THE REPARATIVE THERAPY OF KOHUT AND MILLER

Abstract

This essay is a response to a paper by Janna Sandmeyer which received the Ralph Roughton award. Sandemeyer examines Jule Miller’s 1985 article, ”How Kohut actually worked,” in which Miller describes Kohut’s supervision of his work with a patient struggling with issues of homosexuality. I expand on Sandmeyer’s comments on the heteronormativity and homophobia in Miller´s case description and make observations about the quality of the supervisory relationship between Miller and Kohut. I argue that this treatment was in reality reparative therapy and should be named as such. I posit a parallel to the conversion therapist David Matheson, who recently came out as gay, and suggest that if I am right, Miller and Kohut deserve our compassion. But to grieve and move beyond our crimes of the past, we also need to hold them, and our whole field, accountable. While acknowledging and admiring Sandmeyer´s important contributions to the exploration of heteronormativity and homophobia, I submit that the first step to empowerment and forgiveness is to call a reparative therapy what it was.

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THE REPARATIVE THERAPY OF KOHUT AND MILLER
Malin Fors
To cite this article: Malin Fors (2019): THE REPARATIVE THERAPY OF KOHUT AND MILLER,
Psychoanalysis, Self and Context, DOI: 10.1080/24720038.2019.1642893
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THE REPARATIVE THERAPY OF
KOHUT AND MILLER
Malin Fors, MSc
This essay is a response to a paper by Janna Sandmeyer which received the Ralph
Roughton award. Sandemeyer examines Jule Miller’s 1985 article, ”How Kohut actually
worked,”in which Miller describes Kohut’s supervision of his work with a patient strug-
gling with issues of homosexuality. I expand on Sandmeyer’s comments on the hetero-
normativity and homophobia in Miller´s case description and make observations about
the quality of the supervisory relationship between Miller and Kohut. I argue that this
treatment was in reality reparative therapy and should be named as such. I posit a parallel
to the conversion therapist David Matheson, who recently came out as gay, and suggest
that if I am right, Miller and Kohut deserve our compassion. But to grieve and move
beyond our crimes of the past, we also need to hold them, and our whole field,
accountable. While acknowledging and admiring Sandmeyer´s important contributions
to the exploration of heteronormativity and homophobia, I submit that the first step to
empowerment and forgiveness is to call a reparative therapy what it was.
Keywords: reparative therapy; Kohut; Miller; Sandmeyer; conversion therapy; lgbtq;
heteronormativity; homophobia
In exploring themes of heteronormativity and homophobia in the work of
Miller and Kohut, Sandmeyer addresses an important issue. Her exposure of
heterosexist and homophobic interpretations is not only technically brilliant
Malin Fors,MSc, is a Swedish psychologist and psychoanalyst living in the world’s northernmost town,
Hammerfest, Norway. She works at the Finnmark Hospital Trust and also in private practice. She is an
assistant professor at the University of Tromsø, the Arctic University of Norway, where she teaches
medical students on topics of diversity, privilege awareness, and critical perspectives on cultural compe-
tency. Her book A Grammar of Power in Psychotherapy won the 2016 APA Division 39 Johanna K. Tabin
Book Proposal Prize. She has a DVD in the APA Therapy Series: The Dynamics of Power and Privilege in
Psychotherapy with Malin Fors.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-
NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which per-
mits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is
properly cited, and is not altered, transformed, or built upon in any way.
Psychoanalysis, Self and Context, 2019
Copyright © The Author(s). Published with license by Taylor & Francis Group, LLC
ISSN: 2472-0038 print / 2472-0046 online
DOI: https://doi.org/10.1080/24720038.2019.1642893
1

