The Only Fag Around: Twinship Needs In Gay Childhood

Vicissitudes of transference and countertransference processes come to our rescue to find our bearing and eventually anchor us as we dramatize and transform the events of history into a represented sense of history in a new and public space called a clinical relationship. Henceforth, a new and potential errand of our own making, by our own hand and mind, one that carries a sublimation potential, can be cultivated in treatment.

—Maurice Apprey (2019, p. 350)

It was an oppressively hot New York City summer day, the kind where as soon as you step outside you’re wet with a sticky combination of sweat and humidity. My final patient of the evening, Paul, was running late for his session. Paul and I had been working together twice weekly for five years in a treatment I found both gratifying and frustrating. Paul had grown up in a small working-class New England town where he was, in his words, “the only fag around.” His use of the word fag was demonstrative of the way I could experience him to be two seemingly contradictory things at once—using the word in its reappropriated and destigmatized form as a marker of progressivism and personal evolution (Galinsky et al. 2013) while also identifying in part with the aggressors of his childhood (Ferenczi 1933; Frankel 2002). Though as a child Paul was often bullied for being gay, as an adult he had himself became something of a bullish man. A successful and hard-driving lawyer in his late thirties, Paul was mandated to therapy by the partners at his law firm after throwing a stapler at a colleague’s head during a business meeting.

Over the course of the first several years of our work together, I came to view Paul as what one might call a “narcissistic character,” someone for whom emotional distance from the primary caregiver during childhood had led to profound feelings of need in adulthood, and who then defends against those needs with expressions of entitlement (Kohut and Wolf 1978). Paul was born into a white New England family socioeconomically situated on the precarious border between the working class and the poor. His father, an alcoholic, struggled to keep a job, while his mother, a high school dropout, supported the family with part-time employment while raising Paul and his younger sister. When Paul was five, his father died of an alcoholism-related illness, leaving the family even more impoverished. Often they ate cereal for dinner, and Grandma, his mom’s mom, took over the primary caretaker role so her daughter could work more. Some months into Paul’s therapy he shared a memory or “model scene” (Lachmann and Lichtenberg 1992) from when he was five, just a few weeks after his father had died: his mother sat him down and said, “You’re going to have to learn to be a good little boy all by yourself now, because Mommy has to go out and find another man like Daddy to take care of us.” With Paul’s mother dedicated to her “new full-time job, finding a new man” as Paul described it, Paul was largely left to fend for himself. His mother remarried less than a year later, and Paul described his later childhood as characterized by “afternoons watching TV alone and eating Doritos” (interestingly, Paul often brought a bagged snack with him to sessions).

As Paul grew up, his intellect, tenacity, and interpersonal ability to engage others as supports helped him slowly transcend the class circumstances of his upbringing, first by attending a local college, then transferring to a better college, then heading to a mid-tier law school, and slowly working his way up at a law firm after moving to New York. But the realities and dynamics of scarcity continued to follow Paul into early adulthood; he told me, with a resentful anger that in a moment bordered on tearfulness, of having to deposit seven dollars into an ATM so there was enough in his account to let him withdraw a twenty-dollar bill to pay for beers with his law school colleagues, and of his downstairs neighbors who would sit outside the building and place bets on the rats that would come out to fight in the lobby at night. This context of scarcity, both economic and relational, had real consequences for Paul. On the one hand, his experience of deprivation was often defended against by feelings of entitlement that helped him move through the world with a cloak of assertiveness, a confidence that made him a compelling person to be around. On the other hand, though, that confidence had a brittleness to it that could get him into trouble. As we explored the stapler-throwing incident that brought him to treatment, for instance, we discovered that his anger had been provoked by the feeling that “those fuckers at the office hadn’t been paying attention to what I had been telling them for weeks,” a narcissistic rage evoked by a sense of salt being poured on a long-standing wound of feeling overlooked.

Paul’s history of felt deprivation also facilitated what he considered his greatest strength: his loyalty. The double-edged sword of that loyalty was perhaps the defining characteristic of his particular brand of narcissism, as closeness to Paul was an exciting, up-regulating experience for all involved, but distance or sensed differences were nearly impossible for Paul to tolerate. Paul was married and, as I saw it, really did love his husband to the extent he knew how; though Paul would seemingly do anything for him in ways that were quite heart-warming to witness, his loving acts were always tinged with the sense that “of course I did that for him, I would do anything for him, and I know he would do the same for me.” This sort of transactional, quid pro quo version of love was nearly identical to—if this helps paint a picture—the way Paul spoke about and related to his dogs, whom he seemed to love with equal fierceness.

