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ABSTRACT
The author, in his reply to Kenneth Lewes's discussion of his paper, “Straight, Gay, or Both: The Case of Michael,” takes up several theoretical and technical issues raised by Lewes about how best to understand and work with patients who are confused and conflicted about their sexual orientation. A therapist's theoretical orientation (i.e., Freudian vs. Relational/Intersubjective) can result in differing conceptual emphases (for example, sexual drives seen as primary vs. sexuality seen as reflecting self-esteem and affiliational needs) and differing therapeutic styles of intervention (“probing” and “challenging” vs. what Lewes characterizes as “undue concern for tact”). However each approach inevitably has an impact on the patient's transferential experience, often in unforeseen ways.
The author also discusses some of the implications of the discordance in sexual orientation between therapist and patient, which may complicate the therapy process, and the question of whether sexual orientation is best conceptualized as binary (either gay or straight) or along a continuum that includes bisexuality. Overriding all of these issues is the essential impact of the quality of the communication process (most notably the therapist's or the writer's style and tone, which reflects the “communicator's” subjectivity) upon the “receiver's” experience.