SEXUAL ORIENTATION AND
PSYCHODYNAMIC PSYCHOTHERAPY
SEXUAL ORIENTATION AND PSYCHODYNAMIC PSYCHOTHERAPY
Sexual Science and Clinical Practice
Richard C. Friedman
Jennifer I. Downey
COLUMBIA UNIVERSITY PRESS
NEW YORK
COLUMBIA UNIVERSITY PRESS
Publishers Since 1893
New York Chichester, West Sussex
cup.columbia.edu
Copyright 2002 Columbia University Press
All rights reserved
E-ISBN 978-0-231-53021-7
Library of Congress Cataloging-in-Publication Data
Friedman, Richard C.
Sexual orientation and psychodynamic psychotherapy : sexual science and clinical practice / Richard C.
Friedman, Jennifer I. Downey.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-231-12056-2 (cloth : alk. paper)
ISBN 978-0-231-12057-9 (pbk. : alk. paper)
1. PsychoanalysisPractice. 2. Sexual orientation.
I. Downey, Jenifer I. II. Title.
RC506
616.89'17dc21
2002022512
A Columbia University Press E-book.
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To our patients
Contents
This book was originally written to further understanding and psychotherapeutic treatment of nonheterosexual individuals. Psychological problems and mental disorders common in the general population are even more prevalent among gay and lesbian persons, a problem of major concern. (Cochran, Mays, and Sullivan, 2003). One reason for this is minority stress, but another equally important reason is internalized homophobia. Adverse experiences of nonheterosexual children with authority figures, family members, and peers may have longstanding painful effects that are conscious and unconscious. When this occurs, self-esteem and security suffer even when the person finds his or her way to positive environments later in life. The long-standing unconscious effects of internalized homophobia may cause chronic anxiety, depression, and impairment in the capacity to work and love (Friedman and Downey, 2007).
The psychological developmental pathways of men and women differ, and in the first part of this book we explain why this difference is crucial for understanding the clinical issues we discuss later. Although some of these issues are similar for gay men and lesbians, some are not. The asymmetrical development of boys and girls, men and women, helps explain these differences.
We have made an effort throughout the book to base our conclusions on sexual science. Since the first edition of this book was published in 2002, additional animal research further supports evidence of the influence of the hypothalamus on sexual orientation (Roselli et al., 2004). Although definitive proof of this in humans is still lacking, it now seems even more likely than before that prenatal neuroendocrine influences shape sexual orientation in some people (LeVay and Valente, 2006).
The title of the original book was changed to emphasize the fact that the therapeutic applications of the psychodynamic principles we discuss are most widely used in psychotherapy rather than psychoanalysis. Throughout the book we note where psychodynamic or psychoanalytic theories need to change in order to align with contemporary scientific knowledge of the brain and sexual behavior.
References
Cochran, S. D., Mays, V. M., and J. G. Sullivan. 2003. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting Clinical Psycholology 71(1):5361.
Friedman, R. C., and J. I. Downey. 2007. Sexual orientation: Neuroendocrine and psychodynamic influences. Psychiatric Times 24(9):4752.
LeVay, S., and S. M. Valente. 2006. Human Sexuality. 2d ed. Sunderland, MA: Sinauer.
Roselli, C. E., K. Larkin, J. A. Resko, J. N. Stellfrug, and F. Stormshak. 2004. The volume of a sexually dimorphic nucleus in the ovine medial preoptic area/anterior hypothalamus varies with sexual partner preference. Endocrinology 145:478483.
In doing this work we found meetings of the International Academy of Sex Research as well as of the American Psychoanalytic Association, American Academy of Psychoanalysis, and the American College of Psychoanalysts thought provoking and informative. Drs. Kenneth Zucker, Stefan Stein, and Zira DeFries read the manuscript in early stages and provided many helpful suggestions. The book was read in later stages by Drs. Otto Kernberg, Michael Stone, John Oldham, Stuart Yudofsky, and Harold Lief, and their input, both then and through the years when we were developing our ideas, has been invaluable. We are thankful for Drs. Joseph and Judith Schachters helpful responses to our work as well. The many psychiatric residents, psychoanalytic candidates, and graduate students in psychology we have taught have been a constant source of stimulation and professional enjoyment.
It would not have been possible to carry out this project without the vital assistance of David Lane and Luis Minaya of the Library at the New York State Psychiatric Institute and Columbia University. Our manuscript assistant, Harriet Ayers, has been a crucial member of our team from beginning to end. We are most grateful to Susan Pensak and John Michel, our editors at Columbia University Press.
Finally, throughout years of scholarly effort, our families have provided unending support, for which we are especially grateful.
The following articles were either reprinted or quoted generously, with permission.
Friedman, R. C. and A. A. Lilling. 1996. An empirical study of the beliefs of psychoanalysts about scientific and clinical dimensions of homosexuality. Journal of Homosexuality 32:7989.
Friedman, R. C. and J. Downey, 1993. Neurobiology and sexual orientation: Current relationships. Journal of Neuropsychiatry and Clinical Neurosciences 5:131153.
Friedman, R. C. and J. Downey, 1994. Special Article: Homosexuality. New England Journal of Medicine 331:923930.
Friedman, R. C. and J. Downey, 1995a. Biology and the Oedipus complex. Psychoanalytic Quarterly LXIV:234264.
Downey, J. Counseling homophobic parents of gay and lesbian young adults. Academy Forum 40(3):1215, 1996.
Friedman, R. C. and J. Downey, 1993. Constitutional bisexuality reconsidered. Academy Forum 34(4):912.
Friedman, R. C. and J. I. Downey, 1998. Psychoanalysis and the model of homosexuality as psychopathology: An historical overview. American Journal of Psychoanalysis 58(3):249270.
Friedman, R. C. 1998. Internalized homophobia, pathological grief, and high-risk sexual behavior in a gay man with multiple psychiatric disorders. Journal of Sex Education and Therapy 23(2):115120.
Friedman, R. C. and J. I. Downey, 1999. Internalized homophobia and gender-valued self-esteem in the psychoanalysis of gay patients. Psychoanalytic Review 86:325347.
Friedman, R. C. and J. I. Downey, 2000. The psychobiology of late childhood: Significance for psychoanalytic developmental theory and clinical practice. Journal of the American Academy of Psychoanalysis 28(3):431448.
Downey, J. I. and R. C. Friedman. 1995. Internalized homophobia in lesbian relationships. Journal of the American Academy of Psychoanalysis 23:435447.
Friedman, R. C. and J. I. Downey, 1995. Internalized homophobia and the negative therapeutic reaction in homosexual men.
