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This paper discusses the development of object relations theory which, in Britain, was developed as an extension of Freudian psychoanalysis by such thinkers as Melanie Klein, Fairbairn, Winnicott and their followers and later supported by research from attachment theorists like Bowlby. Object relations theorists made a shift from the conception of a drive-based psyche to one that was primarily motivated towards relationships. Contemporary object relations theory acknowledges the primacy of relationships, which results in the close attention and utilisation of the constantly active system of transference, countertransference, and protective identification in the space between therapist and client. This paper examines object relations in the context of its unique challenges for gay male therapists working with gay male clients in the gay therapeutic dyad. This paper reviews the legacy of homo-negativity in the therapeutic process. It then explores how knowledge of object relations theory can be useful for therapists working within a gay therapeutic dyad. [ABSTRACT FROM AUTHOR]

Generally a distinction is made between the disclosure of personal information and the disclosure of countertransference feelings to a patient. While this may be a necessary distinction to make in the interest of carrying on a coherent conversation on this question, I argue that there is a sort of vanishing point where the difference between "facts" and "feelings" merges. What I wish to suggest here is that, to a certain and necessary degree, the context and the framing of the question of self-disclosure determines what we define as a disclosure. I propose that thinking about a dialectical relationship between sameness and difference is a particularly useful way into the question of self-disclosures in contemporary clinical work. The question of disclosing personal information to patients became a pressing one for me when I found that in some cases it felt necessary to disclose my HIV seropositive status. Here is an example of a fact that is particularly laden with feelings, confounding the distinction between a factual and a countertransferential disclosure. As might be expected in considering the disclosure of personal medical information, I felt there were a variety of reasons to do so, each with specific context. In a long psychotherapy treatment with an HIV-negative man I found that tracking each of our senses of sameness and difference offered a way of understanding the changing meanings of the disclosure of my HIV seropositivity. But more importantly it became clear that it was the process of disclosure rather than the content that exerted the greatest influence on our work, ultimately contributing to a transformative experience for the patient. [ABSTRACT FROM AUTHOR]

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 change din 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. [ABSTRACT FROM AUTHOR]

This paper discusses Gilbert Cole's book, "Infecting the Treatment: Being an HIV-Positive Analyst." The author provides some personal reflections on the outbreak of AIDS and the impact it had upon his work as a psychotherapist. The paper addresses the importance of the cognitive schemata Cole provides to psychotherapists working with seropositive patients. This paper then addresses a powerful technique, a therapist's self disclosure to a patient, upon which Cole's work focuses. Using the example of psychoanalytic strictures regarding self-disclosure, the author argues that self-disclosure is more likely to be adhered to in theory than it is in practice. The author agrees with Cole that non-disclosure is often a technique used by analysts to hide, rather than provide a therapeutic field of action. The specific case of therapists hiding their antihomosexuality when working with lesbians and gay men is used to illustrate the author's perspective. A specific case presented by Cole in his book is then used to both compare and contrast Cole and this paper's author's use of self-disclosure. The paper commends Cole's study for opening a debate on how to use countertransference and self-disclosure as tools which widen and enrich the therapeutic relationship. [ABSTRACT FROM AUTHOR]