(Paper for WTC and Freud Museum conference, Women Today, June 2002.)

In the early eighties, just a few years after the founding of the WTC, and as a budding therapist in all the excitement of the new Marxist and feminist therapy, it took me some time to realise that there really was a problem about being both an out lesbian and a psychoanalytic psychotherapist. Until that time, there wasn’t even a space where this could be articulated or thought about, let alone happen. The WTC provided a safe space, not only where lesbians, including myself, could find non-pathologising therapy, but also where as a therapist I could begin to address some of the issues concerning lesbians, as I did in WTC workshops with Birgitta Johannson and Pam Trevithick. Very often those who don’t know this particular field are surprised to find out the extent of the historic psychoanalytic pathologisation of homosexuality. It is pleasing and gratifying to realise how much positive change in psychoanalytic thought and practice has happened since then, with the founding of PACE, the advent of open critical debate on this subject, and the increasing access of out lesbians and gay men to trainings.

It is important to acknowledge the collective and individual acts of courage involved in this, which still continue. Since the early nineties, when Noreen O’Connor and myself published our book, WDMI, there has been a wealth of writings, containing rich and varied accounts of clinical work with lesbians and gay men, as well as manifold critiques of the mainstream pathologisation of homosexuality. There has also importantly been a search for new ways of conceptualising and theorizing the subject. , which we tried to do in WDMI and which books such as Disorienting. Sexuality. (1995) edited by Dominici. and Lesser, and

Lesbian Lives by Magee and Miller (1997) also do. The so-called Socarides event, in 1995, and the political work that went into the Letter of Concern organised by Andrew Samuels, Mary Lynne Ellis, and myself, was also an important catalyst within the profession in replacing silence and taboo with discussion and change, although it also revealed the amount of fear and anxiety surrounding this subject. Most recently there are indications of how these critiques are being taken on board within more mainstream quarters, for example, a recent (2001), issue of the Journal of the American Psychoanalytic Association, is substantially devoted to pursuing the implications for theory and practice of the depathologising of homosexuality.

The themes of this conference, diversity and identity, have a special resonance in relation to lesbianism and lesbian sexuality, from concerns with acceptance of diversity and what that demands of us, our institutions and our theories, to the intricacies of philosophical and psychoanalytic thinking questioning the concepts of sexual identity and sexual orientation, and received notions of gender. Within this wide scope are a host of specific issues, old and new, some of which I will address here, firstly by looking at some recent work, and then by contextualising this within the new frameworks that have been evolving, with particular reference to some of Judith Butler’s writings. I am especially interested in the psychoanalytic understanding of homophobia, as it relates not just to overt homophobic attitudes or ideas, but also to common countertransference issues in work with lesbian patients; and also in how we conceptualise the interrelationship of homo- and hetero- sexuality and whether the original Freudian notion of universal bisexuality is still a useful postulate.

Starting with institutional and practical politics, whilst much searching and discrimination is still needed, lesbians and others with non-normative sexualities can now access psychotherapy with some confidence that it will be appropriate and helpful. Furthermore, the idea of lesbian or gay pass or psychotherapists is no longer in most quarters the scandalous impossibility it used to be, even if being out in some organisations is still an uncomfortable experience, and some professionals or intending trainees feel compelled to remain in the closet. The historic bar on training gays and lesbians as psa. has been vigorously challenged, and many organisations now have equal opportunities policies, albeit of a general kind. In USA specific public policy statements have been put through the various organisations: the American Psychoanalytic Association has an explicit policy of non-discrimination in relation to the selection of candidates for training, and to the appointment of faculty. In 1996 the then president of the APA made public statements to the effect that psychoanalytic claims about the intrinsic link between homosexuality and psychopathology were incorrect.