but also a masterpiece of discipline and diplomacy. Sandmeyer´s conflict-avoidant
tone may have a pedagogical intent: “Let us revisit the dream sequence and explore other,
equally plausible interpretations that lend an open ear to the homosexual content …”
(Sandmeyer, 2019,p.7)
As Sandmeyer points out, the tendency to interpret homosexual material in the
analysis as parental goes beyond pathologizing the patient; it also contributes to his
infantilization and seems to reflect an inability to see his homosexual strivings as
mature. In Miller´s text, perhaps the saddest example involves a dream in which the
patient was crawling on all fours in front of the therapist, begging him to stay. This
image was interpreted as a child´s crawling on the floor, not as (also?) representing an
adult sexual position toward the analyst—despite the fact that the rest of the dream is
about a homosexually oriented clothing store that sells underwear. The deafness to
homosexual longings evidently shared by both Miller and Kohut seems, to contempor-
ary ears, both astonishing and defensive.
STRAIGHT, STRAIGHT-ACTING OR STRAIGHT-WASHING?
In an amusing part of her commentary, Sandmeyer notes Kohut’s interesting use of the
word “straight”:
Miller writes, “[Kohut] then enunciated a basic principle: one should take
analytic material first in a ‘straight’manner, as if it means what it seems to
mean”(p. 15). While it is unclear if Kohut actually used the word “straight”in
this formulation, Miller clearly heard it as such. And, as much as Kohut disliked
interpretations based on slips of the tongue, it is hard to ignore the striking use
of the word “straight”here, that, in my view, reveals a strong heterosexist bias
(or at best a stunning lack of awareness) in Miller’s article. Even more striking
is that Kohut and Miller seem to repeatedly disregard Kohut’s basic principle, as
they complicate matters by ignoring the overt, homosexual content in favor of
interpretations that repeatedly bolster an idealizing transference.”(Sandmeyer,
2019, p. 6).
In parallel, I found in the Miller paper an interesting double entendre on being out:
“The patient then talked about the beginning of this particular session. He had arrived
early and did not feel like being ‘out and about’in the building but felt more comfortable
sitting in my waiting room, close to me”(p. 23, my italics). But no one heard this
innuendo.
Why is it that heterosexuality needs no evidence, whereas homo- or bisexuality
can be overlooked with almost any amount of evidence? If this patient is not gay or
bisexual, then who is? To “straight-wash”(cf. Ogles, 2017; Smith, 2018) people from
the past, or to naively overemphasize anachronisms to distract from any inference of
gayness, constitutes a kind of violence: it makes the gay person invisible. Consider
a recent Scandinavian controversy: Author Tove Jansson, creator of the famous
2 MALIN FORS

“Moomi”characters, lived openly with her partner, Tuulikki Pietilä, for decades. She
has nonetheless been depicted as living “alone on a small island in the gulf of Finland
where most of her books were written”(Jansson, 2013). Reacting to a documentary
about the Nobel prize winner Selma Lagerlöf, family members and some critics
protested that mentioning her lesbian love life was too speculative and also took up
too much space (Pettersen, 2016).
Drescher (2002), addressing the homophobic attitude of “Don’t ask, don’t tell”in
psychoanalytic training institutes between 1973 and 1991, describes the avoidance of
naming Sullivan as gay: “. . .when a gay colleague who trained at White during the 80s
told his analyst that he had heard Sullivan was gay, the analyst responded somewhat
defensively, ‘How do you know? Do you know anyone who slept with him?’” (Drescher,
2002, p. 53).
Miller’s description of this case supervised by Kohut views the patient’sextensive
homosexual longings through a heterosexual gaze. It is hard to imagine that the same-sex
material could have been any more obvious, though, even when strained through Miller’s
heterosexualized filter. The story reveals the patient’s painful pressure on himself to
accomplish heterosexual sexual acts: He has sex with his wife with his clothes on. He
has one nightmare in which he has to stick the penis into a can and another in which he
has to put his penis into a disposal. “A woman had a can with a certain shape, and he was
supposed to insert his penis into this can. She was holding it in her hand.”(Miller, 1985,
p. 16). Another piece of dream material, about the rear of a car being on fire and his
putting out the fire with his hose, seems pretty clearly about anger and sexuality. I would
be surprised if any homosexually oriented psychoanalyst would not see this as symbolizing
the trauma of being forced to “try to enjoy”heterosexual intercourse.
Sandmeyer is cautious about this:
I am not asserting that Jule Miller´s patient is in fact gay, or bisexual. I have no
way of knowing that. What I am reacting to, however, is the complete absence of
a perspective that views his same-sex longings, experience and excitement as an
expression of healthy tendrils of development. (Sandmeyer, 2019,p.4)
I take issue with Sandmeyer’s demurral here. There is an overwhelming amount of
evidence that the patient is not heterosexual. Miller and Kohut are either deaf about it
or see their proper role as changing the patient’s orientation.
TRANSFERENCE AND COUNTERTRANSFERENCE
As Sandmeyer observes, there is likely also a homoerotic transference from the patient
towards the therapist that is never noted in the Miller text. The patient comes early
and wants “their libraries to merge”—in my view a clear wish for him to move in with
the analyst and become a couple. This man also has overtly sexual dreams about the
therapist. But just as Miller is implicitly trying to correct and cure the patient, Kohut
keeps correcting Miller! In Miller’s account of the supervision, there is a tone of right-
THE REPARATIVE THERAPY OF KOHUT AND MILLER 3

