The analysis of a pre-homosexual child with a twelve-year developmental follow-up

This paper presents clinical material from the three-year psychoanalysis of an eight-year-old boy and his fight to assume his normal gender-defined self-identity. It also outlines a twelve-year follow-up when the patient returned for consultation during crucial periods in his life. The analysis illustrates the psychodynamics underlying the anxieties that led to gender-defined self-identity confusion. The child's attempts to appease an engulfing mother resulted in severe separation anxiety and a tendency toward a resolution of his intrapsychic conflicts by engaging in homosexual acts. Mother presented significant obstacles to the treatment, which continued even as the child began to adopt masculine interests. Father, who was dominated by his wife, was distant, unavailable, and ashamed of his son's effeminate tendencies. He could not express pride in the boy's considerable intellectual abilities and was unable to provide a strong male identity figure. The parents refused to seek psychotherapy for themselves which would have benefited their son. Despite these obstacles, the child's progress in analysis was seen in (1) his ability to function at school, (2) the disappearance of his transvestism, (3) the decrease and near-obliteration of feminine behavior, (4) improvement in aggression control, and (5) a lessening of narcissistic overinvestment in the self. Also, his fears of death and his most prominent anxieties were overcome. What remained was a search for the father, which manifested itself, in his middle to late adolescence, in an attraction toward men. The men he chose to pursue, however, were not homosexuals, and this revealed the patient's ambivalence about embarking on homosexual relationships. At the twelve-year follow-up I encouraged the patient to pursue referrals to an adult analyst. My experience is in child analysis, and he did not seem ready to modify the good child/adult therapeutic imago that was sustaining him. In the subsequent four years, there has been no further contact with the patient.