Here as ever things are less transparent, harder to find out about, recent research by three psychiatrists in London (Phillips. Bartlett and King, 2001) on attitudes of the psa. profession, as represented by BCP registered psychoanalytic psychotherapists, towards these issues shows an equivocal picture with sharply polarised views but also raises some pertinent questions. In the quantitative part of their study, which comprised questionnaire answers from 218 professionals, only one was prepared to indicate that he/she was homosexual, 185 said they were heterosexual, and 18 declined to answer the question about their own sexual orientation. At the same time, most commented that they knew a gay or lesbian colleague. – An interesting dissonance. They also found that many psychotherapists described their work with gay and lesbian patients without any acknowledgement of the relevance of social identities or social attitudes to the experiences of their patients. In the qualitative part, where 15 psychotherapists were interviewed in depth, nearly all knew of gay or lesbian colleagues who had been refused entry to trainings on what appeared to be grounds of their sexuality, though only two thought this was appropriate… Perceptions of discrimination, and fear of social stigma, realistic or not, still seems to be a powerful factor: several spoke about their perception that an open gay or lesbian identity as a therapist would result in the loss of professional credibility and respect; and even where much sensitivity towards patients was described there was also a negative view of the possibilities for gay and lesbian lives. Translated into countertransference terms, this can amount to over-identification with the aggressor.

This study corroborates my sense that change in this area, whilst evidently happening, is uneven, provoking of anxiety, and complex. The interviews also revealed a striking dissonance for some of the psychotherapists between the approach they said they took to their lesbian and gay patients, which was validating of their patients’ sexuality, and what they had been taught in their training organisation. As we also noted in WDMI, many well intentioned therapists, if they do not subscribe to the theories they were taught, do not know what to base their work on, how to think about homosexuality, I am especially interested in how psychotherapists manage this theoretical vacuum, what other articulated perspectives they make use of, as I think this is a crucial area for future change.

This question is also evident in many contemporary articles, e.g. a recent substantial article in JAPA, by two psa. analysts, Auchincloss and Vaughan, subtitled Do we need a new theory? Whilst very interesting as indicating the extent to which radical and critical ideas have been absorbed into one of the psychoanalytic mainstreams (certainly not the most orthodox, but probably middle of the road), their article is also strikingly and instructively timid. Auchincloss and Vaughan criticise the notion that what is required by the extensive re-evaluation that has been put in train is a new psychoanalytic theory of homosexuality, (something that is often demanded as a defensive response to criticism of existing theory). They argue this, firstly, because of the problems associated with the very category of homosexuality, secondly because psychoanalysis should not concern itself, as it has extensively done, with etiological questions about homosexuality. They maintain that the demand for a new developmental theory is a request for more information about the object of scrutiny rather than a reflection on what therapists are doing or might do. I want to consider their arguments and add some comments of my own.

Their first argument is that establishing the category of homosexuality, or any other category of sexuality, diagnostic or descriptive, male or female, is not a psa. task but one rather that psa. took on from psychiatry and sexology. I would add to this, that psa. did this with no acknowledgement of the historical specificity and regulatory role of these categories, something which, following Foucault, is foregrounded in most critical works as a crucial perspective from which to start. . There are multiple problems about such categorisation, as to who fits into it and on what grounds, and these problems have been intensified rather than solved by the elaboration of such sub-categories as ‘primary”, “latent”, pseudo-homosexuality, and even bisexuality . The liberal attempt, , as represented by McDougall (Many Faces of Eros, 1995) and Sturbin, (Sexualities and Homosexualities, 1994) to pluralise the category into homosexualities, in the service of recognising diversity and backing off from the worst excesses of over – generalisation and reification, has hardly caught on and anyhow does not address the basic problem. This is that collecting people together under the label of their apparent sexual orientation, and proposing ideas or theories about what they might have in common as regards etiology, development, or psychodynamics has simply yielded acres of very bad science, and at the same time has ignored the sources of what such individuals might have in common, namely the lived experience of the potent social construction and regulation of homosexuality.

