Discussion of Gilbert Cole's Disclosure, HIV and the Dialectic of Sameness and Difference

ABSTRACT

The author discusses Gilbert Cole's Disclosure, HIV and the Dialectic of Sameness and Difference. The dichotomy often made between the disclosure of countertransference affects and the disclosure of facts is an oversimplification. The disclosure of HIV positive serostatus is more than just a fact, and is filled with transcendental meaning. While there are aspects of having positive serostatus that are unique to that condition, the dialectic between uniqueness and commonality is also important in understanding this process.

Cole appears to eschew a classical view of neutrality. The author briefly reviews some of the controversy surrounding historical views on self-disclosure. The author also reviews some of the psychoanalytic literature dealing with disclosure of a therapist's illness to a patient.

The author sees Cole's disclosure of his positive HIV serostatus to his patient as inadvertent. Inadvertent disclosures occur often in the course of psychotherapy; however, once they occur, they should be dealt with directly in the treatment. The author sees inadvertent disclosure as entirely different from answering a question about a fact that a patient may fantasize about, but about which he has no actual knowledge. The author feels it is important to confirm for a patient something that the patient already knows, but does not want to know. To do otherwise is to potentially retraumatize a patient.

The author discusses the tendency to avoid aspects of the real relationship between therapist and patient. In particular, she underscores the pervasive denial of death in analytic theories and in clinical practice. While the course of HIV infection has dramatically changed in the last decade, it nevertheless carries association to and risk of a potential disease, and a potential disease that carries the threat of death. The author offers a vignette from her own clinical practice in which a patient responded to an unexpected absence due to illness. The author concludes by noting that while most inadvertent disclosures are less significant than the disclosure of HIV serostatus, they all have an important impact on clinical work.

KEYWORDS:

• AIDS
• countertransference
• death
• gay
• HIV
• homosexuality
• illness
• neutrality
• psychoanalysis
• psychotherapy
• self-disclosure
• seropositivity
• sexual orientation