ABSTRACT
My patient, D, came to therapy with more strikes against him than most people. His primary presenting symptom was sexual compulsivity, but he also had been sexually abused by several members of his family, was exposed to extreme violence, had experienced prejudice for being gay, Hispanic, and poor, had a history of substance abuse—and he was HIV-positive. Sexual compulsivity was the main arena in which the transference-countertransference configurations were played out, but I also want to highlight the importance of basic human qualities in our interaction. We focused on shame, dissociation, self-regulation, and character issues, while never losing sight of the shadow of HIV in his life. Our interactions were intense and direct. I thought about cleaning up some of the language, but then realized this would change the character of what happens in the room; so please pardon my French.