The work that categorisation by sexual orientation does is brought out by Elisabeth Young-Bruehl’s study of homophobia (Young-Bruehl, 1996, The Anatomy of Prejudices), which she argues is a prejudice of categorisation.. The vigilant maintenance of the category distinction between homo- and hetero-sexuality, the belief in different types, and the assertion of difference, is vital to the psychic equilibrium of many of those expressing overt homophobic sentiments . In such instances the category is all that stands between the homosexuals and themselves.

From a variety of post-modern positions there have been many advocates of speaking only of sexualities, or of multisexualities, or multiple non-normative sexualities, with emphases on the supposed pluripotentiality, mutability, and fluidity, of sexuality.., Part of the thrust of these arguments is towards an embracing of greater diversity and away from the notions of fixed and coherent gender identities. However the problematics of categorisation are not solved by simply jettisoning the major categories, although the minor ones have been dispensed with in all but the most anachronistic crevices of the profession. Rather, the categories of homo- and heterosexuality need to be seen as socially specific structures of thought and language, with social meanings that none of us can exist outside of, but not as referring to types of people, nor types of sexuality, nor as implying any self-evident or “bedrock” status to gender. This leaves hanging however the much used notion of identity, which I will briefly address.

The question of identity, and identity claims or self- ascriptions, is in some ways the reverse side of the issue of categorisation, and has been widely discussed, with Judith Butler’s work, in Gender Trouble (1990,) and subsequent works, a central reference point, one increasingly used by psychotherapists. Her distinction between the strategic and the ontological uses of identity statements is vital, that is, on the one hand, identity that is forged for vital life affirming and protective needs, for the winning of respect and equality, for a viable social existence, identity that is constituted in and through the doing, and, on the other, identity that betokens an inherent essence or a prediscursive existence prior to the cultural field negotiated. It seems to me that gradually the use of reified language, and the assumption of a lesbian psychology, is lessening, even if at the same time the necessity, desirability, and unavoidability of identity statements in specific circumstances and conditions remains as vital and as complex as ever. Perhaps we are learning how to play with ‘identity”.

The inherent paradox in identity politics, the adoption of injurious terms (like queer) in order to make resistance and opposition possible, is well described by the term assertive resignification.: This paradox is one which lesbian therapists have had to wrestle with in wanting to gain access to the professional field, have a social existence, with the added complication of psychoanalytic non-disclosure. Butler, in The Psychic Life of Power (1997) describes this process , how persisting through categories, names etc that we never chose, that indicate a primary violence, is the only way we can persist as subjects: – “a subject emerges against itself in order, paradoxically, to be for itself”. Butler aims to describe how power forms the subject., not as the internalising of prevailing norms, which has been the more usual feminist understanding, but in the way that norms etc are the condition of the subject’s existence., so that we have a “fundamental dependency on a discourse that we never chose, but that, paradoxically, initiates and sustains our agency”….. “Power is both external to the subject and the very venue of the subject” . This is why any fundamental distinction between culture supposedly “out there” and the inner life of the mind, is not likely to be productive. “Identity” is not in itself a psychoanalytic concept, in that it does not relate to unconscious processes. From both a queer theory and Lacanian position it is criticised as always potentially normalising and likely to induce conformity. We are probably all familiar in and out of therapy with the accusations of disloyalty and betrayal, from self or others, which identity categories and imperialisms give rise to. As well, the notion of a fixed and definable “true” sexual orientation, does not do justice to what we know about the polymorphous and fluid texture of much sexuality, even if there are also other needs for “identity’. There may be instances where the multiplicity of desires is such that we cannot say which one is more real or authentic than any other, but what may be most important is the very sequence and inter-relation. As therapists we are often faced with strong assertions of identity belonging by patients, or else by the demand to help someone decide what their “ real” sexuality is in the face of chronic “indecision’.. I have tried to show , (Ryan, 1997) with a detailed clinical example, how necessary it is for therapists not to be seduced by the seeming plausibility of a concretely posed identity and sexual orientation problem, away from unconscious anxieties that may only be understood within the transference, at the same as sustaining a sufficient awareness of the significance of these sexual dilemmas in social and personal terms. The common Lacanian critique of identity assertions as betraying a psychotic certainty , applied only to homosexual and never heterosexual patients, does not however do justice to the virulence of the social world in which we live. The complexities of working clinically with issues of identity are also well exemplified in Mary Lynne Ellis’s (1997) article ‘Who speaks? who listens?

