Treatment Parameters and Structural Change: Reflections on the Psychotherapy of a Male Homosexual

Abstract

Shechter R. A. Treatment Parameters and Structural Change: Reflections on the Psychotherapy of a Male Homosexual. Int Forum Psychoanal 1992;1:197-201. Stockholm. ISSN 0803-706X

Sequential highlights from a four-year treatment period demonstrate specific instances when technique parameters, defined as deviations from psychoanalytic neutrality, triggered the emergence of repressed memories. These memories were connected to forbidden impulses and intense annihilation and castration anxiety. Parameters also functioned to keep anxiety at tolerable levels, allowing the working-through and rechanneling of highly charged libidinal and aggressive wishes and fears, and the establishment of a reparative transference. As the patient explored affect and memory, he incorporated a more benign superego. Drive was neutralized, sublimation occurred, and structural change unfolded. Intrapsychic change led to behavior change. The patient moved from a monogamous, sadomasochistic, homosexual lifestyle to a more positively invested and pleasurable heterosexual relationship.

Treatment was not a defense analysis. The patient's ego structure could not have tolerated the anxiety of a transference neurosis that mirrored the abuse of childhood. The treatment dyad was a reparative force. Parameters indirectly functioned as interpretations of repressed longings, surgically cutting through false self-deception.