What Do Gay and Lesbian Therapists Do With Their Gay and Lesbian Patients?

Dennis Shelby, PhD

The contribution for this issue of the newsletter comes to us from South Africa. Amanda Kottler has beautifully laid out the treatment of a young man whose highly symptomatic presentation gradually waned as underlying deficits and a developmental transition were tended to. I can remember the time when the very idea of gay and lesbian clinicians working with gay and lesbian patients caused quite a stir in the analytic community. Most clinicians have grown used to the idea, and the literature on working with gay and lesbian people is rich and ever evolving.

The idea of a distinct life course for gay and lesbian folks, the acknowledgement that many gay and lesbian folks seek out therapists from their communities, and that working with homosexual individuals may be a distinct "specialty" are accepted by many, but viewed with caution by some. The interface between a distinctive life course, minority status and the common features of the human mind that we all share, are complex questions that need further exploration.

These theoretical issues are far from settled. The discussion between the clinicians attending at a recent case presentation sponsored by the American Psychoanalytic Association's Committee on Gay and Lesbian Issues, became quiet spirited. A great divide appeared over the question of, "Do we take a patient's sexual orientation as a given, or do we wonder how they got that way?" The "divide" as one may imagine was between "gay" and "straight" analysts. I am sure a few people left feeling insulted, and the deeper questions were never fully explored. What some clinicians felt were naïve, if not homophobic questions and positions, were sincere and serious to others. Like so many issues in the field, understanding, working with and conceptualizing clinical work with gay and lesbian patients is far from settled.

Of course, getting five clinicians to agree on something is a rare event, whether there is something distinct about this familiar phenomenon of our profession and area of sexual orientation remains to be seen.

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