versus-wrong that suggests an interesting parallel process: Kohut and Miller do not
seem to collaborate on understanding the clinical material together. According to
Miller, Kohut tends to correct him in a tone that comes through as quite patronizing
(1985). See Table 1.
Sandmeyer suggests there might be homoerotic transference and countertrans-
ference to explore between Miller and Kohut. I think she may be right.
INTERNALIZED HOMOPHOBIA
What accounts for Kohut’shomophobicstance?Onecannotknowforsure.
According to Sandmeyer and Kohut´s biographer Strozier (2001,2003 &2007),
Kohut may have had homosexual wishes himself. It is widely assumed, based on
parallels in their histories, that his patient, “Mr Z”(Kohut, 1979), was in fact Kohut
himself (Aron & Bromberg, 2019). Strozier describes in some detail Kohut’slong-
standing, close relationship with a gay man. “Mr Z”had gay fantasies and had as his
first sexual experience what Kohut refers to as a “homosexual relationship”(despite
the fact that a sexual encounter between a30-year-oldmanandan11-year-oldboy
suggests not relationship but pedophilic abuse). Although Sandmeyer refers to
Kohut´s positive statements about homosexuality, no positive notes come through
in the case, suggesting ambivalent and internalized homophobia in either Kohut or
Miller or both.
As Kohut was ill and close to his own death when working with Miller, he may
have been uncousciously especially vulnerable to envy of a patient who wanted to live
out some fantasies he had denied himself. Given the human tendency to internalize
negative attitudes, being in a socially devalued role oneself is no vaccine against
personal prejudice (Drescher & Fors, 2018; Fors, 2018). As Sandmeyer notes (see
also Drescher, 2002), even when homosexuality was no longer a DSM diagnosis,
TABLE 1.
Kohut´s comments to Miller.
●“Kohut’s response was that he would have handled this incident differently.”(p. 14)
●“Kohut disagreed with my interpretation…” (p. 15)
●“At this point in my reporting of this session, Kohut interrupted to say he wanted to give me some thoughts.”(p. 17)
●“In commenting on this section of the hour, Kohut said he thought my remarks to the patient had been good, but he
wanted to add something that he felt, while not essential, would definitely have made my interventions richer and
more effective”. pp. 18–19)
●“However, he disagreed with my additional comment…” p. 22.
●“Kohut, of course, took exception to my argument with the patient. He felt it was another instance of my
complicating things unduly and not looking at the positive side of the patient’s experience.”p. 24
●“Kohut thought this was an error.”p. 26.
●“Kohut agreed, but objected to the form in which I made it, because he felt the patient would experience it as if he
were being blamed, and this would make the intervention less effective.”p. 27
●“Kohut summarized the material that had come up in our discussion. He also indicated what he thought I had
handled well, and what had been less than optimum or where I had gone astray in his opinion.”(p. 30)
4 MALIN FORS