Difficulties emerged, not dissimilar to the stapler-throwing incident, when Paul felt others to be inhabiting their subjectivity in a way that felt discordant with his own needs. Examples abounded. Paul felt slighted when his husband traveled for work and often retaliated by ignoring his calls and going on what he called “secret revenge sex binges,” using indiscriminate sex both as a means of getting back at his husband and as a mechanism for self-regulation around his feelings of abandonment and anger. Bonus season at his law firm was an emotionally treacherous time rife with opportunities to feel cheated or overlooked and so lash out. He had little patience with his sister, who struggled with an opioid addiction and serious mental illness; he was regularly incensed at how her struggles “ruined what otherwise would’ve been lovely family vacations.”

This extended bit of relational history sets the stage for what I understood to be recapitulated in the transference and the analytic field. Over the course of some years, largely through a process of sustained empathic inquiry whereby I did my best to understand the world as Paul understands it (Trop and Stolorow 1997), I became a member of his inner circle, someone toward whom he had many of the fierce feelings of loyalty I have described. Broadly, I would say that being “close” to Paul in this way was in part gratifying, especially when he looked to me as someone to idealize, someone who could provide stability and reassurance as he lived through the narcissistic injuries that crowded his life, in part fun as I authentically delighted in his acerbic wit and “queer” capacity for cuttingly spot-on social commentary, in part frustrating when he seemed uninterested in or perturbed by interpretive remarks and other manifestations of my distinct subjectivity, and in part a bit scary. One evening when I was running late, Paul banged on my door incessantly while I was in session with another patient; another night he knocked over my clock when he saw me checking the time. I did my best to interpret his aggression in alignment with my formulations about his narcissism: “I can see how upset you are that you feel as though you don’t have all of my attention,” I would say, with varying degrees of success in fleshing out a dialogue from there. I also set some firm boundaries with him: “No matter how frustrated you get, I’m going to ask you to not destroy things in my office. I know this is challenging for you sometimes, but it’s going to be essential if we’re to do any meaningful work together.”

Heinz Kohut’s concept of the “selfobject transference” (1971), including the notion of selfobjects as “objects which are not separate and independent from the self” (p. 3), has been a particularly helpful way of thinking about the dynamics that emerged between Paul and me. In a selfobject transference, the other is experienced as an object that exists largely to provide needed but absent functions to the patient’s self. As such, the other (the analyst) is not experienced primarily as a separate other with a distinct subjectivity or mind. Kohut developed the theory of selfobjects in the context of his work with patients with severe narcissistic pathology, as such patients, in his experience and in mine with Paul, did not tend to form the more classic neurotic transferences that Freud (1914) theorized. With this theoretical innovation, Kohut pushed back against the idea that narcissistic characters are “unanalyzable,” while still recognizing the notable differences in the texture of the work with these patients (Strozier 2004).

For some (for me, at times) it may be helpful to think of a selfobject transference as a more “primitive” type of transference: it harkens back to moments in development when others were not seen as distinct subjects. I think of the moments when Paul knocked over my clock or banged on my door; what was foregrounded in those moments was less that Paul was upset with me personally than that he was enraged that someone expected to provide the attending function was doing anything other than attending. In Kohutian terms, selfobjects are called upon to perform idealizing functions (someone to look to for organization and guidance), mirroring functions (someone to delight in the patient’s accomplishments), and twinship functions (someone to provide the patient a sense of not being alone in the world). Contemporary Kohutians tend to think of these various selfobject needs as coming in and out of the foreground in various permutations throughout the course of a treatment (see, e.g., Mermelstein 1998). My looking at the clock or attending to another patient was experienced by Paul, I imagine, as my pulling away from providing selfobject functions for him, inciting an episode of narcissistic rage.

Rather than interpreting away selfobject transferences or viewing them as a pathological force that the analysis should focus on transcending, Kohut argued that these transferences are a natural and helpful part of analytic treatment, a harbinger of thwarted developmental needs becoming reactivated in the analytic relationship (see Zimmerman et al. 2019). If the selfobject needs that begin to manifest in the treatment were allowed to live within the transference, Kohut believed, this would facilitate an ongoing selfobject experience that would lead ultimately to the transformation of narcissistic structures and the emergence of growth (Kohut 1971; Kohut and Wolf 1978; Lachmann 2008). I did my best to make space for such an experience for Paul within the analytic relationship, allowing the selfobject transference to take hold and doing my best to not thwart it. This led to some initial gains in the treatment. As the selfobject transference was more or less sustained over the years, and as he came to experience me as a mirroring selfobject he could idealize and rely on for the attention he felt so deprived of, the most flagrant aspects of his aggression began to diminish (Lachmann 2008).

