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I question the manner in which Trop and Stolorow handled the sexual material in the analysis of a patient they described in “Defense Analysis in Self Psychology.” At the beginning of the case report, we are told that the patient came to treatment deeply troubled by a sense of sexual ambiguity — he did not know if he was homosexual or heterosexual. He was particularly distressed about two recent unsuccessful sexual experiences with women. After reading this, I found myself wondering why the patient was pursuing women, what this meant to him, and why he was not pursuing men. There is no report that this material was explored.
The patient later reported that he “wanted to be heterosexual, marry, and have children, but felt he ought to consider that he might be fighting a losing battle and that he was truly homosexual” (p. 430). The analyst, again, does not appear to have inquired into these goals or subjected them to the same scrutiny as he had the patient's homosexual behavior, which was rigorously analyzed. The patient's feeling, when he is associating to the first dream (p. 431), that the analyst supports his pursuing women as part of his own agenda, seems to be congruent not only with the analyst's enthusiasm when told of the patient's making a date with a woman (which the analyst is aware of), but also with the analyst's general approach, that is, of analyzing homosexual material, but not analyzing heterosexual material.