Real Life: Bias on the therapist's couch: Anti-gay prejudice among analysts began with Freud - and still flourishes today, reports Paula Webb

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'HE told me he felt that I would be 'insensitive to certain aspects of human relationships' specifically because I was a lesbian.' Psychiatrist Dr Lucy X is talking about her application interview at the prestigious Institute of Psycho-Analysis, viewed as the Oxbridge of private analytic training by many within the NHS. She had hoped to train there and gain extra skills to supplement her medical qualification to treat the mentally ill.

But an analyst there hinted that she was the one in need of a cure. 'He suggested I have analysis to 'see what would change'. Even if I came back straight, he said, I might not be accepted because they would think of it as a 'surface change'.'

Over 95 per cent of all NHS consultant psychotherapists in London and 30 per cent in other regions have trained in psychoanalysis at the institute. Dr Lucy never went back there and eventually trained elsewhere, but she is not alone in her experience. A new report suggests that discrimination against gays and lesbians working in some psychoanalytical and therapy circles is accepted practice and that classical psychoanalytic theory lies behind it - a serious worry not only for those who want to practise as therapists, but also for those who end up on the couch.

The survey, to be published this week, conducted by analytical psychotherapist Mary Lynne Ellis, is based on a detailed questionnaire sent to known homosexuals in the field and a series of subsequent interviews conducted with several major psychoanalytic training organisations.

Although keen to distance herself from recent media attacks on therapy Ellis feels that informed public debate on this issue is vital. 'It has implications far beyond the doors of analytic institutions,' she insists. 'Homophobic attitudes are very much backed by classical psychoanalysis, in fact it's in psychoanalytic theory that the notion of homosexuality as a perversion has its root.'

Many of us are probably unaware of the extent to which psychoanalysis has informed our 20th-century views and vocabulary on homosexuality. Freud seems fairly liberal compared to those who came after. Everyone was born bisexual, he maintained, and even confirmed that heterosexuals had buried homosexual fantasies. However he viewed active adult homosexuality as an arrest of sexual development - homosexuals were confused about their gender.

From the 1920s onwards, Melanie Klein and others suggested that homosexuality in both sexes was a 'narcissistic defence' against repressed infantile fears carried over from psychic conflicts within the first six months of life. Post-Second World War psychoanalysts such as Charles Socarides concluded that male homosexuality was a response to incapacitating anxiety caused by the mother leading to a fear of intimacy in later life. Male and female homosexuality was an abnormality, perversion or 'pathology'.

Sixties American analyst Robert Stoller encouraged later analysts to cease trying to change 'happy' homosexual patients but their liberalism had limits. In general, orthodox psychoanalysis maintained that active homosexuality in an analyst was a block to the maturity and self-

questioning needed to effectively analyse other people.

In the States, a vigorous campaign against such attitudes is already under way. American analyst and professor of psychiatry Dr Richard Isay, a leading activist, argues that homosexuality is normal for many people. He is particularly worried about the effect on gays and lesbians who are undergoing long-term treatment with biased heterosexual analysts. 'When I applied to be a psycho-analyst I was a homosexual in conflict and so, because no one thought that I was 'really' gay, I was accepted.

'I went into psychoanalysis, for 10 years. I came out married with two kids. It wasn't until I was free of the analysis that six months on I recognised that I was in fact gay.' He says that all his clients now are gays: many have come to him for more therapy after the same distressing (and expensive) experience.

A similar controversy is emerging here. British analytical psychotherapists Noreen O'Connor and Joanna Ryan's recently published book Wild Desires and Mistaken Identities challenges traditional psychoanalytical theories on homosexuality and their inherent value judgements. They have already been invited to lecture in Britain and Mary Lynne Ellis's findings, which support their concerns, will help to widen the debate still further.

Ellis conducted her survey over a three-year period, during which she interviewed 25 subjects. The testimonial of homosexual John H is typical of those that she quotes. As a student psychotherapist, John, like all trainees, had been required to undergo private therapy himself. He had chosen to do this with an analyst from the Institute of Psycho-Analysis but he told Ellis how, near the end of his lengthy training, he asked his analyst for a crucial letter of recommendation that was needed for assessment purposes on his course. The analyst responded 'Homosexuals can't be psychotherapists' and refused to give him the letter.

Another powerful example is an extract from a testimonial by a lesbian called Lisa M. In her assessment interview with the institute Lisa tells how she trusted the analyst there, and readily discussed her lesbian orientation. However, when the question of training was raised she was told 'We don't train homosexuals . . . well, certainly not male homosexuals. We might take a woman if she were very discreet.'

Michael D summed up the experience of more than one male homosexual who'd had an interview for training at the institute and elsewhere. 'It was assumed that as a gay man I might be a rather dodgy therapist.' Another gay man was told that he would not be accepted at one organisation because it was anxious 'to preserve its relationship with the institute'.

In Ellis's report she details how her queries about homosexuality put to the Institute of Psycho-Analysis and similar organisations were met with resistance, polite evasiveness or theorising full of inconsistencies obvious to even those outside the profession. The Chair of Admissions at the institute: 'We'd be more concerned if somebody had a firm homosexual lifestyle or 'object choice'. I think we would wonder about that person's capacity to work in an intensive way with a lot of issues of a heterosexual nature, relationships with children and so on.'

Calls from the Independent on Sunday to the Institute of Psycho- Analysis, the British Association of Psychotherapists, the Lincoln Centre, the NHS Tavistock Clinic and various other psychoanalytic institutions to assess their position on homosexuality confirmed that the issue is a sensitive subject. The institute's response was typical: one analyst there said 'it's not really an issue for us', a second told us that it was 'very much under discussion'.

Dr Brendan MacCarthy, president of the Institute of Psycho-Analysis, said: 'It's very difficult to answer. We have no official policy on admissions - no past history is considered a reason to exclude a candidate. The idea of homosexuality being a perversion is fading fast.

'It's possible that some of the older analysts would say to people applying that homosexuality barred them from practising - but it's not the official position.' He pointed out that 50 per cent of candidates are not accepted - 'including the healthily heterosexual'.

All the organisations contacted insisted that applicants' sexuality was irrelevant, and that they were assessed on their capacity for intimacy. Detailed questions about discriminatory practices or theory were uniformly met with denial. More than one analyst suggested off the record that the humiliation of rejection had caused unsuccessful gay applicants to imagine they'd heard any prejudice.

The implications of prejudice against homosexuality in psychoanalysis and psychotherapy are as important for those gays and lesbians on the couch as for those behind it. Carlos, in his late teens and close to a breakdown due to the pressure of university finals and an unhappy split from his first steady boyfriend, was sent by his GP to an NHS therapist. 'From the moment she realised I was gay she seemed more concerned about the roots of my homosexuality than helping me to cope with the immediate stress caused by the heavy blows life was currently dealing me. I left after only a few sessions.'

Liz Sayce, director of the mental health watchdog Mind, has received similar stories from within both the public and private therapy sector. Like Carlos, she argues that professionals must be more open about their views on homosexuality; consumers can't make an informed choice of therapist if they don't know what questions to ask.

The issue seems set to be another controversy in psychotherapy's crisis of confidence. Who has the right to label one type of sex 'normal' and another 'perverted'? Perhaps it's time to ask who is fit to judge?

Lesbians, Gay Men and Psychoanalytic Training, Mary Lynne Ellis, Free Associations Journal, 22 August.

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