Meetings of the New York Psychoanalytic Society

April 17, 1950. CLINICAL OBSERVATIONS ON THE TREATMENT OF MANIFEST MALE HOMOSEXUALITY. Anna Freud.

Miss Freud approached her clinical observations on the treatment of manifest male homosexuality by first surveying the psychoanalytic literature. Various authors had stressed the instinctual, bisexual basis of homosexuality; others emphasized the significance of such experiences as intense mother fixation, phallic narcissism, sibling rivalry, and trauma in childhood (related particularly to menstruation and circumcision). In the literature, the prognosis seemed largely concerned with the significance of such nosological 'types' as Ferenczi's subject or object homoerotic, or anal-sadistic or passive types, etc. In general an attitude of therapeutic pessimism prevailed, with frequent references to the problem of pleasure-gain associated with manifest homosexuality.

Miss Freud illustrated her experience by discussing four dissimilar cases of manifest male homosexuality, all of whom did well in analysis, and offered some conclusions at variance with, and some paralleling those noted in the literature. In addition to reporting a feeling of therapeutic optimism, she noted that evaluations of the patient's apparent motivation for cure, or of the type classifications based on overt behavior, failed to give accurate prognostic information. On the other hand, an appreciation of the fact that the conflict in these patients is between the desires for both active and passive roles is essential. Awareness of the patient's unconscious fantasy about his changing role in the homosexual relationship leads to therapeutically effective interpretations. Although many preparatory interpretations could enable such men to approach the feared woman with greater ease, only two interpretations seemed capable of allowing these homosexuals to divert their libido from one sex to the other.

These interpretations were based on the following two conceptions: in the case of male homosexuals who