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I’ve long wanted to see my case notes from my psychoanalytically-based therapy at the NHS Portman Clinic in London, England, in the early 1970s, yet till this year I had put off asking for them. Editor's note: Win Salisbury approached the p word to tell his story of conversion from pedophilia in a treatment based on psychoanalysis. My sense is that psychoanalytic theory has long been disputed as any kind of scientific method with a rigorous basis and now carries little authority within psychiatry as a whole. Win clearly attributes the change in his sexuality to these theoretical concepts, and his perspective is shared here as an illustration of the diversity of experience of pedophiles. However, the causal attribution could be post hoc. The majority of pedophiles who report attempting to change their attractions instead generally talk of extremely frustrating and psychologically damaging failures, and there seems little here to indicate the applicability of the methods described to anyone but Win. I’ve long wanted to see my case notes from my psychoanalytically-based therapy at the NHS Portman Clinic in London, England, in the early 1970s, yet till this year I had put off asking for them.
I was nervous about what they might reveal. My treatment had been successful. I’d replaced my paedophilia with adult-adult heterosexuality. So for a long time I’d thought it best to let sleeping dogs lie. Of course, though, I’ve always been intrigued to know what my therapists had thought of the process, and what they had thought of me. I’d had this years-long, crucially important personal relationship with my therapist, and yet I’d learnt so very little about him.
But, as a friend of mine said: "I don’t expect there’ll be anything much in the case notes you don’t already know."
And so I applied to access my case notes, and, after some delays, three big files arrived.
Late night reading
I read them greedily, in one go, late at night, on the day they arrived – and emerged from my reading with my spirits raised, and a new jumble of insights and mental jostlings!
There in front of me was the Termination Note from my therapist, Dr Mervin Glasser, at the end of my three year once-a-week treatment. And there I read: "It is only when looking back at his presenting picture and state of affairs at the beginning of treatment, in order to draw up this report, that I realise that this patient has made quite a degree of progress."
Oh!! Thanks very much for that faint praise, Mervin!!
I’ve long suspected that I was a very frustrating patient, though, and I’ve long thought that 'patience' is one of the most crucial qualities a therapist like him needs.
Mervin had heaps of patience.
The crux
And there in his note was the crux of the problem. He wrote "The treatment came up against an impasse in the transference" (a psychoanalytic term) "where, in session after session, he kept behaving like a little boy, crying in a heart-felt way about himself. He could not stop this even when he saw for himself how this came over him in the sessions, and none of my interpretive work made any impact. It it is only when our discussion of this led to our setting of a termination date that this stopped and he started making use of the treatment."
He was broadly right.
However, I’m sorry that Glasser appears not to have fully realised that I was making major positive use of the treatment long before that late stage. I had made big changes in my life by then. I’d got my education sorted, and my working life was on a new track. I was experimenting sexually with women (with varying success) though my paedophilia had not disappeared.
As importantly, and as a result of Glasser's interpretations, I knew full well that my sexual interest in young boys was a repetition of - an acting out of - my mother’s bath time play with my genitals. I’d taken on board, too, the other "oedipal components" of taking my mother’s side in my parents’ conflict during that time in my childhood. I subconsciously saw my 'sexual involvement' with my mum as a sexual challenge to my father, and my only possible response was to freeze my psycho-sexual development at the stage of that 'sexless' bath time 'little boy sex' with her.
I had to remain a Peter Pan, for the implications of making conscious my sexual rivalry with my father were too horrible to acknowledge.
Fear of genitals
I understood, too, though less completely, the "intense anal-sadistic colouring" (more jargon) I gave to adult-adult heterosexuality, seeing the female genitals as 'a wound' and the act of intercourse as being comparable to my sticking a spear into a woman. My working through of that went on through my early sexual relationships with women, though safely in my mind, not acted out.
Glasser's Note does make clear that he acknowledged that by the end of the treatment my paedophilic attractions had disappeared, though that only appears in the sixth paragraph of a seven paragraph report: "He has now had a number of overtly sexual relationships with girls, and he seems no longer to think about little boys sexually." (In his reference to 'girls' Glasser meant adult women).
For me, the loss of my paedophilic feelings caught me by surprise. It happened almost behind my back. But when I did realise that those feelings had gone it was with the sharpest clarity.
I found myself in an entirely new space.
Fear of the p word
One thing, though, that surprised me about the early part of my case files, from several psychiatric assessors’ reports prior to my starting treatment at the Portman, was their reluctance to accept the category of ‘paedophile’.
The university health centre psychiatrist’s referral report repeatedly categorised me as ‘homosexual’ and ‘upped’ my age of attraction to peri-adolescent boys. (I was attracted to boys aged c. 5-13). At no stage in his long letter did he use the term ‘paedophile’ or report that as my self-description. He described me as making "no effort to obtain medical advice until yesterday". I had actually sought help at his centre 2.5 years earlier and been dismissed with some Valium and a guess that I was 'homosexual'.
I was especially lucky, I think, to be accepted at the Portman after such gross misrepresentation. Perhaps that luck was partly due to the fact that homosexuality itself was heavily pathologised back in 1972?
The Portman's own psychiatric assessor medics were much more accurate, though the first of them described me as having "mostly heterosexual fantasies" (the opposite of the truth) and the second clearly baulked at my self-description as a 'paedophile'.
The second psychiatrist was most sympathetic. Her long report on my Rorschach test results described me as an "anxiety hysteric" in denial of my "affective needs". She anticipated my therapist Glasser’s later insights by highlighting the violent content of my Rorschach ink blot test results, but acknowledged that my "aggressive fantasies are controlled and contained."
She described how I "tend to regress to a state of childhood where young boys are his sexual objects."
That also anticipated Glasser’s initial assessment report’s statement that I "felt (I) was a little boy in a mature body".
A red herring?
Glasser’s assessment of me prior to my starting treatment stated that: "The impression I had of this young man was that his difficulties were neurotic, with strong inhibitions against heterosexual involvement and experiences but consciously aware of desires in this direction. His 'paedophilia' seemed to me to be a red herring designed to help him avoid heterosexual involvement".
I may be wrong, but my hunch is that the tendency to downplay my self-description as a paedophile may have had two reasons.
Firstly, the term paedophile was used heavily by the Portman as a criminological, as well as a psychiatric category. Yet, I was not an offender.
Secondly, paedophilia was very thinly theorised psychoanalytically back then (and still is) and Glasser's own part-theory of paedophilia's causation, the 'Core Complex', was only published in 1979, four years after my treatment by him had ended.
The Portman used broader, less specific psychoanalytic categories to treat paedophilia.
My gratitude is life-long for its robustness of psychoanalytic method, which had respected and worked with my desire for personal change, despite all my subconscious resistances.
And most of all, I cherish my memories of Mervin Glasser.
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