"Altar-ing" perceptions: On working with gay couples and individuals.

June is flying by -- the month when thousands of (heterosexual) Americans marry. June is also Gay Pride Month, when thousands more Americans still can't.

Imagine a fictitious gay couple, Tom and Jeff. They have been together for 17 years -- longer than either of their divorced parents. Imagine they are in couples therapy the day after attending the (heterosexual) wedding of Tom's niece in Pennsylvania, a state (like most) that does not recognize their not-quite-equal civil union from New Jersey.

In the session, Jeff complains about Tom's driving on the way home from the ceremony. "All I did was ask him to slow down a little and not be so aggressive," he tells the therapist. "He was driving like a madman."

"I was not," Tom snaps back. "You were very critical and harsh."

The therapist acknowledges Jeff's frustration and concern about Tom's driving, and encourages him to consider other ways to articulate his feelings. She comments on how the couple's disagreements sometimes devolve into power struggles, and offers advice on how they each might better communicate and express their needs. Tom and Jeff move on to another topic, and the therapist is satisfied that she has replied in a useful manner, based upon her work with many (heterosexual) couples and her own experience with a husband sometimes prone to aggressive driving.

In assuming that Tom and Jeff are like all the couples she has seen, however, the therapist has failed to realize that their relationship faces unique obstacles. Their fight was not simply a power struggle, but also expressed the hurt, shame and anger from feeling marginalized at the wedding.

Tom and Jeff need an opportunity to talk about how dejected they felt watching other couples slow-dance. Or how they both blanched when Tom's mother introduced them to others: "Tom, you remember your cousin Janet! And this is her husband, Paul. Janet and Paul, this is Tom and his, um... Jeff."

Most gay couples (and individuals) must deal with this sense of difference and even shame at times in their lives. In fact, the therapist would be wise to wonder if these feelings ever come up with her, a straight married woman. She may have been avoiding her own fears of not knowing enough, of being judged as different or inadequate. Had she been able to recognize her countertransference, she might have marveled at how similar she was feeling to them as an unacceptable other. She may have found a way to turn her discomfort into empathy.

Of course, gay, lesbian, and bisexual therapists would have their own countertransference reactions to this couple based on their own life experiences. Subtle expressions of homophobia are inevitable regardless of the analyst's sexual orientation. From a psychoanalytic standpoint, the goal is not to exorcise our countertransference, but to find ways to recognize and utilize it.

As analysts, we have a responsibility to become aware of our own beliefs and assumptions as they surface with patients. Additionally, I believe we have a personal and professional obligation to advocate for fairness for all people. Our commitment to alleviate suffering does not end at the consultation room door. Making marriage equal is no panacea, of course. But working for it is a good start.

-- Eric Sherman, LCSW

Eric Sherman is the author of Notes from the Margins: The Gay Analyst's Subjectivity in the Treatment Setting (The Analytic Press).

To find out more about supporting same-sex marriage, visit the websites of Human Rights Campaign (www.hrc.org) and Garden State Equality (gardenstateequality.org).

Common Psychoanalytic Myths: Part 2

Here is another installment in our look at a few common myths about what psychoanalysts and their patients actually do during sessions. We invite your comments and the sharing of your own myths.

MYTH #2

Will I have to spend all my time in a psychoanalytic therapy talking about sex?

FACT

Your question reflects two concerns you might have about psychoanalysis. One is that you will “have to” do something that you may not want to do – in this case talking about a subject that your analyst feels is most important. The second is the concern that your sex life will be the focal point of inquiry.

Tackling concern one: Many people new to analysis imagine their therapist will be an authority figure who will set the agenda for what is discussed. Many worry that they will be criticized, judged, or made to feel embarrassed. Although an expert in human psychology, the analyst’s view of the therapy process is collaborative and accepting. The analyst creates a climate where what is most meaningful and salient to the patient can be explored in a manner that is safe and respectful.

Concern two addresses the stereotype that psychoanalysts believe that sex is at the root of all problems. During the repressed Victorian era when Freud was developing psychoanalysis, he indeed encountered many patients with debilitating symptoms related to sex. He called sexual energy, libido -- a drive from the most unruly, uncivilized parts of ourselves.

Over time, with the benefit of many years of study and clinical evidence, analysts have also observed other causes for emotional difficulties such as ingrained patterns of being in relationships, vestiges of traumas, cultural and environmental influences, and individual genetic and body endowments. All of these and more are possible topics of discussion in an analytic therapy.

The thought that sexual matters may be discussed can be anxiety provoking. However, reflecting on the role of sex in one’s life is important. An essential aspect of the human experience, sex impacts our perception of ourselves, our relationship with others, and the choices we make in all arenas of life. So, analysts will invite you, when appropriate, to talk about sex. To never talk about it would be to bypass understanding yourself fully and omit tapping into a resource for happiness and positive change. Psychoanalytic therapists provide the confidential, private, and safe space for such exploration.

