Meeting of the Psychoanalytic Association of New York

May 20, 1985. HOMOSEXUALITY IN HOMOSEXUAL AND HETEROSEXUAL MEN: SOME DISTINCTIONS AND IMPLICATIONS FOR TREATMENT. Richard A. Isay, M.D.

Dr. Isay offered a clinical perspective that would enable psychoanalysts to work more effectively with male homosexual patients. This perspective is based on two premises: 1) that homosexuals can lead well-adjusted lives with gratifying love relationships, and 2) that efforts to change the sexual orientation of most gay patients are not helpful. The psychoanalytic view that homosexuality is an illness and that we should therefore try to change our patients' sexual orientation is, stated Dr. Isay, a bias based on the belief that only heterosexuality is normal and on the internalization of social prejudice against homosexuality. Countertransference arising from such bias has affected objectivity and theory building, leading to a view that "there are no healthy homosexuals."

Dr. Isay's early efforts to help gay patients change their sexual orientation through analysis of early conflict were not successful. He observed that behavioral change could occur only through exploitation of the transference. Moreover, the unsuccessful attempts of other analysts to alter their patients' sexuality suggested that the resulting repression, denial, or suppression of homosexual impulses often produced depression. Relinquishing the goal of changing the gay patient's sexual orientation is not, however, a nihilistic view of psychoanalytic work with homosexuals. Analysis can be helpful in the same manner and for the same problems as it is for heterosexuals. If carried out with neutrality, it may lead to the gay patient's sexuality becoming less maladaptive and better integrated. Dr. Isay emphasized that it is erotic preference expressed in fantasy, rather than behavior, that defines the homosexual. Homoerotic fantasy is not necessarily exclusive in the homosexual, but is predominant and can usually be recalled from early adolescence or late ch