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by Richard C. Friedman and Jennifer I. Downey
Columbia University Press, 2002
Review by Minna Forsell on Feb 17th 2009

Sexual Orientation and Psychodynamic Psychotherapy

Social psychology has taught us that gender is the first distinction that we make when meeting someone, so essential to our understanding of others that the question of what it is and how it influences us is one of the vastest and deepest in the field of psychology. The link between gender and sexual orientation is equally complex. Given the prominent place of sexuality in psychodynamic theory and treatment, the need for an understanding of its elusive nature is crucial.   

Sexual Orientation and Psychodynamic Psychotherapy is a successful attempt to syncrhonize empirical studies on sexuality with psychodynamic thinking. The result is an engaging exploration of gender, sexual development and psychotherapy that gives thought-provoking perspectives on human sexuality as well as clinical work.

One of the consequences of the fact that psychoanalysis and its therapeutical offsprings have not been too keen to test their theroretical foundations against the empirical knowledge that has been gained in related fields over many years is that science and the psychoanalytic field have been out of tune. In an unbiased fashion, Richard C. Friedman and Jennifer I. Downey seek to relate psychodynamically oriented thinking to neurobiological research and studies carried out in extra-analytic fields. The text is complex, yet approachable for anyone interested in an encompassing view of sexual orientation and treatment.

The question of how psychodynamically oriented therapists understand nonheterosexual patients is thoroughly attended to throughout the book. There have been numerous attitudes, theories and thoughts on the subject in the history of psychoanalysis, and the authors' impression is that many psychoanalysts presently hold contradictory beliefs about homosexuality. Thus, the theoretical/developmental part of the book consists of an extensive discussion of extrapsychoanalytic research in genetics, psychoendocrinology, developmental psychology and sexology, as well as relevant pieces of psychoanalytic theory. Even though this part of the book is laden with references to diverse studies from different fields, it is not heavy nor monotonous to read; the flow of reflections provided by the authors makes it continuously fascinating. It is, however, wide-ranging. For more depth on a specific issue or study you will have to conduct some research yourself.

The clinical part of the book takes us closer to the therapist's treatment room. As in the first part, various perspectives and topics interact. The main focus is on homosexuality and homophobia, including themes such as internalized homophobia, gender-valued self-condemnation and psychopathology. Therapeutic endeavors in the form of conversion therapy and gay-affirmative therapy are discussed, as well as the implications of the sexual orientation of the therapist. Details, case examples and complicated clinical issues are integrated into a broad and challenging take on nonheterosexuality and therapy. In addition, this part provides us with less patient-focused aspects such as homophobic parents, a short history of homosexuality and a critical discussion of the organization of psychoanalysis.

Even though the purpose of Sexual Orientation and Psychodynamic Psychotherapy is to revise psychodynamic theories, it is refreshingly old school in the sense that it honors curiosity about human sexuality. It seems to be grounded in the wish to find out, to know, rather than to prove, and that is inspiring in a business that deals with uncertainties. Authoritarianism, false certainty, conformism and the wish to achieve power and prestige -- factors that are much more present in psychotherapy and its literature than one would like to think -- have given way to erudite bridge building, interesting interplay and well-needed thought expansion. Books such as this one are excellent contributions to the field of psychology, a true offering to collective knowledge.

© 2009 Minna Forsell

Minna Forsell is a psychologist, recently graduated from the University of Stockholm. She currently works in a psychiatric health care center in Volda, Western Norway.


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