On that hot evening five years into treatment, my office door opened and Paul walked in, dripping with sweat.

“Oh Sam, it’s nasty as hell out there! Fucking humidity. I feel so gross and must look so awful. You know what—I have my work shirt in here—hold on just one second.” And in an instant Paul stood up, turned his back to me, removed his sweaty T-shirt, took a dry button-down out of his bag, and changed his shirt right there in the office.

When he sat back on the couch, he looked at me quizzically. “That was okay that I did that, right? I mean, I thought it might be a little strange, but then I figured, eh, we’re just two boys, right?”

I was frozen. Mind empty, jaw vibrating slightly, brow furrowed. Some time passed; it was probably about three seconds but felt more like three hours.

“Perhaps you might change your shirt in the men’s room?” I suggested somewhat meekly. Paul looked at me quizzically, furrowing his brow and tilting his head sideways, shrugged his shoulders, ignored my comment, and proceeded to carry on as if nothing had happened. And that was that. Nothing else was mentioned about the incident for the rest of the hour.

I left the office that evening quite down on myself, and pretty down on Paul, too. I had the sense that something important had happened in the room that evening, something I found myself not only unable to comment on, but unable even to think or feel about in the moment. I felt that it was my responsibility as Paul’s analyst to reflect, to turn inward as best I could, to try to make some sense of what might have been going on for us in that moment, as he disrobed and I did nothing. In what follows, I attempt to relate my reverie and inner musings in the moments following this strange situation.

Once Paul left my office, my feelings were all over the map. I felt shocked and paralyzed and fascinated and curious. A small part of me was flattered by his apparent comfort in my presence, but much more of me felt that my own need to be the respected “analyst” was under attack (Bacal 1994; Bacal and Thompson 1996). I was angry at Paul for violating a boundary, for demeaning me with this cavalier gesture; I was offended by his disregard for decorum, and by what felt like an attack on my stature. Who was he to be changing shirts in my office, I asked myself, and then, quickly, who was I to have been so loose or hyperpermissive, so much the neophyte to have made him think such a thing was in bounds?

I associated briefly to the neuroscience metaphor of the triune brain (MacLean 1988). I was, first, a startled and frozen reptile unable to perceive much more than a shock-worthy deviation from its typical environment. Then, I suppose, I felt myself to be some kind of early mammal, connected to affects of offense, threat, and anger; and then, finally, my neomammalian cortex kicked in and I was an adult, a human being, a therapist at work, in session, who needed to handle a moment where a patient changed his clothes and disrobed in my presence.

As I thought more about it, I found myself wondering which of us, as Paul might say it, had fucked up worse. What was wrong with Paul that he had changed his shirt in the middle of a session? And what was wrong with me that I did nothing about it, or with it? This seemed to me an instance of Jessica Benjamin’s ever helpful paradigm of doer and done-to, a “relation of twoness” as she also calls it, where “each partner feels that her perspective on how this is happening is the only right one . . . as in ‘Either I’m crazy or you are’” (2004, p. 11).

As I trudged through the muggy heat en route to an after-work session at the gym, the part of me that experienced Paul as the crazy one, following Benjamin, connected to a pull to locate his behavior within a framework that Fenichel (1945) called “neurotic acting out” as he attempted to describe the way patients present material in treatment by doing something rather than putting thoughts and feelings into words. The phrase comes with a particular set of associations, at least for me: children “act out” when they are being disobedient or noncompliant. Patients, it would seem, act out when they knock down clocks or bang on doors or change their clothes in session.

In the face of the “acting-out patient,” I then became what Rustin (2001) calls the therapist with his “back against the wall,” attempting to contend with a patient who evidences his psychological pain by becoming “the person who inflicted it” (p. 274). In this iteration of the doer/done-to configuration, my ability to “analyze” the moment with Paul as it happened was compromised because “when acting out is realized directly with the analyst . . . there is an attack on the analytic setting and therefore an attempt to displace the analyst from his function” (Garbarino 1968, p. 194).