homophobia was still a problem, and gay and lesbian people were far from fully
accepted. In the psychoanalytic community, homophobia tended to be couched in
an attitude Drescher calls “coyness”:“Coyness usually results from a conflict between
unconscious disdain and an analyst’s self-representations as a caring and tolerant
individual”(Drescher, 2002, p. 51).
This attitude may explain why the implicit violence in the therapy is never named.
I do not think Miller is aware that he is doing reparative therapy or conversion treatment.
Conversion therapies are any treatments, including individual talk therapy,
behavioral (e.g., aversive stimuli), group therapy or milieu (e.g., “retreats or
inpatient treatments”relying on all of the above methods) treatments, which
attempt to change an individual’s sexual orientation from homosexual to hetero-
sexual. (Drescher et al., 2016,p.7)
ACCOUNTABILITY
Judging people from the past according to today´s norms may be unfair, and
Sandmeyer generously makes allowances for the era and the context of this treatment.
But questions arise. If we downplay the mistakes of our heroes, how can we fully learn
from them? Is it too distressing to be what Sara Ahmed (2010) called “the feminist
killjoy”and critique idealized forefathers? Can we not bear that our exemplars of
psychoanalysis made big mistakes? I want to suggest that exigencies of time do not
obliterate the responsibility of Miller and Kohut. If we see people in the past as
essentially different from ourselves, then racism, homophobia, and violent suppression
are conveniently located in another time and place, carried out by another kind of
human being. Paradoxically, I believe that minimizing the crimes of our predecessors is
dangerous because it invites us to overlook our own potential for badness and our own
susceptibility to a zeitgeist (see also Fors, 2019). The people in Germany during World
War II were not essentially different from us. Neither was Miller nor Kohut.
Four years after the patient terminated, Miller voices no regret or shame about
possible harm done to him. This is not a matter of a few blunders. The paper was
published in 1985, several years after homosexuality was omitted from the DSM
(Drescher, 2015a). For five years, Miller tried to “cure”the patient of same-sex desire,
something we now know is damaging (Drescher, 2015b). Miller goes so far as to judge
the therapy successful.
Debiak (2019) recently noted a shift in psychoanalytic discourse: At some point
we started to problematize homophobia instead of homosexuality. But despite the self-
congratulatory conclusion that we are improving in respecting human rights, we have
to acknowledge and grieve violence done in the past, even by our psychoanalytic
heroes (cf. Drescher, 1998). Miller seems to idealize Kohut, I wonder if we do, too. By
“we,”I mean not only Sandmeyer, but all of psychoanalysis.
THE REPARATIVE THERAPY OF KOHUT AND MILLER 5

ONTOLOGY OF FORGETTING?
Sandmeyer’s judicious tone has some echoes of the “smoothing over”often expected
from people in inferior social positions (Dixon, Tropp, Durrheim, & Tredoux, 2010).
The subordinated are obliged be deferential (Pon, 2009). The Swedish sociologist
Carin Holmberg (1993) interviewed childless heterosexual couples who were seen by
their friends as notably egalitarian, asking about the gender divide in their domestic
life. She found that when their pattern did not fit an egalitarian norm, when the male
partner behaved in a sexist way or expected the woman be more responsible at home,
the task of explaining this division of labor fell to the woman. This finding supports
Akhtar’s(2014) observations about the politeness expected from subordinated groups.
Pon (2009) similarly attributes the forgetting of historical violence to smoothing it over
so as not to be seen as too loud or pushy. Black Americans are accordingly expected to
celebrate July 4 (Akhtar, 2014), and gay people are expected to celebrate the weddings
of heterosexual couples even in countries where they themselves are not allowed to
marry (Fors, 2018).
In my view, Sandmeyer comes off as slightly too polite. To my ear, all of her
interpretations of this case are far more persuasive than those of Miller and Kohut. So
why is she so humble? And despite the fact that throughout her paper she exposes
homophobic interactions, she never uses the terms “reparative”or “conversion.”This
choice may be high-minded, but I worry that it is potentially dangerous and disempow-
ering. The story of this treatment may have some parallel to that of the conversion
therapist David Matheson, who recently came out as gay (Compton, 2019). If so,
Miller and Kohut deserve our compassion. But to grieve and move beyond our crimes
of the past, we also need to hold them, and our whole field, accountable. I submit that
the first step is to call a reparative therapy what it was.
References
Ahmed, S. (2010). The promise of happiness. Durham, NC: Duke University Press.
Akhtar, S. (2014). The mental pain of minorities. British Journal of Psychotherapy,30, 136–153.
doi:10.1111/bjp.12081
Aron, L., & Bromberg, C. E. (2019, April). Disguised autobiography as clinical case study. Panel, Division 39
Spring Meeting of the American Psychological Association, Philadelphia, PA.
Compton, J. (2019, January 23). Once-prominent ´conversion therapist´ will now pursue life as a gay
man´. NBCNEWS. Retrieved from https://www.nbcnews.com/feature/nbc-out/once-prominent-conver
sion-therapist-will-now-pursue-life-gay-man-n961766
Debiak, D. (2019, April). The Stonewall 50th anniversary panel: The resonance of riots: Psychoanalytic
celebrations of queer humor. Panel, Division 39 Spring Meeting of the American Psychological
Association, Philadelphia, PA.
Dixon, J., Tropp, L. R., Durrheim, K., & Tredoux, C. (2010). “Let them eat harmony”: Prejudice-
reduction strategies and attitudes of historically disadvantaged groups. Current Directions in
Psychological Science,19,76–80. doi:10.1177/0963721410363366
Drescher, J. (1998). I’m your Handyman: A history of reparative therapies. Journal of Homosexuality,36,
19–42. doi:10.1300/J082v36n01_02
6 MALIN FORS

