THE REPARATIVE THERAPY OF KOHUT AND MILLER

Abstract

This essay is a response to a paper by Janna Sandmeyer which received the Ralph Roughton award. Sandemeyer examines Jule Miller’s 1985 article, “How Kohut actually worked,” in which Miller describes Kohut’s supervision of his work with a patient struggling with issues of homosexuality. I expand on Sandmeyer’s comments on the heteronormativity and homophobia in Miller´s case description and make observations about the quality of the supervisory relationship between Miller and Kohut. I argue that this treatment was in reality reparative therapy and should be named as such. I posit a parallel to the conversion therapist David Matheson, who recently came out as gay, and suggest that if I am right, Miller and Kohut deserve our compassion. But to grieve and move beyond our crimes of the past, we also need to hold them, and our whole field, accountable. While acknowledging and admiring Sandmeyer´s important contributions to the exploration of heteronormativity and homophobia, I submit that the first step to empowerment and forgiveness is to call a reparative therapy what it was.

Keywords:

• reparative therapy
• Kohut
• Miller
• Sandmeyer
• conversion therapy
• lgbtq
• heteronormativity
• homophobia

In exploring themes of heteronormativity and homophobia in the work of Miller and Kohut, Sandmeyer addresses an important issue. Her exposure of heterosexist and homophobic interpretations is not only technically brilliant but also a masterpiece of discipline and diplomacy. Sandmeyer´s conflict-avoidant tone may have a pedagogical intent: “Let us revisit the dream sequence and explore other, equally plausible interpretations that lend an open ear to the homosexual content … ” (Sandmeyer, 2019, p. 383)

As Sandmeyer points out, the tendency to interpret homosexual material in the analysis as parental goes beyond pathologizing the patient; it also contributes to his infantilization and seems to reflect an inability to see his homosexual strivings as mature. In Miller´s text, perhaps the saddest example involves a dream in which the patient was crawling on all fours in front of the therapist, begging him to stay. This image was interpreted as a child´s crawling on the floor, not as (also?) representing an adult sexual position toward the analyst—despite the fact that the rest of the dream is about a homosexually oriented clothing store that sells underwear. The deafness to homosexual longings evidently shared by both Miller and Kohut seems, to contemporary ears, both astonishing and defensive.

STRAIGHT, STRAIGHT-ACTING OR STRAIGHT-WASHING?

In an amusing part of her commentary, Sandmeyer notes Kohut’s interesting use of the word “straight”:

Miller writes, “[Kohut] then enunciated a basic principle: one should take analytic material first in a ‘straight’ manner, as if it means what it seems to mean” (p. 15). While it is unclear if Kohut actually used the word “straight” in this formulation, Miller clearly heard it as such. And, as much as Kohut disliked interpretations based on slips of the tongue, it is hard to ignore the striking use of the word “straight” here, that, in my view, reveals a strong heterosexist bias (or at best a stunning lack of awareness) in Miller’s article. Even more striking is that Kohut and Miller seem to repeatedly disregard Kohut’s basic principle, as they complicate matters by ignoring the overt, homosexual content in favor of interpretations that repeatedly bolster an idealizing transference.” (Sandmeyer, 2019, p. 381).

In parallel, I found in the Miller paper an interesting double entendre on being out: “The patient then talked about the beginning of this particular session. He had arrived early and did not feel like being ‘out and about’ in the building but felt more comfortable sitting in my waiting room, close to me” (p. 23, my italics). But no one heard this innuendo.

Why is it that heterosexuality needs no evidence, whereas homo- or bisexuality can be overlooked with almost any amount of evidence? If this patient is not gay or bisexual, then who is? To “straight-wash” (cf. Ogles, 2017; Smith, 2018) people from the past, or to naively overemphasize anachronisms to distract from any inference of gayness, constitutes a kind of violence: it makes the gay person invisible. Consider a recent Scandinavian controversy: Author Tove Jansson, creator of the famous “Moomi” characters, lived openly with her partner, Tuulikki Pietilä, for decades. She has nonetheless been depicted as living “alone on a small island in the gulf of Finland where most of her books were written” (Jansson, 2013). Reacting to a documentary about the Nobel prize winner Selma Lagerlöf, family members and some critics protested that mentioning her lesbian love life was too speculative and also took up too much space (Pettersen, 2016).

Drescher (2002), addressing the homophobic attitude of “Don’t ask, don’t tell” in psychoanalytic training institutes between 1973 and 1991, describes the avoidance of naming Sullivan as gay: “…when a gay colleague who trained at White during the 80s told his analyst that he had heard Sullivan was gay, the analyst responded somewhat defensively, ‘How do you know? Do you know anyone who slept with him?’” (Drescher, 2002, p. 53).

