“An Authentically Different Being”: Intersubjective Systems Theory in Clinical Practice with Gay Men

An intersubjective clinical sensibility, as my collaborators and I conceive it (Stolorow, Brandchaft, and Atwood, 1987; Stolorow and Atwood, 1992; Orange, 1995; Orange, Atwood, and Stolorow, 1997), includes at least three components: (1) a focus on the emotional convictions (organizing principles) that pattern a person's experiential world; (2) radical engagement, that is, a self-reflective awareness of the clinician's constant and unavoidable participation; and (3) a refusal to argue about reality, that is, to assume an authoritarian “knowing” attitude. Each of these three, it seems to me, is implicitly present in Jack Drescher's Psychoanalytic Therapy and the Gay Man (1998). Although Drescher's own training is interpersonalist, including the Sullivanian focus on detailed inquiry, he and I often reach the same point by different paths. Further, since I too am always working with gay men, I find his massive and considered body of experience and thinking a great help to my own attempts to do this work within an intersubjective clinical sensibility. Psychoanalytic work with gay men (or lesbians, of course) provides an excellent test of any clinical theory. I will therefore attempt to illustrate ours, with its three elements, as it lives in the clinical world described by Drescher.