Perhaps this does explain my inability to “analyze” in real time this moment with Paul (or even meaningfully comment on it). Perhaps it was that Paul was showing me how much pain he was in by inflicting it, following Rustin, and that in the face of such an aggressive, affrontive display he had displaced me from my ability to move the analysis forward. Surely he had done similar things before, to me and to others. But there was also the question of my own embarrassment and defensive anger organized around the belief that a more serious, more experienced, more something analyst might have held the frame more tightly, so that the patient would not have done such a thing in the office. Certainly that analyst would have had the skill and wherewithal to do something about it in the moment it happened. Maybe Paul was entitled to change his shirt on a hot summer day because we are just two boys, time is precious, and he didn’t want to waste it with an unnecessary trip to the bathroom. Maybe I was having some kind of oversensitive idiosyncratic response to him. Maybe Paul was enacting in real time his identification with various aggressors, his unconscious desire to undermine me, undermine the treatment, and to displace me, and I was his victim, the done-to. Maybe I was too weak, too inexperienced, too unanalyzed to help Paul, and his treatment was suffering because of my limitations; he had only done what patients are supposed to do, manifesting his inner world in the space of the treatment relationship.

My mind was dancing (stumbling?) around the question of how this encounter fit (or failed to fit) my formulation of a selfobject transference between Paul and me. At least in my reflections immediately following the session, I couldn’t make it fit. If the primary transference was an idealizing selfobject transference, I imagined that Paul would have needed to keep me on a pedestal more than his shirt-changing seemed to suggest. If the primary selfobject transference was a mirror transference in which he was seeking my delight in his self-expression, then he might have taken his shirt off in front of me as a way of strutting his physical stuff, except that given how he turned away from me it didn’t at all feel like an act of exhibition. If a twinship selfobject transference was the primary one, I would have guessed that Paul was making some pull toward our alikeness, and in that moment I felt that he and I couldn’t have been more different. Of course, these brief sketches of the different types of selfobject transference and the various ways they might have been activated in the session with Paul are quite cursory and certainly do not do justice to the complexity of these concepts. My intention here, though, is not to rigorously investigate every possibility of how I might have conceptualized this encounter with Paul, but rather to provide some insight into my moment-to-moment attempts to make meaning of the situation at hand.

As I felt my own perspiration begin to seep through my undershirt as I walked further and further downtown, I contemplated the potentially sexual or erotic aspects of the moment; Paul had, after all, been bare-chested in my office while changing shirts. One thing was certain, though, which is that I certainly felt nothing erotic in the room: not emanating from Paul, uncomfortably perspiring as he turned his back as he changed and labeled us with the preadolescent, preadult moniker “boys,” ¹ and not from me amid my preoccupation around whatever “acting out” might have been happening. To the extent that the act of disrobing itself has an inherently erotic dimension, I imagined it as some version of the defensive process that Kohut (1979) described as “the propensity of the psyche to respond to traumatic states by various forms of sexualization—by sexualizing the overburdening psychological task” (p. 23). Coen (1981) has written more about the defensive process he calls “sexualization”; other theorists speak of “eroticization” or “instinctualization” where “sexual behavior is used for the purpose of defense without ‘true’ sexual meaning” (Auchincloss and Samberg 2012, p. 176; see also Rappaport 1956, 1959; Swartz 1967; Blum 1973). My sense is that any erotics in the room were largely evidence of an unconscious attempt to divert us away from some potentially painful material rather than a consequence of lust or adult sexual longing; that the appearance of sexuality in the moment was not going to be fodder for the development of a new therapeutic surface relating either to Paul’s relationship to his own sexuality (here I mean sexuality not in the sense of sexual identity or orientation) or to an alive current of adult sexuality between us.

I made it, finally, to the gym I had recently joined located in an historically gay part of the city. I was relieved to know that if I was going to face a weight room floor and locker room on such an unpleasant evening (spaces I had avoided for most of my life because of their organization around norms of heterosexual maleness), then at least I would be somewhere with a sizable presence of queer folks like me. When I made it to the air-conditioned locker room, I realized how good it felt to change out of my sweat-soaked clothes, letting go of the evening and stepping into a different mode, preparing for my workout. For a moment I registered myself as a grown man confidently inhabiting a space I once thought I could never feel fully safe in.

Describing some of the intrapsychic struggles faced by “homosexually inclined boys,” Phillips (2001) argues that the daily rituals of boyhood can be overstimulating for these boys because they experience them to have an erotic charge unfelt by their straight peers (p. 1235). Coining the term “the overstimulation of everyday life,” Phillips explores how “the frequent experience, for example, of homosexually inclined children and adolescents placed . . . in the company of same-gender parents, siblings, and peers in various degrees of undress or nakedness” may be overstimulating for such children by creating a “double vulnerability to shame; they not only fear exposure of their sexual arousal but also dread exposure of the homoerotic source of their arousal. . . . Precisely for these reasons, homosexual adolescent boys live in fear of school athletic locker rooms” (pp. 1252–1254, emphasis added).

