Written by admin on 2009-04-07T04:55:32+0000">April 7, 2009 – 4:55 am
Socarides notes that there are two important criteria for selecting homosexual patients for psychoanalysis: (1) the availability of guilt feelings for unconscious wishes underlying the homosexual impulses is an important index of the patient’s capacity for therapeutic change. If such guilt is not conscious, this does not necessarily mean that the patient is not suffering from guilt, but the unconscious guilt may be experienced as a need for punishment or as compelling him to self-destructive behavior. Along with guilt we can suggest that some sense of shame may also be important to evaluating the patient’s therapeutic potential. (2) The second point Socarides makes is that patients must undertake the treatment voluntarily. If the patient is under any duress or compulsion from others, whether they be parents, superiors, or any other authority figures, the patent’s hostility toward parental figures will be readily transferred and will both undermine an effective therapeutic alliance and interfere with positive transference. Positive transference is important to the treatment of homosexuals, since it is through it that the patient ultimately is able to identify with the good father-therapist and thus obtain what he has been unsuccessfully striving to gain through homosexual contacts, namely, the assimilation of masculine strength and identity. This therapeutic gain allows him to begin to free himself from the entangling dependency and enslavement to the mother.
The treatment of homosexuals is complex and difficult and as the preceding discussion suggests, encounters developmental vicissitudes on a number of levels, often of an intensely ambivalent and pregenital character. The difficulty of the therapy and the problems it involves, as well as the likely resolution of underlying conflicts and the possibility of adequate heterosexual adjustment largely depend on the levels of adequate personality development achieved and the extent to which early developmental conflicts and impairments are part of the genesis of homosexual behavior.
Nonetheless, certain critical points are characteristic in the treatment of such patients. Particularly noticeable are the oedipal incestuous and aggressive fears, particularly those relating to the negative oedipal constellation. It is central to the successful resolution of the homosexuality that these oedipal conflicts be resolved and that the nuclear pre-oedipal anxieties be discovered. These often entail primitive fears of incorporation, particularly of engulfment by the mother, with associated fears of loss of identity and personal fragmentation that may be inherent to any attempt to separate from her or to gain any real individuation.
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