Auchincloss and Vaughan’s second argument, is that the concern with causation, or explaining why someone is lesbian or gay, is simply rather bad developmental theory. They criticise attempts at new psa theories of homosexuality which present psa as being able to account for the origins of homosexuality., The question of developmental origin or cause is much more often a concern to therapists than it is to patients but as they note, it is also important to be able to work with patients’ own ideas or fantasies of the origins of their sexualities., and the use to which these may be put. They hold out for the possible primary status of homosexuality, (meaning it just ‘is’, as heterosexuality always has been) as at least one model, a position which appears to be gaining considerable ground.. None of these arguments render the psychoanalytic understanding of personal history and conflict any less necessary.

Their major conclusion is that clinicians need a new capacity for listening, which they claim would free up further questions, allow therapists to hear more about growing up homosexual, and remove the primacy of damage as an integral part of lesbian and gay sexuality.. It is impossible to disagree with A. and V. that new and better capacities for listening to lesbian and gay patients would be very welcome, but it is a strikingly anodyne and unchallenging statement, and one which denies the all important social and discursive context .. It ignores the need for critical theoretical frameworks of other kinds, and also of course that there can be no-theory or value free therapeutic position from which to listen.. The authors do rightly dispute any disappointed reaction in their readers that this better listening would be “just analysis” since so often ordinary “just analysis” has not taken place, and is much needed, as indeed Stoller pointed out many years ago.

However, it is important to enquire (which they do not) why so many therapists find it hard to “just listen” analytically, even with the best of intentions to their lesbian and gay patients, especially, but not only, where erotic material is concerned. This also connects with the sense of a vacuum noted in the survey above. One explanation for these very common therapist inhibitions and difficulties lies in a detailed exploration of countertransference issues, which A and V do not mention. Such countertransference phenomena as well as being related to individual fears and conflicts about homoeroticism, have also to be seen in the problematic social status that homosexuality has more widely., the ramifications of internalised homophobia, and the effects of this on psychoanalytic thought and practice. I am very struck by the absence of any useful teaching about these important countertransference phenomena in most training organisations, and this is clearly an area where major change is needed.. I have (Ryan, 1998) described various forms of these difficulties for women therapists with women patients, which include: therapists’ anxieties at being the object of lesbian transferences; therapists’ fears of and also ignorance of lesbian sexuality , issues and lifestyles; and therapists’ fears of being homophobic, and guilt and confusion resulting from this. Quite often this can result in a failure to take up erotic or sexualised issues adequately, thereby reinforcing the culture wide silencing of lesbian sexuality. Other countertransference phenomena also include a level of incomprehension about lesbian parenting and co-parenting.

Looking at what is involved in these reactions, and their associated anxieties, impels us to understand more about homophobia in its manifold forms, and psychoanalysis is uniquely placed to do so, even if to date it scarcely has – one of the unfortunate consequences of its preoccupation with etiology and pathology. Recent thinking includes Young-Bruehl’s (1996) descriptive typology of overt hysterical and obsessive homophobias, in which she foregrounds the centrality of repression and repudiation , where the repudiated, desires can threaten to break through unless savagely held in place., generating overt hostility and also speaking to unconscious envy of those so targeted.. As such her analysis conforms with classic Freudian ideas about universal potential bisexuality, and is I would suggest of most use in relation to overt and conscious homophobic attitudes.

