When New York psychoanalyst Dr Sue Kolod asked my advice over a patient who might be paedophilic, I was pleased but not entirely surprised – pleased because usually the very last person to be consulted on matters of minor-attraction is a minor-attracted person; unsurprised because Sue and I are both members of Prof. Mike Bailey’s forum, Sexnet, so she already knew quite a lot about me from reading my posts over a couple of years.

An email exchange followed, in which I did my best to give an honest, straightforward, opinion; after that I thought no more of it. Then, quite a long time later, out of the blue, comes news from Sue that she had drafted a book chapter featuring the patient in question and also our emails. She was going to be on a conference panel looking at the “scandalous” patient. Would I be prepared to answer some questions for her, as background preparation? After seeing her interesting chapter, I was happy to do so. We have talked quite a bit here at Heretic TOC about whether MAPs should have any dealings with the mental health world, and if so how. So this seemed a valuable opportunity to explore a model of engagement that might turn out to be more useful than the typically coercive kind encountered in forensic and penal settings.

Sue’s conference contribution, as I hoped, was very positive. The event as a whole, aimed at mental health professionals, was wide-ranging, with “the unspeakable” as a major theme. The full title of her panel’s joint session was “The ‘scandalous’ patient: outrage, titillation and compassion”. The quote marks around “scandalous” conveyed the idea, even before Sue spoke, that not every alleged scandal should necessarily be considered scandalous. So that was a good start.

Before coming to the specifics of Sue’s speech, I think it is important to put ourselves in the shrinks’ shoes. Strangely, in view of the great emphasis Freud put on sex, the training of the modern analyst – and the same is even truer of the cognitive behavioural therapy (CBT) types – does not typically extend to a sophisticated understanding of sexuality and its diversity. Apparently psychoanalysis is mostly about object relations theory these days. so there is plenty of scope, especially among analysts whose own sexuality is “normal”, to be all too easily susceptible to accepting supposedly “scandalous” behaviour at face value. Accordingly, the real struggle for understanding in which even the most humane and well intentioned therapist must engage is worth bearing in mind in what follows. The official programme notes introducing the panel capture quite well this tussle of the imagination:

Patients involved in a sex scandal or other “scandalous” activities can evoke reactions of disgust, fascination and sexual arousal in the analyst. They are often transformed from suffering patients into special exotic beings. This panel will discuss the disorientation that can ensue when scandal takes center stage and how the clinician can regain equilibrium.

I heard Sue’s talk from an audio recording she kindly sent me. She told her audience she had wanted someone alongside her on the speaker’s panel who had actually been involved in a scandal. She tried American politicians Eliot Spitzer and John Edwards but neither was keen once they knew the subject. So that was where I came in, as an “unapologetic paedophile” who had been “the head of a pro-paedophile organisation”. She said the conference committee rejected the idea of giving me a platform, as this might be seen as endorsing undesirable behaviour. She may not have realised this, but I would probably not have been allowed into the US anyway!

Sue said she had learned, in preparing for the conference, that even just by showing yourself ready to hear a person out, if they have been in a scandal, you get implicated in the scandal yourself. But scandal can be based on gossip. What people make of it can be very different from the original event. Thus anyone can be caught up in scandal. Also, it is relative: what would once have been scandalous no longer is, and vice versa. Not that long ago famous psychoanalyst Harry Stack Sullivan (1892-1949) was able to have sex with his patients without causing a scandal. This is because it was hushed up – something that could not happen today. But what is even more amazing is that James Inscoe, allegedly an underage male hustler, a patient of Sullivan’s or both, became his partner. That would be utterly beyond the pale now, but not then, when Sullivan encouraged his male gay patients to have sex with him.

On how people react to scandal, Sue quotes with approval an article “The Sex Monster”, by sociologist Abby Stein: “We have all have disowned parts of ourselves that wish to do harm. In the presence of perpetration, we may be repelled but we are also excited. In an odd way, people who have done awful, lurid, sexual things to others are not just more interesting to both lay and professional folk, they are downright sexy.”

Against this background, in which even professionals are not immune from feelings of both outrage and titillation, Sue recounted the story of her patient Frank, arrested and jailed after being accused of sexually abusing his seven-year-old granddaughter. Charges were dropped when the child recanted, but by then he had lost his job and the taint of scandal continued to poison his professional and family life. His file was kept open by the Administration for Children’s Services (ASC) and he was only permitted supervised visits with his granddaughter. He went voluntarily to therapy to be treated for depression and PTSD: he was having revenge fantasies over being got into trouble. He had also hoped Dr Kolod would provide a letter to say he did not fit the profile of a typical paedophile. Such a letter, his lawyer had told him, might persuade the authorities to close their file on him.

However, she began psychotherapy on the condition that Frank not ask her to advocate for him with ASC, with his family or in any court-related hearings. This was because there was no way she could know that the original allegations were false. My own opinion, having read some of the details of the case in Sue’s book chapter, is that the granddaughter’s original account could well have been true.

Frank was in therapy with Sue for two and a half years. His presenting problems abated without her ever being sure he was or was not a paedophile. She said the case gave her a problem of “countertransference” i.e. loosely speaking, emotional entanglement with her client. She had feelings of disgust, apprehension, outrage and fascination. In her book chapter she wrote:

Never sure whether I could trust my gut instincts, I was more distant with Frank than I usually am with my patients; more suspicious and also less likely to ask pertinent questions. For example, I was unusually reluctant to inquire into Frank’s sexual life and fantasies, a subject that was clearly relevant. I often experienced a distinct “not me” reaction to him. In short, I was uncomfortable with the idea of finding myself in him.

