THE AMERICAN JOURNAL OF PSYCHOANALYSIS 3:7:253-255 (1977)

BRIEF C O M M U N I C A T I O N S

GENDER-SPECIFIC THERAPY PROBLEMS IN MALE YOUTHS

The concept of gender and core-gender identity has developed in recent de- cades as a result of the work of many authors, especially Stoller. His research clearly indicates that core-gender identity develops in the first two to three years of life. He has also clearly demonstrated that early intervention is absolutely necessary in the working-through of maladaptive gender identity situations. The longer one waits to treat this type of psychopathologic condition, the more one is faced with behavior which becomes either ego-syntonic or ego-dystonic but unavailable to change because of its chronicity.

As psychiatrists we must also be aware of the fact that our culture frequently determines what is psychopathology and what is not. Psychopathology and gender disturbance are significant areas being reviewed by psychiatrists, sociologists, and anthropologists. Whether or not a situation is considered psychopathologic is somewhat related to whether the potential patient identifies his sexuality as a problem and whether he Sees a psychiatrist who also views his difficulty as a psychopathological state which needs treatment. If we can assume that both the patient and the psychiatrist are in accord, then we can proceed with the concept of therapy problems in male youth. An understanding of the psychodynamic devel- opment of the young man, including his sexual behavior, and an attempt to understand the specific conflicts centering around adolescent sexuality and dys- function are necessary in order to treat the adolescent growth period in males.

As a psychoanalyst, I concur with the early developmental pathology that Stoller has described in his clinical observation of the individual with gender-identity disturbance. I would suggest that specificity in sexual psychopathology, if we view it from a medical model, is closely related to traumatic experience early in life as related to the parenting object of the same sex and/or the opposite sex. In this situation the child has an inability to obtain early care and love from the mother or parenting object, and out of frustration and anger either fails to identify with her, as would be found in the female, or, in the case of the male, decides to identify with the

First presented at the Annual joint meeting of the American 'Psychiatric Association/American Academy of Psychoanalysis, Miami, Florida, May 1976. Brief Communications does not include references or bibliographies. These may be secured by writing to The American Journal of Psychoanalysis.

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feared object (the mother) and fails to identify with the father. Concomitant with this the work of Greenson indicates that boys have an extra step in terms of their early developmental history which is different from girls. The boy must dis-identify from the first source of identification, the mother, give up this object, and then later identify with the father. For this reason it might be possible that more male sexual psychopathology is seen by the psychiatrist and that men and boys appear to be more fragile in their masculine concepts than are women in their feminine con- cepts.

Some authors have suggested that one of the specific forms of therapy for the adolescent with sexual problems includes working with a therapist of the same sex. It is not clear to me that this is necessary or accurate. It appears that each male, as each individual, is unique, and his needs are unique in the therapeutic situation. The important consideration is that the therapist have a psychodynamic perspective which includes an understanding of both early pregenital conflict and Oedipal problems and distortions, as well as the cultural expectations of the male adoles- cent. Of course combined with this is the whole concept of the doctor-patient relationship, or transference. The male adolescent can easily develop a positive transference relationship with either a male or female therapist. Where there is very early disturbance, a female therapist might act as a facilitator in the recognition and treatment of such disorders via the transference neurosis. At some later date the young man can possibly be transferred to a male therapist where a different quality of work may go on in terms of positive identifications arid the building of new sources of male imagery.

A short vignette about this type of therapy might be in older. Approximately eight years ago a patient was referred to me. At this time he was an eighteen-year-old homosexual. Our work was successfully resolved with his beginning to free himself of the internalized, devouring, angry mother who left him with little concept of himself and his beginning to understand what a woman is. This was the work of the transference. In the aspects of the real part of our relationship he was more able to significantly integrate me as a male object to model himself after. However, as therapy proceeded, it became clear to me that a lot of the early developmental psychopathology, although ihtellectually understood and felt through the trans- ference, was not clearly identified emotionally by the patient. Although he gave up a good deal of his homosexual behavior, he was still most fragile as to his sexuality and i~ a sense felt neuter, I guggested to him that he continue his work with a female psychiatrist in the com~unity~ He agreed and saw one for approximately two to three years longer, at which time he integrated a new image of a mothering object both pgychologically and realistically thus allowing for a more integrated construct of th~ male self.

Although either male or female therapists can deal with the specific conflicts of male adolescent sexuality and its dysfunction, at times there are specific reasons when the male or female therapist present certain aspects of themselves which allow a further working through of sexual and other psychopathology.

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The concept of gender-specific therapy for the male adolescent can present unique situations but, as with other psychopathologic conditions, it is an expression of psychopathology related to developmental lags and should be treated as such. When one approaches this problem with the perspective of a general understand- ing of psychodynamics and the concept of resistance and transference, then the treatment does not become quite as specific as one might originally consider. What is pertinent is that we understand and respect the uniqueness of all individuals whatever their problems.

Arnold L. Gilberg, M.D. , Ph.D.

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