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Tall, ruggedly handsome, and athletic, twenty-year-old Fred entered outpatient treatment at his own request after a brief psychiatric hospitalization. Observation had been required to avert a threatened but unspecified suicide attempt. The ostensible precipitant to his suicidal ideation, an acute bisexual panic which he was able to discuss haltingly and only with considerable difficulty, was the traumatic discovery of his sexual interest in his best male friend and roommate. The two had picked up a coed one Friday night at a local bar in the college town where all three resided as students, partied until closing time, and proceeded to the young men's apartment to engage in a group ménage à trois sexual encounter. Of paramount importance to the presenting problem, and of considerable diagnostic significance to understanding the context of Fred's acute crisis, was the older roommate's impending college graduation and acceptance of a job offer in a faraway state. The anxiety generated over both the acute event and the contributing loss of the relationship prevented him from maintaining full-time student status and, lacking the emotional resilience to continue as an emancipated teen, necessitated his returning to live with his family consisting of mother, father, and younger sister in the nearby community where he had been reared as a child.
The client also struggled with the relationship needs of his current girlfriend (older by three years) with whom he had had an ambivalent, “off and on” connection from his junior year in high school when they began dating. She was pressuring him for an engagement announcement and a ring. The more she demanded, the more he felt threatened. After sex with her, he would stand naked looking at himself in the mirror as if to reassure himself of his intactness and wholeness. These were experiences that
contrasted sharply to his feelings of power and well-being when in close compani