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In the field of psychotherapy, transmittable technical knowledge is accumulated through the gradual accumulation of individual case studies as well as through training and supervision. What is lacking is body of literature that speaks frankly about what therapists actually do, in contrast to much of the existing literature which sets forth theories of technique or of mind. In his response to commentaries by Robin Goldberg, Owen Renik and Thomas Domenici to Infecting the Treatment: The Experience of an HIV-Positive Psychoanalyst, the author discusses the subjective experiences of illness, vulnerability, and vicissitudes encountered in training and developing as a clinician. KEYWORDS. AIDS, countertransference gay, HIV, homosexuality, intersubjectivity, mutuality, psychotherapy, psychoanalysis, self-disclosure, subjectivity, transference

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 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 sell-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 if 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 a 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. KEYWORDS. AIDS, countertransference, dialectical thinking, dichotomous thinking, dynamic systems theory, HIV positive, mutuality, sell-disclosure, sexual compulsion, transference

The author, writing as a therapist who has become interested in discussing his own HIV positive status publicly, raises the question of how HIV and AIDS present unique problems to psychotherapists, not only clinically, but also in the ways they write about their work. Writing about work that involves something as laden with meaning as HIV/AIDS might lead the therapist to feel as if she or he is risking exposing more of herself or himself than in writing about less anxiety-provoking subjects. The author sees Leli and Weinstein's contributions to the clinical literature pertaining to HIV/AIDS as important for many reasons, not least because they demonstrate, in very different ways, how questions of mortality that have been so inextricably bound up with HIV/AIDS figure into the therapist's daily work. In addition to his discussion of two case presentations, the author reviews the sparse psychoanalytic literature on HIV/AIDS and critically discusses psychoanalytic attitudes, illustrated in a published case by Grosz, that pays more attention to the presumed origins of his patient's homosexuality, rather than the patient's experience of living with AIDS. As the world enters the 'protease era,' the meanings associated with HIV/AIDS can be considered in a different context; that of life continuing rather than impending death. KEYWORDS. AIDS, countertransference, HIV, homosexuality, psychotherapy, psychoanalysis

When behavior is reported that objectively places the patient and others at risk and subjectively exposes the therapist to a vivid range of private experience, the challenge in maintaining a clinical stance is complicated to say the least. This complication is intensified to the degree that the clinician's aim involves understanding rather than discipline and control. To specify details of that challenge, I discuss two patients whose unsafe sexual practice confronted me. In these clinical situations, I found it useful to be mindful that bareback sex contains a range of meanings, including the search for a quality of relating that can enliven an inner deadness. Thinking this, I found it necessary to be alert to wishes for creativity as well as destructiveness. Attending to such paradoxes also required me to come up with a new way of working with countertransference: to render it an imaginary theatrical performance. [ABSTRACT FROM AUTHOR]