Miller’s description of this case supervised by Kohut views the patient’s extensive homosexual longings through a heterosexual gaze. It is hard to imagine that the same-sex material could have been any more obvious, though, even when strained through Miller’s heterosexualized filter. The story reveals the patient’s painful pressure on himself to accomplish heterosexual sexual acts: He has sex with his wife with his clothes on. He has one nightmare in which he has to stick the penis into a can and another in which he has to put his penis into a disposal. “A woman had a can with a certain shape, and he was supposed to insert his penis into this can. She was holding it in her hand.” (Miller, 1985, p. 16). Another piece of dream material, about the rear of a car being on fire and his putting out the fire with his hose, seems pretty clearly about anger and sexuality. I would be surprised if any homosexually oriented psychoanalyst would not see this as symbolizing the trauma of being forced to “try to enjoy” heterosexual intercourse.

Sandmeyer is cautious about this:

I am not asserting that Jule Miller´s patient is in fact gay, or bisexual. I have no way of knowing that. What I am reacting to, however, is the complete absence of a perspective that views his same-sex longings, experience and excitement as an expression of healthy tendrils of development. (Sandmeyer, 2019, p. 379)

I take issue with Sandmeyer’s demurral here. There is an overwhelming amount of evidence that the patient is not heterosexual. Miller and Kohut are either deaf about it or see their proper role as changing the patient’s orientation.

TRANSFERENCE AND COUNTERTRANSFERENCE

As Sandmeyer observes, there is likely also a homoerotic transference from the patient towards the therapist that is never noted in the Miller text. The patient comes early and wants “their libraries to merge”—in my view a clear wish for him to move in with the analyst and become a couple. This man also has overtly sexual dreams about the therapist. But just as Miller is implicitly trying to correct and cure the patient, Kohut keeps correcting Miller! In Miller’s account of the supervision, there is a tone of right-versus-wrong that suggests an interesting parallel process: Kohut and Miller do not seem to collaborate on understanding the clinical material together. According to Miller, Kohut tends to correct him in a tone that comes through as quite patronizing (1985). See Table 1.

Table 1. Kohut´s comments to Miller.

“Kohut’s response was that he would have handled this incident differently.” (p. 14)

“Kohut disagreed with my interpretation…” (p. 15)

“At this point in my reporting of this session, Kohut interrupted to say he wanted to give me some thoughts.” (p. 17)

“In commenting on this section of the hour, Kohut said he thought my remarks to the patient had been good, but he wanted to add something that he felt, while not essential, would definitely have made my interventions richer and more effective”. pp. 18–19)

“However, he disagreed with my additional comment…” p. 22.

“Kohut, of course, took exception to my argument with the patient. He felt it was another instance of my complicating things unduly and not looking at the positive side of the patient’s experience.” p. 24

“Kohut thought this was an error.” p. 26.

“Kohut agreed, but objected to the form in which I made it, because he felt the patient would experience it as if he were being blamed, and this would make the intervention less effective.” p. 27

“Kohut summarized the material that had come up in our discussion. He also indicated what he thought I had handled well, and what had been less than optimum or where I had gone astray in his opinion.” (p. 30)

Sandmeyer suggests there might be homoerotic transference and countertransference to explore between Miller and Kohut. I think she may be right.

INTERNALIZED HOMOPHOBIA

What accounts for Kohut’s homophobic stance? One cannot know for sure. According to Sandmeyer and Kohut´s biographer Strozier (2001, 2003 & 2007), Kohut may have had homosexual wishes himself. It is widely assumed, based on parallels in their histories, that his patient, “Mr Z” (Kohut, 1979), was in fact Kohut himself (Aron & Bromberg, 2019). Strozier describes in some detail Kohut’s longstanding, close relationship with a gay man. “Mr Z” had gay fantasies and had as his first sexual experience what Kohut refers to as a “homosexual relationship” (despite the fact that a sexual encounter between a 30-year-old man and an 11-year-old boy suggests not relationship but pedophilic abuse). Although Sandmeyer refers to Kohut´s positive statements about homosexuality, no positive notes come through in the case, suggesting ambivalent and internalized homophobia in either Kohut or Miller or both.

As Kohut was ill and close to his own death when working with Miller, he may have been uncousciously especially vulnerable to envy of a patient who wanted to live out some fantasies he had denied himself. Given the human tendency to internalize negative attitudes, being in a socially devalued role oneself is no vaccine against personal prejudice (Drescher & Fors, 2018; Fors, 2018). As Sandmeyer notes (see also Drescher, 2002), even when homosexuality was no longer a DSM diagnosis, homophobia was still a problem, and gay and lesbian people were far from fully accepted. In the psychoanalytic community, homophobia tended to be couched in an attitude Drescher calls “coyness”: “Coyness usually results from a conflict between unconscious disdain and an analyst’s self-representations as a caring and tolerant individual” (Drescher, 2002, p. 51).

