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Heterosexual therapists treating gay, lesbian, and bisexual patients should know as much as possible about common experiences of people of minority sexual orientation and about issues that may arise in their psychotherapy. The author describes four paradoxes or tensions that have arisen in her work with homosexual and bisexual patients who have known or assumed she is straight: the patient's experience of wishes both to be seen as ordinary and to be understood as special; the requirement that the therapist appreciate the power of dominant sexual scripts while enjoying polymorphous fantasies; the tension
An earlier version of this paper was presented on August 22,1993, in Toronto, Ontario, Canada, at an American Psychological Association symposium entitled “Bridging the Gap of Difference in Therapist-Patient Sexual Orientation.”
Acknowledgment: I am especially grateful to Judith Glassgold for her ongoing help with these ideas, and also to Lewis Aron, Thomas Johnson, April Martin, Wilson Carey McWilliams, Lin Pillard, Helen Raytek, Seth Warren, and Nina Williams for their contributions to my thinking. In addition I thank the patients from whom I learned much of what follows, especially the former analysand “Alice” whose treatment is discussed here, who critiqued the early drafts of this essay and permitted me to use her material.
Nancy McWilliams is Visiting Professor at the Graduate School of Applied and Professional Psychology at Rutgers, the State University of New Jersey and is a senior analyst with the Institute for Psychoanalysis and Psychotherapy of New Jersey and the National Psychological Association for Psychoanalysis. She is the author of Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process (New York: Guilford Press, 1994).
between the patient's increasing pride and mounting grief; and in same-sex erotic transferences, the coexistence of deep yearning with mortifying renunciation that requires considerable therapeutic sensitivity.