Disclosure and the development of trust in the therapeutic setting

ABSTRACT This essay describes my personal path towards becoming an openly lesbian therapist, the internalized homophobia that interfered with this evolution, and the impact of this process on my patients. I then explore the interplay between when and how the therapist and/or the patient disclose in therapy, the link between homophobia and shame to the fear of disclosure, and the subsequent development of a more trusting therapeutic relationship that results from disclosure.

Engorging the lesbian clitoris

ABSTRACT This paper argues that colloquial language that casually refers to the male genitals as significations of power and authority (i.e., "having balls," "getting it up," "strapping it on," etc.) has a particularly injurious effect upon lesbian subjectivity because of the critical ways in which lesbians must reject the hegemony of the phallus in order to experience themselves as richly embodied. In working with and against Judith Butler's formulation of the "lesbian phallus," this essay theorizes an "engorged lesbian clitoris" as a way of infusing vernacular language with a form of female genital privilege that is as arbitrary and idealized as its predominating male counterpart. While acknowledging the risks of reification, reductionism, and essentialism inherent in such a formulation, Freud's views on the clitoris and Lacan's on the phallus are examined for their collaborative contribution to an unconsciously held cultural standard grounded in male anatomical metaphor that transmits attributions of influence, fecundity, and capability. The essay argues for the elevation of the "engorged lesbian clitoris" to an unremarkable position in the everyday language of dominance and desire.

Transference and countertransference in therapy with lesbian patients

ABSTRACT Like gender, sexual orientation is an important determinant of one's perception of human relationships, therefore influencing the therapeutic process. Through a framework derived from cross-cultural therapy literature, this article explores how lesbian patients' transferences are influenced by their perception of their therapists' sexual orientations and how therapists' countertransferences differ according to their sexual orientations. This analysis took shape through dialogue with heterosexual and lesbian therapists working in a variety of settings, some generic mental health settings and some lesbian, gay, and bisexual identified.

Clinical success, political failure?

ABSTRACT This paper argues that the dominant language used by the domestic violence movement to conceptualize relationship violence inadequately captures the psychological complexities involved in abusive lesbian relationships. As a corrective, a language based on feminist and psychoanalytic concepts is presented. Against the backdrop of this language, the author reflects on the lived experience of lesbian clients who have come to therapy for relationship violence. It is concluded that a language based on the ethos of postmodern feminism and neo-Kleinian concepts and technique more appropriately addresses the complexities involved in abusive lesbian relationships within a therapeutic context than the polemical language of the domestic violence movement.

Introduction

ABSTRACT This volume presents a collection of psychoanalytically influenced authors writing about lesbian concerns. Profound changes have occurred within psychoanalysis due to the efforts of lesbian, gay, and bisexual scholars and the evolution of psychoanalytic theory away from classical models. The writers in this volume represent a second generation of scholars who have more latitude in using psychoanalysis to study sexual orientation and gender. The article summarizes the major changes in this field and outlines areas where further improvements in psychoanalysis can occur.

Psychoanalysis today

The paper discusses the precarious position of psychoanalysis, a therapeutic approach which historically has defined itself by freedom from constraint and counted treatment length not in terms of number of sessions but in terms of years, in today's era of empirically validated treatments and brief structured interventions. The evidence that exists for the effectiveness of psychoanalysis as a treatment for psychological disorder is reviewed. The evidence base is significant and growing, but less than might meet criteria for an empirically based therapy. The author goes on to argue that the absence of evidence may be symptomatic of the epistemic difficulties that psychoanalysis faces in the context of 21st century psychiatry, and examines some of the philosophical problems faced by psychoanalysis as a model of the mind. Finally some changes necessary in order to ensure a future for psychoanalysis and psychoanalytic therapies within psychiatry are suggested.

The use of dreams in psychotherapy: a survey of psychotherapists in private practice

Since the publication of Sigmund Freud's The Interpretation of Dreams, dream interpretation has been a standard technique often used in psychotherapy. However, empirical studies about the frequency of working on dreams in therapy are lacking. The present study elicited, via a self-developed questionnaire, various aspects of work on dreams applied by psychotherapists in private practice. The findings indicate that dreams were often used in therapy, especially in psychoanalysis. In addition, a significant relationship was found between the frequency of the therapists' working on their own dreams and frequency of work on dreams in therapy. Because work on dreams was rated as beneficial for the clients, further studies investigating the effectiveness and the process of working on dreams will be of interest.

Trauma and Delayed Memory: A Review of the "Repressed Memories" Literature

This review aims to draw balanced conclusions about trauma and memory from the intensely polarized debate currently raging over "repressed" memories, or better, delayed memories (hereafter DM). Research suggests that: emotion impacts memory; psychogenic amnesia can be a reaction to unusual levels of trauma; memory is malleable and delayed memories are prone to errors; however, inaccuracies in traumatic memories are more likely to be in peripheral details than central details. Also reviewed are infantile amnesia, clinical surveys on DM, and two psychoanalytic perspectives on DM. Treatment recommendations are culled from the literature. In order that the debate over adult DM not divert attention from the reality of child abuse and its damage, child abuse issues begin and end the review.

Projective identification, self-disclosure, and the patient's view of the object: the need for flexibility

Certain patients, through projective identification and splitting mechanisms, test the boundaries of the analytic situation. These patients are usually experiencing overwhelming paranoid-schizoid anxieties and view the object as ruthless and persecutory. Using a Kleinian perspective, the author advocates greater analytic flexibility with these difficult patients who seem unable to use the standard analytic environment. The concept of self-disclosure is examined, and the author discusses certain technical situations where self-disclosure may be helpful. (The Journal of Psychotherapy Practice and Research 1999; 8:225-233)

Fathering

Fathering is an art, a skill, and an integral part of life to which investigators of the human condition have long paid scant attention. In an era when family dynamics and structure are again undergoing change, it is timely to look at some of our concepts of fathering.