discussion of specific topics relevant to psychodynamic psychotherapy with gay men.
Analysts, because they believed that homosexual object choice was based on intrapsychic conflict, have frequently viewed change in sexual orientation as the goal of treatment for gay patients. The authors in this volume do not equate homosexuality with psychopathology per se. “Affirmative” psychotherapy means that heterosexual and homosexual orientations are viewed by the therapist as equally desirable, valid, and potentially healthy, a perspective often lacking both in society and amongmental health clinicians. The focus of affirmative dynamic treatment is on the resolution of intrapsychic conflict, repair of self-esteem, and consolidation of identity that lead to improved capacity for interpersonal relations, intimacy, and sexual fulfillment. As with heterosexuals, psychodynamic treatment is not undertaken with a specific agenda or bias on the part of the therapist regarding what the patient should become.
A prominent theme throughout the early chapters (1-3) is the need for clinicians to recognize the negative developmental and intrapsychic impact associated with growing up homosexual in a heterosexual culture characterized by widespread homophobia. Frequent developmental events for gay men include paternal withdrawal in childhood, as fathers perceive their homosexual sons as “different,” and alienation from largely heterosexual peer groups that demand conformity in adolescence. Internalization of social bias often leads gay men to suppress and deny homosexual longings and makes self-acknowledgment of homosexuality painfully ego-dystonic. Delayed self-awareness frequently impedes identity consolidation and slows the development of intimate relationships.