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Abstract
A case of a gay therapist treating a gay patient raises several issues that include the patient's sexual identity, the therapist's sexual identity, and the potential interplay of those identities in a therapeutic encounter. Although an understanding of a gay patient's sexual identity will certainly be an important issue across the course of his treatment, it will not be the only subject talked about in therapy. Conversely, although a patient's gay identity is not necessarily the primary focus of treatment in many cases, its impact upon the course of treatment cannot be overlooked nor easily separated out from his other concerns. In this case, a young gay man enters treatment after a long, life-threatening illness. Having survived his illness, his dissociative defenses began to falter. The patient linked his illness in a critically judgmental way to his gay identity. The course of the patient's treatment, which included a greater acceptance of his gay identity, is illustrated through a series of dreams.