In an attempt to neutralise these feelings she decided to do something unorthodox. She would engage not with a fellow professional but with a paedophile: me! This would give the opportunity to see her feelings “in a context”. She took my advice not to seek a confession from Frank. After this, she said, her countertransference diminished: she was more able to see him as a suffering human being. She realised her job was to treat what he had come in for: depression and PTSD, not paedophilia. In the book she wrote:

Subsequent to this email exchange, I completely stopped trying to get Frank to confess to anything. Once I relinquished responsibility to get him to confess, I found that I was able to empathize with him. I stopped feeling either apprehension, disgust or fascination towards him and was able to experience him as a fellow suffering human being. My exchange with Tom O’Carroll helped me to “defetishize” my patient and to see him as “more simply human than otherwise”.

Sue read out from the emails between us. In the Q&A that followed her talk another analyst, Dr Mark Blechner, described it as a “remarkable exchange”. Sue wrote to me afterwards saying that Blechner, who is a training and supervising psychoanalyst at the William Alanson White Institute, which was holding the conference, “advocates if you have a patient with a problem or condition with which you are not familiar, it is important to consult with an expert on the subject. He was very laudatory of our interchange for that reason.” Blechner is the author of Sex Changes: Transformations in Society and Psychoanalysis (2009), a major theme of which is that some sexual practices once thought to be disgusting, perverse and illegal have become accepted.

After about two years, when Frank’s symptoms had significantly abated and he was doing a lot better, Sue finally felt able to confront her resistance to asking about his sexuality. She had sensed “an erotic transference”, with Frank becoming attracted to her. Frank told her he had become infatuated with a younger woman but was still married to his wife. In a dream he had been brought up against the need to decide. Sue recognised ambiguity in what he was saying: was the “younger woman” of his dreams his little granddaughter? This led her to have dreams herself, in which her countertransference came back, albeit in a milder form than before. She dreamt Frank was her date. When he embraced her, she was disgusted and broke free. Frank became despondent. She then felt guilty and sorry for him.

As treatment drew to a close Frank thanked her for all her work but also frequently asked if she believed him when he said he was not a paedophile. Her answers validated his understanding that some ambiguity remained in her mind, but despite that the pair parted “with warmth and loving feelings towards each other”.

Having heard all this in Sue’s talk, I found myself astonished and impressed by the candour with which she had described her own complex, deep and ambiguous reactions to her engagement with Frank. We MAPs, it seems to me, all too often fail to take account of the fact that even with the best will in the world, which I think Sue was demonstrating, it is extraordinarily difficult, when confronted with a demonised Other, just to toss that sense of Otherness out of one’s mind. So I believe we should respect that sincere effort, especially when it leads to a positive outcome, as in this case.

Sue recently wrote about follow-up work:

I am currently teaching a course at White on psychoanalytic process. I am playing recordings of my sessions with “Frank”. He gave me permission to tape him and to use the tapes for teaching purposes. At the last class I read from my correspondence with you and the students reacted very positively. They said that your comments helped them to see the patient in a more human light rather than as the “exotic other” – exactly the point of my presentation at the conference!

To be honest, my comments in those emails strike me as no big deal. It was very basic, simple stuff that focused in a matter-of-fact way on the patient’s feeling that the therapist should be there for them, not as some sort of detective trying to solve a crime. It is a simple message that accords well with traditional medical ethics. Encouragingly, it was taken seriously in this case.

Well, I say encouragingly, but it is a moot point whether MAPs will be able to secure ethical treatment in other settings. Those who find themselves coerced into taking part in sex offender treatment programmes at present are almost certain to find they are treated by therapists who regard crime prevention as their first goal, with the interests of the nominal “client” coming a vanishingly distant second. These are nearly all manual-based, one-size-fits-all CBT programmes in which the individual is systematically bullied into conformity. Treatments rooted in the Freudian tradition have at least taken an interest in looking deeply into people as individuals, but these probings, too, can be oppressive in a context of promoting “normal” sexuality: psychoanalysis since Freud, especially in America, has a poor track record of accepting even plain vanilla gayness as anything other than pathological.

As we have seen from Sue’s approach, though, the world of psychoanalysis is perhaps not as monolithically conformist as it perhaps once became in the US. It was a “sex offender”, actually, who first alerted me to its more radical possibilities. Ben Capel’s Notes from Another Country drew my attention to the fact that analysts such as Jacques Lacan, his protégé Jean Laplanche and British practitioner Adam Phillips (who gave the opening keynote speech at Sue’s conference) have struck a far less politically correct tone. Perhaps organisations such as B4U-ACT and its fledgling British equivalent FUMA (Forum for Understanding Minor Attraction), may see some merit in pointing individual MAPs in the direction of therapists who subscribe to this more radical tradition. This need not commit anyone to signing up for the sometimes abstruse theory these guys go in for: it’s the spirit that counts. Lacan himself is long gone; Laplanche died last year; Phillips, however, born in 1954, is still in private practice in London. As the William Alanson White Institute conference showed, there are also others.