Sally Rudoy, LCSW

Can This Relationship Be Saved?

If you're anything like me (and for your sake, I hope you're not), you were a little unsettled by the recent separation of Al and Tipper Gore. If Washington's charmed couple could come undone after four decades, whose relationship is safe?

Who knows what happened that, seemingly out of the blue, what worked for the Gores for 40 years suddenly no longer did. Was it an affair? A slow drifting apart? After more than 14,000 days spent together, could Tipper no longer stand the toilet seat being left up one more minute?

Anyone who has ever done couples therapy (or been in a couple) knows that needs and interests that were once compatible can shift over time. We certainly hope they do. A relationship that doesn't change becomes stagnant. What marks a successful couple from an unhappy one is not whether the partners fight or how often, but how well they complement each other -- and how they navigate things when they don't.

Often, the very characteristics that attract us to our mates can pull us apart over time. The way he was so carefree and spontaneous now feels childish and irresponsible. "Why does he 'yes me’ whenever I ask him to do anything -- but then not do it?" The way she hung on our every word now seems suffocating. "Can't she give me a little space when I ask for it?"

We were so happy at first. What changed?

Undoubtedly many things. Here's one that a couples therapist, working from a psychoanalytic perspective, might consider. Without realizing it, we (unconsciously) choose a mate who embodies undeveloped aspects of our own personalities. His spontaneity excites us because we get anxious taking risks. We are afraid of our unmet dependency needs, and so are drawn to her seemingly unflinching trust. His ying is her yang. He introduces us to the world of freedom, she to safety and commitment. So far so good. But so long as our partner expresses a part of us we cannot tolerate, we become jealous of him for what we think we don't have. What we loved in them now frightens us. How come he gets to go out and have fun when we are always stuck with the kids? Ying and Yang remain split, and conflict brews. So long as she is the needy one, he never has to confront his own neediness, and she her fear of being alone.

Couples therapy helps each partner take back what the other is burdened holding for both of them. He begins to see that he has always been afraid to depend upon others for fear he will be abandoned. In fact, by ignoring her whenever she makes a demand, he in essence abandons her before she can reject him. Similarly, by choosing a critical, distant man, she has married someone just like the father who ignores her and shuts down her confident, fun-loving side.

As they work through these issues together in therapy, he can finally risk being more vulnerable with her, and she can discover her own strengths and capabilities. Each can feel safe learning from the other rather than railing against them. Differences can complement and enhance, not threaten. Not only does the relationship grow stronger, so do both individuals, as they get in touch with parts of themselves that were hidden within them all along.

-- Eric Sherman, LCSW

The New Jersey Couples Therapy Training Program (NJCTTP), a division of the Center for Psychotherapy and Psychoanalysis of New Jersey, offers a unique multitheoretical training program for mental health professionals, from both family systems and diverse psychoanalytic points of view. For more information, visit http://cppnj.org/njcttp.php.

Common Psychoanalytic Myths

Woody Allen has famously been called the “poster child” of psychoanalysis. Ironic isn’t it that the comedian/filmmaker has become the recognized face of psychoanalysis? Well, perhaps not. Psychoanalysis -- what it is and what happens during sessions has historically been the butt of jokes in culture, film and literature. Here we tackle a few myths about what psychoanalysts and their patients actually do during sessions. We hope to dispel, elaborate, or corroborate those familiar myths. We invite your comments and the sharing of your own myths.

MYTH

Psychoanalysts encourage patients to re-hash their troubled childhoods over and over

FACT

While analysts do encourage exploration of the patient’s experiences in childhood, parental and family relationships, cultural background, and traumas, they are not the exclusive focus of attention. What all analysts share in common is a profound respect for the unconscious: the contents of mind that operate out of awareness but influence and direct our thoughts, feelings, behaviors, and relationships. It is usually problems and disturbing patterns in these areas that bring people to treatment.

Analysts help patients become acquainted with the unconscious so as to have more freedom to make choices about their lives. Talking about childhood experiences and parents is one route to uncovering the invisible influences. But also, we examine how the patient functions in the world today and the perennial obstacles that stanglehold the person from achieving goals. Tuning into what is going on in the mind, body, and action in the present moment is a valuable source of information. Recent dreams, fantasies, everyday actions and reactions provide rich clues to where difficulties originate.

One of the most powerful ways the unconscious is revealed is in the very current, very alive relationship of analyst and patient. Once trust has been established, analysts invite the patient to collaborate on how the dynamics evolving between them may replicate difficulties in other relationships. The therapy room becomes an “in vivo” laboratory for the study of the unconscious with the goal of untangling the patient from past and present constraints.

Sally Rudoy, LCSW