My thoughts returned to Paul. I was reminded of his use of the word “boys” and wondered if the anachronism was a window into something beyond his just “acting out” as he changed his shirt in my office; his behavior may also have been an unconscious move toward an earlier, painful, profoundly vulnerable moment—perhaps one where he was overstimulated by an “everyday” scene of shirt-changing and was left not with the erotic excitement of disrobing with same-sex peers but rather with damning feelings of shame, danger, and fear.

That the pain of a patient’s past would somehow be recapitulated in the here and now of the treatment is another familiar idea in psychoanalysis; Freud posited his classic theory of repetition in the 1914 essay “Remembering, Repeating and Working-Through,” hypothesizing that moments too unbearable to be mentally stored in accessible words and pictures were repressed and “remembered” through behavioral repetitions. “The patient does not remember anything of what he has forgotten and repressed, he acts it out. . . . without, of course, knowing that he is repeating it. For instance, the patient does not say that he remembers that he used to be defiant and critical towards his parents’ authority; instead, he behaves in that way to the doctor” (p. 150). In Beyond the Pleasure Principle (1920) he further underscored that the patient “is obliged to repeat the repressed material as a contemporary experience instead of . . . remembering it as something belonging to the past” (pp. 18–19).

Loewald (1971) expanded these ideas by characterizing repetitions as re-creations of the past motivated by a desire to master it; the French analyst de M’Uzan (2007) elucidated them further with the example of an author editing a story, writing that “we would not, for example, mix up a situation in which we go back constantly to the same text—in order to redraft the same story—with a situation in which . . . we would be limited to an identical recopying of the text” (p. 1196). De M’Uzan’s work underscores how repetitions are not copies but recapitulations, the reawakening of something old in the form of something similar but not identical, steps on a quest to master that original thing.

William Auerbach (2014), a gay analyst who wrote about a gay patient disrobing in session, follows these theoretical ideas, leading him to see his patient’s behavior as a repetition compulsion rooted in an “inability to represent finished events” and an unconscious desire to work through what cannot be remembered and talked about (p. 207). Painful early experience, posits Auerbach, “disrupts the developmental capacity to organize events sequentially,” fragmenting a patient’s sense of what happened and when (p. 207). Auerbach’s paper strikes me as another way of articulating Stolorow’s straightforward but affecting dictum about how the most terrible things in life affect us: “Trauma destroys time” (2011, p. 54).

These theoretical concepts fit well with my locker room reverie that evening. Instancing the idea from intersubjectivity theory that the commingling of the subjective worlds of analyst and patient lies at the heart of the analytic process, my reflections about Paul and about myself began to drift together in a way that shifted my thinking (Stolorow, Brandchaft, and Atwood 1987; Atwood and Stolorow 2014). I began to wonder if Paul was creating an embodied re-presentation of a painful early moment of boyhood overstimulation by everyday life that he unconsciously wished to “redraft” or master. How might the treatment shift if I conceptualized Paul’s actions as such? And where might I fit in to that repeated scene? Was I a classmate around whom Paul felt scared to be seen bare-chested? Another child with whom he had a longing for shirtlessness? Or perhaps I was a teacher or coach around whom Paul was confused about how to comply? The possibilities were hazy in my mind, but each felt like a potential harbinger of “new relational experiences” in the treatment (Fosshage 1995).

Two days later, Paul came back for his second session of the week.

Paul:

I don’t know what’s gotten into me, but I’ve been really bad, Sam, in a way I haven’t been in a long time. Yesterday [the day after the immediately previous session] in the afternoon something came over me, I was just feeling like absolute shit. Was sitting at my desk and felt so alone there, like nothing mattered. So I got online and found these guys who were having a lunchtime sex party at a hotel nearby. And Sam I don’t know what got into me. I walked in there and I wasn’t even turned on, I wasn’t even hard! But I was just going from guy to guy, sucking them off. I don’t know what I was hoping was going to happen, but it was just like I wanted to feel something, or something.

