Reply to Renik and Spezzano

Drs. Renik and Spezzano offer responses to my paper that reflect a genuine effort on their part to grapple with the clinical issues I raise concerning psychoanalytic treatment and same-sex desire. Their discussions are helpful and instructive in that they raise the kinds of questions that need to be addressed in furthering a dialogue about analytic theory and technique with homosexual patients. Both shed light on the varying ways in which different theoretical perspectives, beliefs, and assumptions about homosexuality guide the analyst's attitude in working with patients who are gay. From my own vantage point, I will attempt to highlight the underlying belief systems, attitudes, and assumptions about homosexuality reflected in Renik's and Spezzano's discussions and how they might influence an analyst's actual work with homosexual patients.

Renik aligns himself with a theoretical position concerning the origins of a homosexual orientation. He describes homosexuality as a choice and states that we should “regard sexual behavior, like the rest of human behavior, as the outcome of complex decision-making processes influenced by an array of constitutional and environmental factors” and states a bit later that “all we really have to offer our patients … is the opportunity to review and revise the choices underlying attitudes and behaviors that cause distress.” While he does not specify his theoretical position beyond these two statements, Renik's view of homosexual desire appears to be consistent with those psychoanalytic theories that conceive of homosexual fantasy and behavior as a compromise formation, dynamically maintained by an interplay of drives, anxieties, and defenses. To make explicit what I believe is implied in Renik's position is to state that if a homosexual patient is distressed by his sexuality, psychoanalysis can offer him the tools to change his sexual orientation, if