The Psychoanalytic Treatment of Homosexuality: Some Technical Considerations

This paper provides a critical appraisal of what I have designated as the directive-suggestive approach, which has dominated the analytic literature on the treatment of homosexuality. I demonstrate that this approach rests upon unproven presuppositions, a conceptual unclarity concerning the nature of activity and passivity, and an overvaluing of behavioural alterations at the expense of internal, structural factors. I further suggest that behavioural changes obtained through such an approach seem to be the result of a subtle interplay between compliance and defiance in the transference. The implications of the failure to deal adequately with the themes of compliance and defiance in the transference are considered, both in cases resulting in 'success' and in 'failures'. The possibility that this approach functions as a defence against homosexual themes in the countertransference is also considered. These issues are illustrated in a presentation of the analytic treatment of a patient who, in a previous analysis, had renounced an exclusively homosexual orientation. An examination of the directive-suggestive approach to the psychoanalytic treatment of homosexuality opens up important questions concerning the nature of influence with respect to psychoanalytic inquiry in general.