I was struck by Paul’s remarks for several reasons. For one, I was reminded of how varied my experience of Paul could be: having seen him just two days earlier in an encounter that felt destabilizingly affrontive, it was striking to feel him landing on me now as someone curious, genuine, and vulnerable. The moment made me reflect on how varied my experience of my own mind could be in Paul’s presence. In the previous session, I found it difficult to think with him in the room, and struggled to make sense of what had happened in our session as my mind churned it over for hours afterward. Now, in this session, I felt more psychically free, clear, and able to access a type of experience I know in myself when the gestalt of the patient’s presentation and my theoretical knowledge create a metaphorical holding environment in my mind (Winnicott 1960).

What accounted for such a shift? Susan Sands (2009), building on the seminal work of Philip Bromberg (2006), argues that both patients and analysts will move between different self states over the course of a treatment, and that paying attention to such shifts will likely yield valuable insight. Thinking of Paul through the lens of varying self states has explanatory potential on multiple levels, both in the way it lines up with the differences I perceived in him in these two sessions and in the way it offers a framework for more broadly understanding the disparities between the more organized/mature parts of Paul (his ability to maintain a career and a marriage, his self-effacing humor, his warmth) and the more unorganized/childlike parts of him (his ragefulness, his spitefulness, his acting out). For me, I believe that as I was able to “decenter” from the intensity of my initial reaction to Paul in the moment, new reverie was possible in my mind (see Atwood and Stolorow 2014). After leaving the heat of that evening (both literally and symbolically) and re-regulating in an embodied context around like others, new ways of thinking and feeling my way through Paul’s behavior became possible. I shifted self states, which opened up space for me to hear and receive Paul in a new way during the following session.

Amid this sense of greater psychic freedom my mind wandered to the uncanny similarity between Paul’s report and a patient described in a 1985 publication by Jule Miller in which he presents a case he brought to Heinz Kohut for supervision. ² Kohut observed that the strength of the selfobject transference between Miller and his patient fluctuated based on Miller’s ability to attune to the patient’s developmental strivings, what Miller called the “forward edge.” When Miller failed to acknowledge those strivings, the patient felt deflated and less understood; to compensate, he sought the lacking feelings of vitalization and organization elsewhere by visiting sex shops and walking in the aisles of pornography stores “in search of an improved sense of being anchored and alive” (Miller 1985, p. 16).

Paul said that he spent the day after our last session feeling “like absolute shit” and like “nothing mattered,” rather like Miller’s patient felt when Miller underemphasized the selfobject dimension in their interaction. The patient’s affect-seeking trips to the pornography stores and Paul’s time at the sex party, not aroused but hoping to “feel something,” also seemed to be of a kind. These links led me to believe that in our last session I had likely missed Paul’s surfacing an important selfobject need, and that his sexual behavior afterward was an unconscious attempt to compensate for the affective deflation brought on by my oversight.

This is a major shift. Instead of the focus being on Paul’s destructive impulses, which I had not only recognized but in some sense been overtaken by in the previous session, my association to Miller led me reorient my perspective to see what Paul was striving for, what he was trying to get, perhaps maybe even what he needed. To the extent that my initial formulation and intervention had overlooked the “forward edge” of Paul’s shirt-changing, I became curious about what specific selfobject need might have both emerged and been thwarted in the locker room. Tolpin (2002) speaks to the complexity of these forward edges, and the necessity of attending to them; “it is crucial,” she writes, “to stress that fragile tendrils of remaining healthy needs and expectations are not readily apparent on the surface. . . . we have to be primed to look for them in order to see them and tease them out from the trailing edge pathology in which they are usually entwined” (p. 169). As I linked Paul’s affect-seeking sexual behavior to my misattunement, I felt an impetus to disentangle those “fragile tendrils” of forward movement from the “trailing edge” aspects of our encounter.

For an instant I was transported to a moment in my own childhood. I was nine years old and beginning to train with a local cross country team when, for the first time, scary and overwhelming feelings of difference from my male peers entered my awareness. It was that year that it was first pointed out to me that I was the only member of the boys’ team who did the training runs under the hot North Carolina sun with his shirt on, and that despite usually being quite chummy with my teammates I was always somehow off to one side when we changed clothes in the locker room. Not certain of why I was apart from the other boys but feeling increasingly like that was where I belonged, I recalled not necessarily wanting to be closer to them but nonetheless feeling saddened to be on my own. I, too, had once been the only fag around, and could recall viscerally how awful it felt.

