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Psychoanalytic treatment approaches that advocate a neutral stance in working with male homosexual patients are critically reviewed. While neutrality improves upon those more blatantly judgmental, directive-suggestive models of treatment, the neutral stance is felt to be problematic and insufficient in working with homosexual patients. Internalized homophobia is understood to be an unavoidable consequence of the developmental experience for homosexual individuals in a homophobic culture. Repressed and encapsulated feelings of shame and guilt, tied to early self-experiences of gender nonconformity and homoerotic feeling, may interfere with the adult homosexual man's ability to form sexually intimate and loving relationships. Little, if any, attention has been given to the analyst's role in helping homosexual patients achieve a positive sense of self within their sexual orientation. Analysts who adopt a surface neutrality toward their patients' homosexuality are often guided by hidden countertransference, which prevents them from adopting an affirmative stance toward the patient's homosexuality and negotiating transference material in a helpful manner. An affirmative stance that emotionally communicates to the patient the analyst's belief that homosexuality is a natural developmental end point for some individuals is viewed as the correct application of psychoanalytic technique with homosexual patients. Clinical material is offered to illustrate this approach.
I would like to thank Lucy Slurzberg, C.S.W., and David Schwartz, Ph.D., who made themselves available for dialogue and offered helpful suggestions.
Dr. Frommer is a supervisor and faculty member at the Institute for Contemporary Psychotherapy in New York City. He maintains a private practice in New York City.
© 1994 The Analytic Press, Inc.