Butler’s analyses, especially in The Psychic Life of Power (1997), are probably of more relevance to the position of the well-intentioned therapist subject to the kinds of difficulties I have described.. Butler focuses on the notion of foreclosed rather than repressed desire, desire that is rigorously barred, but which constitutes the subject through a preemptive loss that is not available for reflection: “The foreclosure of homosexuality appears to be foundational to a certain heterosexual version of the subject. The formula ‘I have never loved’ someone of a similar gender and ‘I have never lost ‘ any such person predicates the ‘I” on the ‘never-never’ of that love and loss.” Such loss cannot be avowed ,and so cannot be grieved, and this foreclosure is ritualised and repeated by our social and cultural discourses. Butler notes the absence of cultural conventions for avowing the loss of homosexual love as such, and, to summarise an extended argument, she sees this as creating a culture of heterosexual melancholia , the symptom of an ungrievable and ungrieved loss, with its attendant hyperbolic identifications of heterosexual masculinity and femininity. From a clinical perspective it is not hard to see the problematic consequences of such unrecognised foreclosure: incomprehension, unconscious hostility and envy, panic and denial, and also the reification of and attachment to notions of masculinity and femininity.

One way forward, more generally, I would suggest, for us as therapists to eschew all usages of femininity and masculinity and their attendant theorisations. These terms are well past their sell-by date, and can only return us, however liberal or circumscribed their use, to socially normative and heterosexually reproductive binarisms. They do not help promote diversity in our thinking and divert us from the profound ways in which language and culture construct gender.

These considerations also prompt us to question how we understand the inter-relationship or hetero- and homo-sexuality,, both at a cultural level and also for individuals, and whether the Freudian concept of bisexuality is adequate here. Looking at this would entail an examination of the structures of gender binarisms that our language is imbued with ; here I would just like to end with a suggestion of Butler’s, that heterosexual and homosexual passions may not be so much like separate strands of a braid, as much as simultaneous vehicles for one another., not discrete sexual orientations, posed as alternatives, but passions that are conduits and venues for each other, where identificatory positions are often confounded and multiple.. Freud’s case of heterosexual jealousy is an example of this. One question that confronts us is how we can talk about bisexuality as an adult sexuality rather than as origin or as infantile.

In conclusion, the changes that have been set in train in the last 25 years have opened up many areas of new exciting and challenging thinking as well as securing immeasurably better access to appropriate services for lesbians and gay men., and also the possibility of a social existence for lesbian and gay therapists/analysts.


  1. Wild Desires and Mistaken Identities, N. O’Connor and J. Ryan, Virago, 1993.
  2. Disorienting Sexuality, ed, T. Domenici and R, Lesser, Routledge, 1995
  3. Lesbian Lives, M. Magee and D. Miller, Acad. Press, 1997
  4. Journal of American Psychoanalytic Association, 2001, Vol.49, no.4 Examining Gender and Sexuality.
  5. Psychotherapists’ approaches to gay and lesbian patients/clients, P.Phillips, A. Bartlett, M.King, Brit. J. of Medical Psychology, 2001,74, 73-84.
  6. E.Auchincloss and S. Vaughan, Psychoanalysis and Homosexuality: Do we Need New Theory?. As 4 above.,1157- 1186
  7. J.McDougall, The Many Faces of Eros, FAB, 1995
  8. J.Sturbin, Sexualities and Homosexualities, Karnac, 1997
  9. The Anatomy of Prejudices, E. Young-Bruehl, Harvard, 1996
  10. J. Butler, Gender Trouble, Routledge,1990
  11. J.Butler, ,The Psychic Life of Power, Stanford, 1997
  12. J.Ryan, Fantasies and problematics of identity. In Psychotherapy with Women, M.Lawrence and M. Maguire, Macmillan, 1997
  13. Mary Lynne Ellis, Who speaks? Who listens? Different Voices and different sexualities? Brit. J. Psychotherapy, 1997,13,369-383
  14. J.Ryan, Lesbianism and the therapist’s subjectivity. In Contemporary Perspectives on Psychotherapy and Homosexualities, ed .C.Shelley, FAB, 1998