Kohut (1984) defined twinship as “a need to experience the presence of essential likeness” (p. 194), a fundamental need for “confirmation of the feeling that one is a human being among other human beings” (p. 200). In describing patients who have had inadequate twinship experiences during development, VanDerHeide (2012) wrote that such people are much more likely to have long-lasting, residual “bleak feelings of disconnection, alienation, and loneliness” (p. 381). I thought of Paul’s description of being at his desk and feeling “alone” and “like shit,” and hypothesized that there had indeed been a budding tendril of a twinship selfobject transference between us, one I had not sufficiently attuned to, emerging out of the deprivation of good enough twinship experiences throughout Paul’s development. That somewhere entwined in Paul’s behavior was the reactivation of a boyhood need for twinship, a re-presentation of a profound need to feel like a human among humans. Once upon a time, when the day-to-day customs of boyhood required Paul to disrobe in the presence of his male peers, Paul felt profoundly, fundamentally alone.

With me, I hypothesized, Paul was yearning to feel that he and I could be “just two boys,” two presexual beings who could take their shirts off with each other without the shame and loneliness of feeling like the only fag around, who could have the everyday ritual of changing clothes with same-sex peers without the terror of overstimulation. Conceptualized as such, I was neither a classmate about whom Paul had repressed erotic feelings nor an adult with whom Paul wanted to test a boundary—I was standing in for a dashed childhood hope for another fag around, another with whom Paul could twin, what Beebe et al. (2003) have described as an ability in infancy to “apprehend that the partner is similar to the self: in essence, in a presymbolic format, ‘You are like me’” (p. 810).

Therapist:

You went around from guy to guy wanting to feel something—how did that end up?

Paul:

It was a total fucking nightmare! I left there feeling even more empty than when I arrived.

Therapist:

You left feeling as empty as you had before you got there. I wonder if you have a sense of what it was that needed filling, what inside you felt like it had been depleted.

Paul:

I guess I don’t know. I guess if I knew I wouldn’t have gone to that party in the first place.

Therapist:

That you were in some ways grasping at straws, very much unsure of how to understand what you were feeling, and that if you had known more about what was going on with you, you wouldn’t have gone to a sex party where you weren’t even turned on by the guys.

Paul:

Exactly.

Therapist:

I’m wondering—do you think it’s possible that something that went on in our last session might have been at all related to what you were feeling?

Paul:

I’m not sure. I can’t think of anything in particular that stands out that would have bothered me.

Therapist:

I’ve been thinking about the moment when you changed your shirt in here and I suggested you change in the restroom. I realized that in so doing, I failed to acknowledge how safe and comfortable you must feel here to be able to change shirts so freely! And how could it not be nice to feel able to do that here, with another boy, as you said, after all the experiences you’ve had with other boys where changing your shirt must’ve been so distressing.

Paul:

Yeah, it was a little off-putting, seemed out of character, when you suggested I go to the bathroom. I figured after all this time we’ve been working together you’d be comfortable enough with me that I could change my shirt real quick without wasting time in our session with me going all the way to the bathroom. Or at least, I hoped you would be comfortable enough. You usually understand me so well.

Therapist:

Yes, I know how important it is to feel understood here, to feel like we’re two boys, or, rather, two gay men, who can relate and connect on a meaningful level.

In line with my hypothesis that Paul’s feelings of deflation after our last session were connected to a break in the selfobject tie between us, my intention in the above exchange was to take an initial step toward repairing that rupture. Ornstein and Ornstein (1996) have written that “empathic interpretive responses, which include acceptance, understanding, and explaining, facilitate the establishment of one of the selfobject transferences that, in turn, brings about an increase in self-cohesion” (p. 106). It was my hope that as I retraced my steps with Paul and spoke to the selfobject needs Paul expressed (and I had missed), I would remobilize the selfobject transferences previously derailed by my misattunement. In speaking to the implied sense of safety I imagined in Paul’s actions and to the similarity and connection between us, I hoped to acknowledge the twinship-seeking leading edge; by gently pointing out Paul’s use of the word “boys,” I hoped to open up a possibility of exploring some of the trailing edges once things between us were restored. Paul’s response seemed to indicate that we were slowly heading back in the right direction, evidenced by his comments that he did not want to “waste time in our session” and that I usually understand him “so well.” I took both of those remarks as signs that he was once again leaning back into our connectedness, joining with me to repair the selfobject tie that would be a critical driver of the work as we continued (Geist 2011).

I’ve felt compelled to think, write, and speak about these two sessions with Paul for some time now. In part, that has been because those forty-eight hours seem to contain an unending supply of grist for the psychoanalytic mill: questions about aggression, its root causes, how its extraanalytic manifestations should be treated, and how it should be worked through when it shows up in the consulting room. Questions about sex, sexualization, erotics, and eroticism, what they do or don’t look like, what those words do or don’t mean, and how they should or should not be analyzed. Questions about the notion of repetition compulsion and the degree to which it should or should not be considered broad enough to encompass ideas from varying psychoanalytic disciplines. Questions about the nature of intersubjectivity and relationality, about how the inner worlds of analyst and patient exert mutual influence.