Drescher, J. (2002). Don’task,Don’t tell: A Gay Man’s perspective on the psychoanalytic training experience
between 1973 and 1991. Journal of Gay & Lesbian Psychotherapy,6,45–55. doi:10.1300/J236v06n01_05
Drescher, J. (2015a). Out of DSM: Depathologizing homosexuality. Behavioral Science,5, 565–575.
doi:10.3390/bs5040565
Drescher, J. (2015b). Can sexual orientation be changed? Journal of Gay & Lesbian Mental Health,19,
84–93. doi:10.1080/19359705.2014.944460
Drescher, J., & Fors, M. (2018). An appreciation and critique of PDM-2´s focus on minority stress
through the case of Frank. Psychoanalytic Psychology,35, 357–362. doi:10.1037/pap0000199
Drescher, J., Schwartz, A., Casoy, F., McIntosh, C. A., Hurley, B., Ashley, K., …Tompkins, D. A. (2016).
The growing regulation of conversion therapy. Journal of Medical Regulation,102,7–12. doi:10.30770/
2572-1852-102.2.7
Fors, M. (2018). A grammar of power in psychotherapy: Exploring the dynamics of privilege. Washington, DC:
APA Books.
Fors, M. (2019). The implosion of the moral third: Moral omnipotence in the era of horror about Donald
Trump. Studies in Gender and Sexuality,1,11–16. doi:10.1080/15240657.2019.1559510
Holmberg, C. (1993). Det kallas kärlek [It is called love]. Gothenburg, Sweden: Anamma Förlag.
Jansson, T. (2013). Moomi and the little ghost. London, UK: Penguin Books Ltd.
Kohut, H. (1979). The two analyses of Mr Z. International Journal of Psychoanalysis,60,3–27.
Miller, J. P. (1985). How Kohut actually worked. Progress in Self Psychology,1,13–30.
Ogles, J. (2017, May 16). 19 Queer characters straightwashed for TV and film. www.advocate.com.
Retrieved from https://www.advocate.com/arts-entertainment/2017/5/16/19-queer-characters-straight
washed-tv-and-film#media-gallery-media-7
Pettersen, J. (2016, December 26). Sinne i Sverige: - Har brukt en av våre største forfattere som
unnskyldning for å fortelle om pirrende lesbisk kjærlighet. Dramaserie om forfatteren Selma Lagerlöf
skapte oppstuss. Dagbladet. Retrieved from https://www.dagbladet.no/kultur/sinne-i-sverige—har-brukt-
en-av-vare-storste-forfattere-som-unnskyldning-for-a-fortelle-om-pirrende-lesbisk-kjaerlighet/66573810
Pon, G. (2009). Cultural competency as new racism: An ontology of forgetting. Journal of Progressive
Human Services,20,59–71. doi:10.1080/10428230902871173
Sandmeyer, J. (2019). Understanding Homophobia in our forefathers: Rethinking how Kohut actually
worked. Psychoanalysis, Self and Context,1–17. doi:10.1080/24720038.2019.1592929
Smith, L. (2018, April 20). What is straight washing? When Hollywood erases gay characters from films.
Pink News. Retrived from https://www.pinknews.co.uk/2018/04/20/what-is-straightwashing-gay-charac
ters-hollywood-films/
Strozier, C. (2001). Heinz Kohut: The making of a psychoanalyst. New York, NY: Farrar, Strauss and Giroux.
Strozier, C. B. (2003). Reply to Karen Maroda’s (2002): Heinz Kohut the making of a psychoanalyst.
Psychoanalytic Psycholology,20, 378–381. doi:10.1037/0736-9735.20.2.378
Strozier, C. B. (2007). Heinz Kohut and the meanings of identity. Contemporary Psychoanalysis,43,
399–410. doi:10.1080/00107530.2007.10745917
Malin Fors, MSc
Finnmark Hospital Trust
UiT - The Arctic University of Norway
VPP Hammerfest, Sykehusveien 28
9613 Hammerfest, Norway
malin.fors@mac.com
THE REPARATIVE THERAPY OF KOHUT AND MILLER 7