ABSTRACT
Men between the ages of 18 and 30 inevitably confront sexual developmental challenges. Some have trouble mastering these tasks and avoid sexual opportunities. My psychiatric training in Boston in the early 1970s led me to assume that any sexual impairment was due to unresolved developmental conflicts or repetitions related to the family of origin. I believed that therapy required a patient exploration of these issues. Treatment outcome rarely supported this approach. Using a method that encompassed both the traditional model and a more directed sexual format, I was able to treat many young men with considerable success. I understood the young men’s personal histories in a new way and provided them with specific suggestions. In order to overcome their patterns of avoidance of sex with partners, these single men had to confront their social awkwardness and discomfort and their inordinate focus on their sexual performance. Men in committed relationships were often surprised by changes in sexual desire and were helped to understand the sources of their declining interest. Gay young avoidant men have some special challenges. I will describe in detail what I say to my patients in my attempt to model for you how to be helpful to your patients. I hope this will help you to use your psychodynamic understanding of your patients to speak practically to them, enabling them to get better.