But I think there’s another reason, too, why these sessions have lived in such an active register of my mind for so long. I think it’s because this experience with Paul caused me, as an analyst and as a person, to change. I believe that throughout analytic work but especially in the most challenging moments, the “crunches,” as Paul Russell (1973) so aptly put it, there can sometimes be no meaningful way out unless both the analysand and the analyst are able and willing to reckon with themselves, to confront the stuckness or crunch as a co-created phenomenon that requires change from both parties in order for the treatment to move on.

This idea makes intuitive sense to me, that if we are to work with other human beings as they reach down into the deepest wells of their distress then we, as co-participants in that process, will be marked, changed somehow, by so doing. To put it differently, can you imagine the analyst who doesn’t change as a result of working through the most trying moments alongside a patient? Relational theory has done much to help us think about the depths to which the analytic encounter is a co-created two-person system that involves and impacts both participants. I think here especially of Slavin and Kriegman’s seminal paper “Why the Analyst Needs to Change” (1998), where they speak to some of these ideas. “Transference is a vehicle,” they write, “a means to arrive at an arena in which the therapist’s own identity, own real strivings and interests, become deeply engaged in the negotiation process” (p. 280). Our patients will, by “tapping into the fault lines in our identity, our conflicts . . . take us someplace that is obviously hard for us to go. But we go there and often change in the process, because having a relationship with them requires it” (p. 281). This captures well how I have come to understand one dimension of the significance of this episode in my work with Paul: we had to go somewhere challenging for both of us in order to come out with a restored, therapeutic relationship intact.

In thinking back on my own contribution to the impasse-like elements of this encounter, especially my inability to analyze the moment when Paul changed his shirt, I have reflected a lot about my sensitivity as a professional—whether I was skilled enough, if I was experienced enough, too young, too green, too informal, too something or not something enough to handle that moment with Paul. How do we grow up, as analysts? How do we develop the sense, the meaningful sense, that we have the good enough capability to face the challenges inherent in this work? Surely in part it is through the slow and steady process of reading, working, reflecting, thinking, and feeling our way through the project of being and becoming analysts. But also, I imagine, it has to do with certain nodal moments, “now moments,” as the Boston Change Process Study Group (2013) calls them, moments of dyadic reckoning where the temperature is so hot that neither member of the dyad can come out unchanged.

The clinical encounter between Paul and me that I have described was one such nodal moment, for us as a dyadic system and for each of us as individual participants in that system. This is not to create a binary, of course, that would suggest that I believe I felt inexperienced and unconfident before this part of the work with Paul, and now feel experienced and confident because of it. It is to say, however, that as I have had the time to reflect on these sessions, and to think about them in the broader trajectory of my self-development, I have come to see them as having had a transformative impact on my sense of self as an analyst. Since then, there has been a shift in me, an ability to let go of a certain type of anxious preoccupation around my “readiness” that I believe was made possible by this encounter. Though of course there have been many moments in my practice since that time when I’ve felt stuck, confused, ill-equipped, or underprepared, there was a certain saturation, a hyperpigmentation to those feelings during these moments with Paul that I haven’t experienced since. I have grown up since that moment and in part because of it; there has been a meaningful developmental shift in my trajectory of becoming an analyst. I am now a bit more confident, a bit more self-assured, and feel a bit more ready to face the consulting room. In some basic sense, following Slavin and Kriegman, I needed to change and I did.

Paul remains in treatment. There aren’t many show-stopping indications of transformation to report, but his process and our relationship continue to move forward. He’s had a series of conversations with his husband about how difficult it is for him when he travels, and in response his husband is making shifts to his schedule and delegating some travel to his supervisees. One sweet change is that Paul has discovered a passion for mentorship. He now volunteers at a legal clinic helping young lawyers provide pro bono services to at-risk LGBTQ youth and families, and has expanded his role at his firm to help lead a “big sibling” program for new staff. Paul still occasionally uses sex as a way to regulate mood and affect. We talk about it. Sometimes, in lieu of going out for sex, he listens to what he calls “depressingly revelatory underground girl pop.” Once in a while he sends me a track that, usually, I think is pretty good. All in all, Paul and I are hanging in there. Together.