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One of the more controversial aspects of the ongoing reconsideration of the phenomenon of homosexuality within psychoanalysis is the assertion by Isay (1989) that only gay and lesbian clinicians should treat gay and lesbian patients. Responses to this position were immediate, have been rattling in the halls of psychoanalytic institutes, and continue to appear in publications. For example, Goldberg (1995) basically states that this position values familiarity over technique. While MacIntosh (1994) purports to convey the evenhandedness of the psychoanalytic community, ultimately, the work conveys considerable ambivilence as to whether homosexual desire can be viewed as genuine versus defensive in nature.
Since human beings are capable of using a wide array of activities in a defensive manner, it becomes problematic to assert that all homosexual desire is “genuine.” Clearly, there is a difference between homosexual acts and a homosexual orientation. And clearly there are men whose erotic fantasies and potential to form relationships are oriented towards men. With this population it is more appropriate to look at sexualization or defensive use of sexuality within the context of their orientation. This is the population of men that this chapter addresses.
The assertion that only certain people should treat certain people clearly intersects with the larger question of what is curative in psychoanalysis or psychotherapy. Though technical issues are raised, the issue