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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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Psychoanalysis, Self and Context
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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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Malin Fors, MSc
This essay is a response to a paper by Janna Sandmeyer which received the Ralph
Roughton award. Sandemeyer examines Jule Millers 1985 article, How Kohut actually
worked,in which Miller describes Kohuts supervision of his work with a patient strug-
gling with issues of homosexuality. I expand on Sandmeyers 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 worlds 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-
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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
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 analystdespite 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.
In an amusing part of her commentary, Sandmeyer notes Kohuts interesting use of the
word straight:
Miller writes, [Kohut] then enunciated a basic principle: one should take
analytic material first in a straightmanner, as if it means what it seems to
mean(p. 15). While it is unclear if Kohut actually used the word straightin
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 straighthere, that, in my view, reveals a strong heterosexist bias
(or at best a stunning lack of awareness) in Millers article. Even more striking
is that Kohut and Miller seem to repeatedly disregard Kohuts 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 aboutin the building but felt more comfortable
sitting in my waiting room, close to me(p. 23, my italics). But no one heard this
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
Moomicharacters, 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 Dont ask, dont tellin
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).
Millers description of this case supervised by Kohut views the patientsextensive
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 Millers
heterosexualized filter. The story reveals the patients 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 enjoyheterosexual 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 Sandmeyers 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 patients orientation.
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 Millers account of the supervision, there is a tone of right-
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.
What accounts for Kohutshomophobicstance?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 Kohutslong-
standing, close relationship with a gay man. Mr Zhad 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,
Kohut´s comments to Miller.
Kohuts 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. 1819)
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 patients 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)
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 analysts 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 treatmentsrelying on all of the above methods) treatments, which
attempt to change an individuals sexual orientation from homosexual to hetero-
sexual. (Drescher et al., 2016,p.7)
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
killjoyand 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 curethe 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.
Sandmeyers judicious tone has some echoes of the smoothing overoften 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
Akhtars(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 reparativeor 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.
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Malin Fors, MSc
Finnmark Hospital Trust
UiT - The Arctic University of Norway
VPP Hammerfest, Sykehusveien 28
9613 Hammerfest, Norway
... This area encompasses politically related, internalized processes that affect psychotherapy, including internalized oppression and internalized privilege (Davids, 2003(Davids, , 2011Fanon, 1952Fanon, /2008Fors, 2018aFors, , 2018cLaMothe, 2014;Layton 2002Layton , 2006aLayton , 2006bWeinberg, 1972). Writing on this topic addresses both conscious and unconscious themes related to how our social surround affects clinical functioning (e.g., Fors, 2018aFors, , 2018bFors, , 2018cFors, , 2019b. ...
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Jule Miller’s (1985) article entitled “How Kohut Actually Worked,” remains a valuable window into Kohut’s clinical perspective toward the end of his life. However, one disturbing element to the article is Kohut and Miller’s homophobic and heterosexist approach to the homosexual material as described by the patient in the patient’s experience of self. Understanding Kohut’s perspective on homosexuality is a complex undertaking, complicated by the intersection of the context of the times in which he lived, his experience of homosexuality in his personal life, and his theoretical positions. The purpose of this article is threefold: (a) to highlight the clinical principles that exemplified Kohut’s way of thinking toward the end of his life, as communicated by Jule Miller, and to apply these same principles in a way that broadens exploration of the clinical material; (b) to maintain the relevance of Miller’s article in the self psychology canon by offering a corrective for the damaging nature of the homophobic and heterosexist aspects of the article; and (c) to combat psychoanalysis’s historic antipathy toward gay people in an effort to make psychoanalysis accessible and appealing to people of diverse sexual identity. The author suggests three intricately entwined factors contributed to Kohut and Miller’s perspectives on the patient’s homosexual fantasy and desire: the period in which the supervision occurred, a conjunction in the supervision, and Kohut and Miller’s personal reactions to the patient’s homosexual desires and behavior.
The paper is divided into four parts: 1) intersecting subjectivities, or the “back story” of the author's personal relationship with Heinz Kohut, which, it is argued, must be a part of any biographical project with an avowed psychological purpose; 2) Jewish identity, or the many confusions Kohut harbored about his Jewishness, from his childhood, through his youth in Vienna, and into his emigration to America; 3) sexual identity, or the fluid sexual boundaries he negotiated throughout his life, and that culminated in an asexuality that allowed him to sacrifice his life to his creativity; and 4) theoretical meanings, which asserts that the point of deep immersion in a life, including some controversial elements, is to probe the larger meanings for the theory of personal experience. Kohut, the paper concludes, needed to change psychoanalytic theory in order to find a place for himself in it.