This attitude may explain why the implicit violence in the therapy is never named. I do not think Miller is aware that he is doing reparative therapy or conversion treatment.

Conversion therapies are any treatments, including individual talk therapy, behavioral (e.g., aversive stimuli), group therapy or milieu (e.g., “retreats or inpatient treatments” relying on all of the above methods) treatments, which attempt to change an individual’s sexual orientation from homosexual to heterosexual. (Drescher et al., 2016, p. 7)

ACCOUNTABILITY

Judging people from the past according to today´s norms may be unfair, and Sandmeyer generously makes allowances for the era and the context of this treatment. But questions arise. If we downplay the mistakes of our heroes, how can we fully learn from them? Is it too distressing to be what Sara Ahmed (2010) called “the feminist killjoy” and critique idealized forefathers? Can we not bear that our exemplars of psychoanalysis made big mistakes? I want to suggest that exigencies of time do not obliterate the responsibility of Miller and Kohut. If we see people in the past as essentially different from ourselves, then racism, homophobia, and violent suppression are conveniently located in another time and place, carried out by another kind of human being. Paradoxically, I believe that minimizing the crimes of our predecessors is dangerous because it invites us to overlook our own potential for badness and our own susceptibility to a zeitgeist (see also Fors, 2019). The people in Germany during World War II were not essentially different from us. Neither was Miller nor Kohut.

Four years after the patient terminated, Miller voices no regret or shame about possible harm done to him. This is not a matter of a few blunders. The paper was published in 1985, several years after homosexuality was omitted from the DSM (Drescher, 2015a). For five years, Miller tried to “cure” the patient of same-sex desire, something we now know is damaging (Drescher, 2015b). Miller goes so far as to judge the therapy successful.

Debiak (2019) recently noted a shift in psychoanalytic discourse: At some point we started to problematize homophobia instead of homosexuality. But despite the self-congratulatory conclusion that we are improving in respecting human rights, we have to acknowledge and grieve violence done in the past, even by our psychoanalytic heroes (cf. Drescher, 1998). Miller seems to idealize Kohut, I wonder if we do, too. By “we,” I mean not only Sandmeyer, but all of psychoanalysis.

ONTOLOGY OF FORGETTING?

Sandmeyer’s judicious tone has some echoes of the “smoothing over” often expected from people in inferior social positions (Dixon, Tropp, Durrheim, & Tredoux, 2010). The subordinated are obliged be deferential (Pon, 2009). The Swedish sociologist Carin Holmberg (1993) interviewed childless heterosexual couples who were seen by their friends as notably egalitarian, asking about the gender divide in their domestic life. She found that when their pattern did not fit an egalitarian norm, when the male partner behaved in a sexist way or expected the woman be more responsible at home, the task of explaining this division of labor fell to the woman. This finding supports Akhtar’s (2014) observations about the politeness expected from subordinated groups. Pon (2009) similarly attributes the forgetting of historical violence to smoothing it over so as not to be seen as too loud or pushy. Black Americans are accordingly expected to celebrate July 4 (Akhtar, 2014), and gay people are expected to celebrate the weddings of heterosexual couples even in countries where they themselves are not allowed to marry (Fors, 2018).

In my view, Sandmeyer comes off as slightly too polite. To my ear, all of her interpretations of this case are far more persuasive than those of Miller and Kohut. So why is she so humble? And despite the fact that throughout her paper she exposes homophobic interactions, she never uses the terms “reparative” or “conversion.” This choice may be high-minded, but I worry that it is potentially dangerous and disempowering. The story of this treatment may have some parallel to that of the conversion therapist David Matheson, who recently came out as gay (Compton, 2019). If so, Miller and Kohut deserve our compassion. But to grieve and move beyond our crimes of the past, we also need to hold them, and our whole field, accountable. I submit that the first step is to call a reparative therapy what it was.

Additional information

Notes on contributors

Malin Fors

Malin Fors, MSc, is a Swedish psychologist and psychoanalyst living in the world’s northernmost town, Hammerfest, Norway. She works at the Finnmark Hospital Trust and also in private practice. She is an assistant professor at the University of Tromsø, the Arctic University of Norway, where she teaches medical students on topics of diversity, privilege awareness, and critical perspectives on cultural competency. Her book A Grammar of Power in Psychotherapy won the 2016 APA Division 39 Johanna K. Tabin Book Proposal Prize. She has a DVD in the APA Therapy Series: The Dynamics of Power and Privilege in Psychotherapy with Malin Fors.