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The ideas of psychoanalytically-oriented psychotherapists about human sexuality have changed radically in recent years. During the past three decades we have worked toward revising traditional psychoanalytic ideas about sexual orientation in particular. This revision has contributed to changes in clinical theory and practice, and we review both our own work, and these changes, in this article. We have approached the many complex scientific and clinical problems in this field from a developmental, biopsychosocial perspective. We have also emphasized the importance of integrating psychoanalytic theories of sexuality with advances in neuroscience, descriptive psychiatry and sexology generally.
In this article we draw on our experience as researchers and clinicians to discuss such common clinical problems in psychotherapeutic work with non-heterosexual patients as assessment of the patient, homophobia, internalized homophobia, gender differences among patients and therapists, the ageing patient, sexual orientation of the therapist, and transference and countertransference.